Heroes cleaned these25 November 2020
Before Covid-19, life down in the world’s sterile processing departments (SPDs) felt like a lot of pressure for little reward. Could the pandemic change that? Tim Gunn asks SPD directors Sharon Greene-Golden and Tony Thurmond what they’ve learned about working across their facilities and supply chains to help hospitals cope with the strain of keeping patients safe in the most difficult circumstances. Deep in the disinfected bowels of the hospital, far from patients’ eyes – behind airlocks and shoe covers – and further from their minds; go as low as the lifts go, lower than acclaim will follow: down to the nooks and gleaming crannies where nary a doctor dared before to venture; find the bardo where their instruments are purged. For there, someone whispers, they’ve still got PPE
The actual locations of hospitals’ sterile processing departments (SPDs) might never have been quite that arcane, but Covid-19 has certainly given doctors and nurses reasons to confront their ignorance and seek them out. It’s not just that some SPD managers keep stockpiles of PPE: many of them have had to go against decades of best practice in order to reprocess N95 masks and keep their colleagues on Covid wards safe.
As a result, they’ve glimpsed a future outside of the silos in which they’ve been imprisoned for so long. This is undoubtedly a success story, but like every shard of brightness in the pandemic, it’s been hard-won.
Not all heroes wear capes
As high-risk and low-reward as SPD work might be, Sharon Greene-Golden, director-manager of an SPD in the Adventist Healthcare System in Maryland, US, had enough inspiration to sustain an entire industry long before Covid-19 hit. “If anything,” she says, “we should have had our capes on early, with a big sign saying ‘Hero’, and been the cavalry.” What gives her pause is the fact they didn’t, and they weren’t.
“The biggest lesson I learned was that sterile processing as a whole was not necessarily doing its fiduciary job, because Covid came in and we immediately got excited,” Greene-Golden says. “But our job didn’t change: Covid is just another virus.”
Indeed, a functional SPD supports the work of the rest of the hospital by following a sort of inversion of its Hippocratic oath. When surgery trays come in, remember, ‘first, it will harm’. “We treat them all like they’re Ebola,” says Greene-Golden, “and our job is to eradicate.”
Helpfully, when it comes to avoiding a respiratory virus like Covid-19, being cloistered away (and continually supplied with clean air) in the SPD is actually a boon. “We’re strategically placed in a secure area where nobody can just show up and come in,” says Greene-Golden. “For all the years that we’ve talked about being at the backs of buildings and on lower levels, this was one time where that was a good place to be.”
But fear follows its own logic. Before the pandemic, Tony Thurmond led a team of 82 as the central service manager at the Christ Hospital Health Network in Ohio. It’s less than that now.
“I’m not sure if it surprised me,” he says, “but it hit me in a way that I didn’t know it would hit me. We had eight employees who just said, ‘I don’t want to work in healthcare anymore. It’s not worth it’.”
When people reach that point, talking them through all the dangers associated with their work outside of the context of a global pandemic can only ever be cold comfort. Thurmond contrasts the way many SPD staffers and qualified nurses considered the risks as the virus began to spread.
“It’s their first job in healthcare and they’re not getting paid what a nurse would get paid,” he explains. “They’re like, ‘Well I think I could work for Amazon for the same amount, or maybe a little more, and possibly not be exposed’.”
The fall in the number of surgeries – down to around 15% of pre-pandemic levels in the Christ Hospital Health Network – also hit Thurmond’s team hard, as a further 36 SPD members were furloughed. “One of the things that I think organisations don’t think about is that you’ve broken up a second family,” Thurmond says. “Now, when we’ve brought these people back, we’ve had challenges where they didn’t feel as much like they were part of the team because they were sent away.”
Although surgeries have since returned to 80% to try and ‘mend’ his team while making a business case to senior leadership for filling 18 empty spots.
“I’ve been doing this for 38 years,” he says, “and I’ve always been part of making decisions for purchases and staffing, but this really opens your eyes more to the fact that it’s a business. We do have people to care for patients, don’t get me wrong, but decisions had to be made that were hard for all involved.”
All part of the team
In the SPD in particular, family feeling needs to counter any sense that work is equivalent to business. Unlike nurses and doctors, who, quite apart from having years of training to fall back on, see first-hand the importance of their work with patients, sterile-processing professionals rarely interact with anything more personal than a casenumber. Their work might not require the same expertise, but it still encompasses a complex, interconnected set of washing, handling and sterilising procedures, as well as a very high level of risk. The support and motivation SPD members receive is the support and motivation they can give to each other.
Thurmond gets his staff together in a ‘huddle’ between each shift. He’s a little worried people get tired of hearing some of his favourite comments, but they bear repeating. Today, for example, there are 104 surgeries on the schedule. “We will probably not interact with or know any of those patients,” he says, “But I ask that our staff leave at the end of the day knowing that they had an impact on 104 lives.”
“Most patients who come into hospitals never even know that we’re the ones putting the trays together, cleaning the instruments,” adds Greene- Golden. “All they know is there’s a doctor and the nurse and somebody drew my blood and there was a lady that said welcome at the door. They don’t even know we exist. So, we work undetected – the unknown heroes, because if we did not do our jobs, that could compromise patient care.”
Undetected, but recognised. Both Thurmond (executive board member and immediate past president) and Greene-Golden (2018 Award of Honor winner) are active members of the International Association of Healthcare Central Service Materiel Management (IAHCSMM), a certification body that is absolutely relentless in supporting continued education. “We’re the most educated people in the hospital,” laughs Greene- Golden (CRCST, CER, FCS), who notes that the reduction in surgeries gave her team even more chances to attend vendor-organised training sessions. Thurmond (CRCST, CIS, CHL) also highlights the success of the IAHCSMM virtual conference in educating and informing more members than ever before. For Greene-Golden, all this education is important in empowering and motivating her team members to research and apply professional standards and best practices in every aspect of their work, and for cultivating a sense of pride in their ability to meet the needs of doctors, nurses and patients.
“But we haven’t always had the best reputation, and we haven’t always been our biggest supporter,” she stresses. “So, what I also teach people is it’s a poor frog who does not celebrate his own pond. In sterile processing, what you do matters. People have been clapping the nurses and the doctors, and I say they’ve been clapping for us, too – they just didn’t know we were going home as well. But we’ve worked just as hard.”
Indeed, Thurmond became his hospital’s roving disinfection expert, building up vital connections with leaders across the rest of the facility, while his team took on extra responsibilities on wards as the managers, cleaners and mechanics responsible for front-line colleagues’ controlled air purifying respirator (CAPR) helmets. “It made us feel part of [the hospital],” he recalls, “like we were really helping. And that was very rewarding for us. The doctors and nurses see that we’re there for the patient, just like them, and our staff have been able to put faces to the statistics.”
Perhaps the only thing the SPD ever lacked was visibility. Greene-Golden’s inclined to think so. “I’m not gonna sit back while they say ‘We want to thank the nurses and the doctors’ and there’s a big ovation,” she says. “I’m going to stand up and say, ‘And the sterile processing staff who took care of the front line by processing masks so they had something to wear.’ Then people cheer for us too. So it’s all about being willing to share.”
Adapt to survive
That same directness actually helped SPDs adapt to reprocessing N95s. Even the youngest technicians knew that wasn’t in any guidelines. “But this is a war,” stressed Greene-Golden, “and in a war, the rules change. Something is better than nothing.”
Once they had their units on board, both Greene- Golden and Thurmond went out and spoke in depth about the rationale and procedures for the change with their front-line colleagues, patiently hearing and responding to concerns, and making it clear that this was only happening because of the pandemic. From there, Greene-Golden posted her process on LinkedIn for her fellow sterile processing education fiends to use, discuss and refine. In a war, you play to your strengths – and you get closer.
Indeed, since then, Greene-Golden has used all she’s learned to personally check the processes of the new local FDA-approved N95 reprocessing plant to make sure it’s good enough for her front-line colleagues if shortages continue. And after such open discussions and shows of commitment, it would be hard for anyone in the hospital to forget about the SPD ever again. Thurmond’s team, which walked the halls picking up used masks, processing them and returning them to their owners, made the local evening news.
“You’d be surprised at the phone calls we get if someone doesn’t get their mask back,” he laughs. “People are just really worried about their mask, like they’d invested a lot of money into it. One time a nurse came looking for hers and we explained we had to discard it because of the make-up on it. And she was like, ‘That was mine then – yes.’”
Far more than solemn thanks and public performances of gratitude, it’s the little jokes other hospital workers bring down to the SPD that suggest something meaningful is happening. “It’s unfortunate that it took something at this level to change things,” says Thurmond. “But it definitely did.”
Level of surgeries inthe Christ Hospital Health Network in the early months of the pandemic, compared with prepandemic levels.
Current surgery levels, compared with 2019 levels.
Christ Hospital Health Network