SPDs turn up heat on infection control: but lack of consensus creates new challenges - Infection Connection

In the face of the myriad challenges confronting sterile processing departments, central service professionals are developing a stronger voice and forging more productive interdisciplinary relationships--factors that have gone a long way in enhancing facility--wide infection control efforts.

The days when SPDs were virtually shunned from discussions involving infection control and were barely on a first-name basis with the facility's infection control practitioner are fading into a distant memory for many CS professionals. In fact, many CS professionals are making themselves known at both the infection control and administrative levels, and as a result, are serving as key combatants in the fight against infections, sources told Healthcare Purchasing News.

"While some sterile processing professionals may still be left out of the loop, particularly with ICPs, I think many have managed to make the leap," said infection control consultant Libby Chinnes of IC Solutions, Mt. Pleasant, SC.

"Many are making themselves heard with ICPs and being taken much more seriously than in the past. Because of that involvement, ICPs are including sterile processing in their environmental rounds, instead of just visiting the area when a problem arises."

Emerging infection control threats

Having improved relations with ICPs and an enhanced role in infection control activities has never been more important, particularly in light of new, potentially devastating microbial challenges both in the present and on the horizon.

Among the most pressing is the potential development and progression of severe acute respiratory syndrome in the United States. Although SARS has yet to manifest in the U.S., one sterilization expert warns that the virus is still very much a cause for concern. Charles O. Hancock, president of Hancock & Associates, Fairport, NY, says the SARS epidemic underscores the need for stringent infection control record-keeping and facility-wide policies and programs that ensure the most effective patient care.

"I predict that SARS will have an impact far greater than what we've seen," he says. "One thing that has shaken the industry in Canada is the effect of personnel policies on SARS and the role that healthcare workers play in spreading the disease," adding that much of the problem stems from part-time caregivers moving from hospital to hospital to earn a living, an activity that increases the chance of spreading the disease to patients as well as to family. "This same trend is happening in the United States, which makes it a major issue that needs to be addressed."

Further compounding problem is that the sterile processing profession is unclear about its role in the management of SARS. While being consistent and uniform in disinfection and sterilization practices will likely be enough to eliminate the risk of transmitting the disease via instruments, Hancock cautioned that some departments "are falling short."

Beyond its sterile processing implications, the respiratory virus may also pose a problem from the purchasing side. According to Lyndle Dorrell, administrative director of materials management for Cox Health System in Springfield, MO, "there's a potential mask shortage in the vendor market because of SARS."

Lack of consensus

Although not as new to the infection control radar as SARS, other diseases still create numerous challenges for SPDs. Creutzfeldt Jakob disease, for example, remains a worry for many CS professionals, particularly because so much still needs to be learned about the ailment. That's especially true where sterilization is concerned, and because of conflicting recommendations on how to process instruments used on suspected CJD patients. The World Health Organization, Centers for Disease Control and Prevention, and professional groups such as AAMI, AORN and HICPAC, differ in their recommendations, which Hancock says makes developing policies and procedures difficult.

"If we do have an outbreak, I fear we will be hard-pressed to deal with it because there are so many unknowns. There is no scientific basis and precautionary measures are anecdotal at best," he explained. "In almost any other area, we've been able to take a scientific approach, but that hasn't been the case with CJD. There's also dissention among manufacturers in regard to what sterilizers can take care of, which is only adding to the problem."

In the absence of firm data and recommendations, some healthcare facilities have decided to err on the side of caution by simply discarding all items used on suspected CJD patients.

"People just aren't sure what to do when it comes to CJD, and all the different recommendations have become very confusing. Every time I read about [the disease], it seems I had to change our policy," explained Laurie Davis, sterile processing supervisor at Kootenai Medical Center, Coeur d'Alene, ID. "It got to the point where we decided as a facility to just throw everything away. We felt that it was safer to do that than question our practices, at least at this time."

Confusion from practice recommendations extends beyond CJD, however. In fact, even some of the most basic functions of sterile processing may prompt SPDs to question the efficacy of their practices. Julie Jefferson, director of infection control and central service at St. Catherine of Siena Medical Center, Smithtown, NY, said one area of confusion revolves around soak times for high-level disinfection. Although manufacturers determine time frames, independent efficacy testing has shown that soaking can be accomplished in less time. Further complicating matters is that HICPAC recommendations cite soak times that differ from the manufacturer times--even though from a legal standpoint, facilities are bound to manufacturer recommendations.

Jefferson added that CS professionals are also questioning how frequently they should use biological indicators. Although her facility runs biologicals every day on implantables, she said that future HICPAC guidelines may recommend that biological indicators be used at least weekly.

Back to basics

While getting a grip on the latest infectious diseases is critical, sources agreed that it's equally important to stay on top of day-to-day functions. Consultant Chinnes said traffic control, departmental design, separation of clean and dirty areas and appropriate use of personal protective equipment are just a few issues that continue to pose problems for some SPDs.

"A lot of the more common problems still revolve around the most basic elements of sterile processing," she said. "An example may be reminding staff to wash instruments under water, rather than above, or not running back and forth from dirty to clean areas. Even those infection control measures that seem so simple and routine need to be regularly addressed. If not, staff can become complacent, which can present some big problems that may have been easily prevented by a little ongoing education."

In Idaho, Davis agreed, adding that SPDs should push for education at the administrative level and team with the facility's infection control practitioner for more support.

"CS as a profession has historically been put at the bottom of the list for education, which is a real shame considering the important role the [discipline] plays in infection control and patient care," she noted. "At our facility, we've been extremely fortunate to have an ICP who comes to us at least weekly, is willing to share information and goes to bat for us at the administrative level. I have learned firsthand how imperative it is to have CS and infection control linked and working together."

Davis isn't alone. Dorrell said his department has also been fortunate to have such a strong relationship with infection control. The two departments sit on committees together, including product selection and standardization committees, he said. Standards and policies are also jointly developed.

"We rely heavily on infection control, and they recognize our strengths and value our expertise," he explained. "Any CS department that doesn't have a good relationship with infection control needs to get one. If they aren't coming to you, you need to go to them. It's that important."

Chinnes said it's also vital for CS and infection control to have adequate representation during construction planning, regardless of whether the construction takes place in the department.

"CS and infection control should sit down together with the architect and express concerns and potential infection-related challenges that could arise as a result of construction activities. Even if construction is taking place on the floor above the CS department, that may still have an impact," she noted. "What if water started coming through the ceiling where instruments are being wrapped, for example. If CS and infection control are able to voice their concerns in these areas, problems can be addressed before they have a chance to surface."

Surveyors' expectations

As if improved policies and procedures and enhanced interdepartmental collaboration aren't good enough reasons to foster more effective relationships between CS and infection control, perhaps a push by surveyors will give the departments the nudge they would appear to need.

Because sterile processing seems to fall under infection control's function, Chinnes said she believes the Joint Commission on Accreditation of Healthcare Organizations will be looking for greater integration between the two disciplines. What's more, Jefferson stressed that facilities should be using results of sterilization and washer/decontamination monitoring as an infection control performance indicator.

Hancock agreed, adding that facilities that view infection control as an administrative function that merely counts outcomes, and doesn't seek assistance from key disciplines such as sterile processing, will be putting themselves at risk for citations--and more importantly, infections.

"Managing infections effectively takes strong collaboration. ICPs should be knowledgeable of proper procedures in sterile processing and CS professionals should be given a voice and viewed as the experts when it comes to sterile processing activities," he said. "Given the critical role CS plays in patient care and infection control, no infection control program is complete without its representation. When CS and infection control come together and weigh in with different expertise and knowledge, the benefits become quite clear."

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