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CRCST Self-Study Lesson PlanLesson No. CRCST 125 (Technical Continuing Education - TCE)

Sponsored by:

by Carla McDermott, RN, CNOR, CR

OBJECTIVE 1:NOTE FOUR GOVERN-MENTAL AGENCIES THAT IMPACT

SAFETY ACTIVITIES FOR CSSD

There are several federal governmentalagencies that have enacted laws designedto protect workers on their jobs, alongwith healthcare patients and the environ-ment. The U.S. Food and Drug Admin-istration (FDA), Occupational Safetyand Health Administration (OSHA),Environmental Protection Agency (EPA),and the Agency for Healthcare Adminis-

tration (AHCA) enact statutes (laws) toprovide a reasonable degree of safety foall healthcare workers, including CSSDpersonnel. CRCST lesson 112 (May-Jun2010) provides a detailed descriptionof the specific areas impacted by eachof these agencies. Additionally, severalprofessional associations which havepublished voluntary standards to enhahealthcare safety and quality service ardiscussed in that lesson. This informatiis well worth another review.

LEARNING OBJECTIVES

1. Note four governmental agencies that

impact safety requirements for CSSD

personnel

2. Discuss the types of safety hazards

that confront CSSD personnel

3. Explain why safety concerns are critical

in CSSDs

4. Evaluate the benefits of safety audits

in CSSDs

5. Describe a proactive approach topreventing workplace violence

This series of self-study lessons on CSSD topics

was developed by the International Association of

Healthcare Central Service Materiel Management

(IAHCSMM). Purdue Universitys Extended Campus

and IAHCSMM both offer grading opportunities for

Extended Campus points.

Earn Continuing Education Credits:

Online: You can use these lessons as an in-service

with your staff, or visit www.iahcsmm.org for online

grading at a nominal fee.

By mail: For written grading of individual lessons,

send completed 15-question quiz and $15 to: PEC

Business Office, Purdue University, Stewart Center

Room 110, 128 Memorial Mall, West Lafayette, IN

47907-2034.

Scoring: Each 15 question online quiz with a

passing score of 70% or higher is worth two points

(2 contact hours) toward your CRCST re-certification

(12 points).

IAHCSMM provides online grading service for

any of the Lesson Plan varieties. Purdue Univers

provides grading services solely for CRCST and C

lessons.

More information: Direct any questions about

online grading to IAHCSMM at 312.440.0078.

Questions about written grading are answered by

Purdue University at 800.830.0269.

THE VITAL WORK PERFORMED IN CENTRAL STERILE SUPPLYDepartments (CSSDs) has always required attention to details and safety.Patients, surgeons, nurses and coworkers have always depended on skilledand conscientious CSSD personnel to provide the necessary instrumentat

and equipment required to provide care for patients. The very nature of this work caexpose one or all of the parties to a wide variety of hazards. Acute awareness of thesehazards and the knowledge required to avoid injuries must be an integral part of thebasic education for CSSD personnel. In this lesson, several common safety concernswill be explored.

Central Sterile SupplyDepartment Safety Practices

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CRCST Self-Study Lesson Plan

OBJECTIVE 2:DISCUSS THE TYPESOF SAFETY HAZARDS THAT CON-

FRONT CSSD PERSONNEL

A list of every safety hazard that CSSDpersonnel might encounter would bevery lengthy. However, there are fivemajor types of hazards in the healthcareworkplace: biological, chemical, physical,physiological, and social.

Biological hazards include bloodbornepathogens, which may cause acquiredimmune deficiency syndrome (AIDS) andhepatitis, and have received a great deal ofattention in the media and in the work-place. Only slightly less attention is givento the multiple drug-resistant super-bugbacteria that have evolved and becomeextremely difficult to treat or manage withmedications. Commonly referred to by theiracronyms, these are multiple drug-resis-tant staphylococcus aureus (MRSA) andVRE (vancomyocin-resistant enterococ-ci). The list of super bugs is growing,and CSSD personnel must remainvigilant as they perform their cleaning,

disinfection and sterilization duties.Chemical hazards are also prevalent inCSSDs. Chemicals take many forms, suchas concentrated liquids with extreme pHlevels, sterilization liquids and gases, plas-ma vapors, and other disinfecting liquidsand aerosols. Chemical-resistant personalprotective equipment (PPE) is requiredfor CSSD personnel as they use theseproducts, as is training in and supervisionto ensure their safe use.

Physical hazards include the extremelysharp surgical instruments with which

CSSD personnel must work. It is alsoextremely difficult to maintain dry floorsin the decontamination area, so slips andfalls can occur. Surgical instrument setscan be heavy, bulky and difficult to liftproperly, so muscle strains are possible.Sterilizers generate heat and steam, whichpresents burn hazards.

Pneumatic instruments must be man-ually cleaned and tested, and this creates

a double hazard: the compressed gasused for the testing, and a ruptured hosethat can fail the test. Some facilities arefortunate enough to have medical air ornitrous gas piped into the CSSD; however,others still use large H size cylinders,which are large and heavy, and a rollingstand to transport them. OSHA requiresthat they be secured while being movedand when in use, and frequently, they arechained to the wall. This creates a safetyhazard involving the tanks neck and reg-

ulator. For example, if the tank falls overand is damaged, the cylinder can act likea torpedo and critically injure personneland cause extensive damage to the facility.

In the same way that rapidly escapinggas can propel the cylinder, a hose beingtested can also explode and injure theperson holding it. The gas supply shouldbe in the off position before connectingthe hose to the gas supply. It should thenbe visually inspected first for obvioussigns of excessive wear, bubbling or holes.Likewise, the gas should be off and the

line pressure released by activating thedrill or saw hand piece before disconnect-ing the hose.

Physiological hazards can occur withthe repetitive motions of instrumentassembly and wrapping items for steriliza-tion. For example, these motions can causecarpal tunnel syndrome of the wrist.

Also, computerization of the work flowadds a new level of safety concern. When

computers are added to existing workspaces, they can cause crowding of thework space. This, in turn, results in theneed for additional and excessive turnior twisting to view the monitor and thework surface. Glare from the computerscreen can also strain eyesight.

There are additional safety hazardsin CSSD, as well. The environment canbe excessively cold or hot dependingon the facilitys location and the abilityto control the immediate environment.

Extended periods of standing or bend-ing can cause muscle fatigue and strainRespiratory irritation can be caused byfiber flock shedding from wrap materials. When CSSD personnel service thRadiology area, Cardiac Cath Lab andSurgery areas, they may be exposed toX-rays, laser beams or chemicals otherthan those routinely found in CSSD are

Knowledge is power and everyonedeserves to know what the potential hazaare and how to avoid exposure to them. Min-depth information about these topic

can be obtained by reviewing CIS LessPlans 222 and 223. (November-December, 2010, and January-February, 2011)

A fifth category of hazards is thosethat are less often considered until one them becomes an acute problem in theCSSD. Social hazards include work-relaed stress, burn-out and depression. Whthese maladies seem very personal, theeffects impact the workplace. They are

Chemical hazards are also prevalent iCSSDs. Chemicals take many forms, such a

concentrated liquids with extreme pHlevels, sterilization liquids and gases, plasm

vapors, and other disinfecting liquidand aerosol

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CRCST SELF-STUDY LESSON PLAN

a sense, contagious and unless co-workersor managers recognize the symptoms andwork to combat them, they will spread toother personnel.

A few signs and symptoms to be alertfor include increased absenteeism,

extended breaks or lunches, and anyunusual changes in behavior patterns.Pay attention to increased or unusualemotional outbursts, belligerence,threats, or changes in appearance andattitude of a teammate. Share yourobservations with and seek assistancefrom a manager if these patterns becomeapparent. Many workplaces have access toEmployee Assistance Programs that canbe very beneficial.

Other social hazards include variousforms of discrimination. For example, the

U.S. Equal Employment OpportunityCommission (EEOC) enforces laws thatprohibit numerous types of discrimina-tion that relate to age, disability, equalpay/compensation, genetic information,national origin, pregnancy, race/color,religion, retaliation, sex, and sexualharassment. These laws exist to protectworkers from the identified social hazardsand provide opportunities for CSSD

personnel to reduce these types ofworkplace abuse.

OBJECTIVE 3:EXPLAIN WHY

SAFETY CONCERNS ARE CRITICAL

IN CSSDs

The impacts of safety hazards in theworkplace include bodily harm andeven death. They also include decreasedmorale and productivity, and increasedabsenteeism and the number and severityof accidents. CSSD employees know thatpatients, surgeons, nurses, and coworkersare also at risk when safety hazards exist.

While accidents can just happen, theseare frequently other forces at work whichallow them to occur. Sometimes there arehuman factors and attitudes that can leadto injuries. It may be as simple as thinking

It cant (or wont) happen to me, or Ivenever seen that happen. CSSD personnelcan influence the human dynamics ofsafety and decrease the frequency andseverity of accidental injuries in theirdepartment.1For example, if employersare away from work recovering frominjuries, they cannot protect their patientsor each other, and this adds to the stressand workload of their coworkers.

OBJECTIVE 4:EVALUATE THE BEEFITS OF SAFETY AUDITS IN CSS

Safety audits can help to identify andreduce risks in CSSD. One common tacis to analyze the last five CSSD audits thhave occurred. Are there significant risfindings? If they were performed by a CSemployee, they may be less effective becathey may be seen as simply normal tothose who work in the area with the samequipment and instruments every day.Invite someone from another departmto perform the audit. For example, whepublic university hospital invited aPreliminary Risk Analysis (PRA) teamaudit their CSSD, the results were astouning. The team identified 416 hazardoussituations with 81 listed first in priorityleading to 141 risk scenarios. The PRAteam helped to develop 23 follow-upactions and preventive measures and 1safety parameters.2Take the challengeand invite a Safety or Risk Manager inyour facility to perform an audit or inva colleague from another facility to tou

the CSSD. Any risk or hazard that iseliminated will improve the functioninand safety of the department.

OBJECTIVE 5:DESCRIBE A PROAC

TIVE APPROACH TO PREVENTING

WORKPLACE VIOLENCE

Workplace violence is on the rise in theUnited States. Contributing factors to anearly three-fold increase in this type oviolence include a weak economy andlabor markets. Stress is everywhere andappears to be coming from all direc-

tions. For example, family, friends andcoworkers deployed in the military, thebanking and healthcare crises, recessioand massive unemployment all contribute to stress levels. Those who attempt further their education and secure gainemployment face an uphill battle, as weWorking full-time, attending college anmaintaining a family can be exhaustingWhen the candle is burning at both en

Safety audits can help to identify and reducerisks in CSSD. One common tactic is to an-alyze the last five CSSD audits that have oc-curred. Are there significant risk findings?If they were performed by a CSSD employee,they may be less effective because they may be

seen as simply normal to those who workin the area with the same equipment and in-struments every day.

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CRCST Self-Study Lesson Plan

without relief, a meltdown is almost asure thing (pun intended!), and violencecan erupt. Healthcare- and hospital-basedjobs are not immune from these forces.

The National Institute for the Preventionof Workplace Violence defines workplaceviolence as: Acts of aggression or violencethat occur in, or are related to the work-place, whether intentional or reckless,including assaults, threats, disruptive,aggressive, hostile or verbal, or emotion-ally abusive behaviors that generate fearfor ones safety or entail a perceived riskof harm to individuals, or damage to anorganizations resources or capabilities.3

This is a rather broad definition be-cause it includes any action that makesanother person feel fearful, and it includesanyone in the workplace who is physicallyor emotionally injured. All CSSD person-nel must be able to recognize and reportpotential risks for workplace violence andknow what should be done if an incidentoccurs. The CSSD workplace is a stressfulenvironment, and there are physical haz-

ards that must be avoided every day. Thejob requires acute attention to detail.

Sometimes the smallest of things canpush a person to violence just like thestory of the straw that broke the camelsback. Employees can note any unusualchanges in behavioral patterns as theyinteract with coworkers and report thechanges to the manager. Discussing theissue with the manager is typically betterthan discussing it with the employee be-cause the manager may have knowledgeof personal or other matters that have not

been shared with coworkers. Additionalinformation, recommendations and ac-tion plans are available from OSHA andThe National Institute for the Preventionof Workplace Violence.

IN CONCLUSION

CSSD personnel should be congratulatedfor consistently doing the right thingsevery shift and every day. Their diligent

attention to detail and willingness to dowhat is required ensures that patient careproducts are safe to use. Their actions,including continuing education, safety re-views, and team-building activities, helpto ensure that coworkers and patients donot contract an illness, disease or disabili-ty while on the job.

REFERENCES

1. E Scott Geller. The Psychology of Safety Hand-

book. Virginia Tech, Blackburg, Virginia. 2000.

2. British Medical Journal: Quality & Safety.

(Published online March 8, 2011)

3. The National Institute for the Prevention of

Workplace Violence, Inc.2011. Workplace Vio-

lence Prevention Fact Sheet.

ADDITIONAL READING

International Association of Healthcare Central

Service Materiel Management. Certified Instru-

ment Specialist (CIS) Lesson Plans 222 & 223.

International Association of Healthcare Centr

Service Materiel Management. Certified Regi

tered Central Service Technician Lesson Plan

112.

Michael Woodward. Tips for Recognizing and

Preventing Workplace Violence. www.foxbusi

ness.com.

IAHCSMM acknowledges the assistance of t

following two CSSD professionals who revie

this lesson plan:

LISA HUBER, BA, CRCST, ACE, FCS;Steril

Processing Manager, Anderson Hospital,

Maryville, IL

PAULA VANDIVER, CRCST, CIS, CS

Technician;Orthopedic Specialist, Anderson

Hospital, Maryville, IL

SCOTT DAVIS, CMRP, CRCST, CHMMC

Materials Manager, Surgical Services

University Medical Center of Southern Neva-

da, Las Vegas, NV

SUSAN KLACIK, ACE, CHL, CRCST, FCS

CSS Manager, St. Elizabeth Health Center

Youngstown, OH

PATTI KONCUR, CRCST, CHMMC, ACE

Educational Specialist, IAHCSMM

NATALIE LIND, FCS, CRCST, CHL

Educational Director, IAHCSMM

DAVID NARANCE, RN, BSN, CRCST

Nurse Manager, Sterile Reprocessing

Med Central Health System, Mansfield, OH

CAROL PETRO, CNOR, CRCST, RN, BSN

OR Room Educator for Surgical Services

IU Health Nor Hospital, Carmel, IN

TECHNICAL EDITOR

CARLA MCDERMOTT, RN, CRCST

Clinical Nurse III, South Florida Baptist

Hospital, Plant City, FL

SERIES WRITER/EDITOR

JACK D. NINEMEIER, PH.D.

Michigan State University

East Lansing, MI

ADVISORY COMMITTEE FOR

SELF-STUDY LESSONS

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JULY / AUGUST 2012 Communiqu www.iahcsmm.org

CRCST Self-Study Lesson Plan Quiz -Central Sterile Supply Department Safety PracticesLesson No. CRCST 125 (Technical Continuing Education - TCE) Lesson expires July 2015

OBJECTIVE 11. Professional associations publish ________

standards to enhance healthcare safetyand quality.

a. Mandatoryb. Voluntary

OBJECTIVE 2

2. Bloodborne pathogens are an example ofwhich type of healthcare workplace hazard?a. Chemical

b. Physicalc. Physiologicald. Biological

3. Super-bug bacteria are creating significantchallenges for healthcare operations

because they: a. Multiply quickly b. Live for a long time c. Are multiple drug-resistant

d. Are not killed by sterilization

4. Chemicals used in the CSSD include: a. Plasma vapors b. Sterilization liquids c. Sterilization gases

d. Concentrated liquids e. All of the above

5. Pneumatic instruments are best cleaned andtested with automated equipment.

a. Trueb. False

6. A cylinder hose used to test pneumaticequipment should not be connected to thegas supply when the test is done.

a. True b. False

7. Viewing a computer can cause carpal tunnelsyndrome of the wrist.

a. Trueb. False

8. Which can cause respiratory irritation? a. Fiber flock b. Excessive periods of standing

c. Exposure to laser beams d. A cold or hot environment

9. Which is a potential sign of social hazards? a. Stress

b. Burn-outc. Depressiond. All the above

10. Employee assistance programs can bebeneficial when addressing what category ofsafety hazard in CSS departments?

a. Biologicalb. Physical

c. Psychologicald. Social

11. Which form of discrimination is not prohibitedby the U.S. Equal Employment OpportunityCommission (EEOC)?

a. Ageb. Weightc. Pregnancyd. Religion

OBJECTIVE 3

12. Employee attitudes can lead to injuries inCSS departments.

a. True b. False

13. The impact(s) of safety hazards in the workplace may include:

a. Decreased morale b. Decreased productivity c. Increased absenteeism

d. A and B above e. All the above

OBJECTIVE 414. How many CSSD safety audits are common

analyzed to help identify and reduce risks inCSSDs?

a. One b. Three c. Five d. Seven

15. CSSD safety audits performed by a CSSDemployee are probably the best type of safeaudits that can be performed becauseemployees know about safety concerns.a. True

b. False

16. Any risk or hazard that is eliminated becaus

a CSSD safety audit will improve the functionand safety of the department.

a. True b. False

OBJECTIVE 5

17. Stress is a common cause of workplace violen a. True b. False

18. What type of aggression or violence is classas workplace violence?

a. Intentionalb. Reckless

c. A and B above d. It depends upon the situation

19. Any action that makes another person feelfearful is considered workplace violence.

a. True b. False

20. Employees who note unusual behavior of acoworker should discuss this immediately wthat coworker.

a. True b. False

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