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Reacting to Risks: How to Respond to Dangerous Practices in Sterile Processing Departments

Join me on a short thought experiment: You are a second shift sterile processing technician in a medium-sized academic hospital on the East Coast. A few months ago you received your first industry certification, but you’re still one of the youngest members of your department team. In fact, they all still call you “newbie” to your face and behind your back.

As long as you’ve been working in this department, you’ve had questions about how particular staff members follow (or don’t follow) manufacturer’s instructions for use during the decontamination stage. But it wasn’t until studying for your certification exam that you realized how dangerous these processing shortcuts really were. Now, each time you get assigned to work in decontam with these particular co-workers you cringe, knowing that you will either have to ignore their risky behavior or do something about it.

But what can you actually do? What should you do? No matter your experience level or credentials, regardless of your title or lack thereof, you should have confidence in your ability to respond to risks in your sterile processing department. Here are four categories of responses to consider the next time you are confronted with choosing silence or action.

1. Talk to the person creating the risk
While this is one of the most difficult things to do on this list, in some cases it can also be the quickest resolution to the problem. There can be many different reasons why a co-worker is engaging in risky behavior. Were they taught the wrong way to do something and over decades it has become a habit for them? Are they responding to various pressures of high surgical volume or turnover demands? Have they simply decided the rules do not apply them? The reason for their decision to take shortcuts or ignore best practices will have a lot to do with how they may respond if you brought the particular risk to their attention.

If you decide to take this approach and talk with the person, do so in a manner that is as nonconfrontational as possible. For instance, rather than calling them out in the middle of a staff meeting or speaking up with other co-workers around, consider waiting for a moment to speak to them privately. Let them know that you do not want to assume bad motives, and ask why they are choosing to take the particular action that you believe is risky for patient safety. You may be surprised at their answer. Of course, they may not appreciate you pointing out they are ignoring guidelines either. You should be mentally prepared for a diversity of responses, and commit to humbly sharing your perspective and then disengaging from the situation.

2. Discuss with leadership/chain of command
Nearly every healthcare organization that has a chain of command will expect you to utilize it in situations of potential risk to patient safety. If you are unfamiliar with this term, chain of command simply means the reporting structure or organizational chart of how supervisors report up to managers, who then report to directors, who then report to vice presidents, etc. It’s usually a bad idea to take any kind of concern around your immediate supervisor and “skip” over links in the chain of command.

For instance, if a co-worker is forging biological indicator results, your first conversation (with rare exceptions) should be with your supervisor, not with your division vice-president. If your immediate leader cannot or will not remedy the issue, then you should attempt to escalate the concern up one level to your department manager or whomever your supervisor reports to. This process should continue until you reach a level where the problem can be dealt with and the risk to patient safety removed.

3. Use compliance hotlines
Occasionally, there are situations in which the department culture is so toxic or the chain of command is so broken that employees do not feel comfortable using traditional reporting structures to address risky behavior among their co-workers. In cases where you feel your leadership team is unsupportive of your valid safety concerns, most facilities have enabled anonymous compliance hotlines that allow employees to call in their concerns and initiate an internal investigation by the quality, infection control, or human resources department.

It is important to keep in mind that most of these compliance hotline calls are addressed first with department leaders. So you may not hear back directly about a report that you have filed, even if the investigation has already been initiated or after the issue has been rectified. However, if you continue to witness the same risky behaviors after notifying your compliance hotlines and exhausting the channels in your chain of command, there is one final option available to you.

4. Notify regulatory/accreditation agencies
If all other types of collaborative communication fail to address tangible risks to patient safety in your sterile processing department, you do have the ability to notify state and federal regulatory agencies directly, in addition to notifying the accrediting organization over your facility. This option should really be seen as a worst-case scenario because it means that you have been unable to locate a single internal advocate who will assist you in mitigating the risk to patient safety at your hospital. Unfortunately, situations like this do occur, and you should be aware of the opportunity you have to bring this issue directly in front of state health department surveyors and regulatory professionals to deal with on an administrative level. Regardless of how this notification plays out, you are protected by federal whistleblower statutes that prohibit any type of retaliatory actions by your employer. This does not mean that the process will be an easy one, but you can trust that the patients who you are defending will support your decision as well.

No one enjoys dealing with the kinds of difficult situations and conversations that this article addresses, but every sterile processing professional must also understand the critical role we play in protecting patients against surgical harm. If you see something risky going on in your department, you have a number of options in front of you to reduce those risks. However, one option that none of us has is to ignore it. Patients are counting on us to step up and, when necessary, stop the line.


Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL

Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant

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