Why Is Quality So Illusive?

Why Is Quality So Illusive? What Sterile Processing Professionals Need To Know by Cynthia Hubbard, RN, BS Objectives After completion of this self-study activity, the learner will be able to: 1. Identify key work goals in sterile processing. 2. Define four components of sterile processing quality. 3. Identify human variables that impact successful decontamination and sterilization of medical devices. 4. Describe how effective sterilization monitoring can assist in meeting the quality and work goals of sterile processing. Test Questions True or False 1. There is a sequential nature to the steps in medical device processing. If you take one out of order, skip a step altogether or perform it inadequately, unsatisfactory results will occur. Many thanks to the team at 3M Health C a re for working with Managing Infection C o n t r o l to provide the following accre d i t e d course. IAHCSMM has awarded one and onehalf (1.5) contact points for completion of this continuing education lesson toward IAHCSMM re c e rtification. The CBSPD has pre a p p ro v e d this inservice for one (1) contact hour for a period of five (5) years from the date of publication, and to be used only once in a re c e rtification period. This inservice is 3M Health Care Provider approved by the California Board of Registered Nurses, CEP 5770 for one (1) contact hour. This form is valid up to five (5) years from the date of publication. Instructions for submitting results are on page 97. Managing Infection Control and 3M Health Care will be working collaboratively to provide continuing education courses in monthly editions of Managing Infection Control. 86 MANAGING INFECTION CONTROL

2. One of our work goals is to maintain positive interpersonal relationships with our customers and coworkers. 3. Aside from any official organizational chart, in the bigger picture, the operating room (OR) staff are part of the sterile processing team. 4 Training for adults is equally successful if it is experiential, visual or auditory. 5. To d a y s sterile processing workforce frequently includes members of three generations the baby boomers, generation X and generation Y. 6. Baby boomers are now starting retirement, but U.S. Census workforce projections indicate that almost 25% of the 65 74 age groups will still be working in 2012. 7. The application of ergonomics in the sterile processing work environment will help to address physical issues, such as diminished strength and arthritis, of an older work force. 8. Product testing is recommended by the Association for the Advancement of Medical Instrumentation, A N S I / A A M I ST79:2006 Comprehensive guide to steam sterilization and sterility assurance in health care facilities recommended practices to ensure effective sterilization of complex medical devices in your setting. 9. Use of Continuous Quality Improvement (CQI) is recommended as a tool to objectively monitor our processes and ensure that the outcome meets standards. 10. Sterilization monitoring tools, such as physical monitors, chemical and biological indicators, assist us in determining the probability that an item is clean and the sterilization cycle has been effective. Introduction What do sterile processing professionals need? In an arena of increasing pressure to do more with less, diminished financial resources and generational stresses, sterile processing technicians and leaders need people, processes and equipment that will function together to achieve our goals. The required outcome of our sterile processing efforts is a sterile device 100 percent of the time. Sterilization monitoring tools provide our only upfront data to verify that we have achieved this goal. Obviously the primary goal of the sterile processing team is to provide the highest level of sterility assurance for each item processed for patient care use. But there are other important work goals, such as complying with regulations, maintaining current policies and procedures, and, because we re human, working in an environment that fosters positive interpersonal relationships and encourages us to act with integrity. Complying With Regulations The Joint Commission and Occupational Safety and Health Administration (OSHA) are two important agencies that regulate the basic nature of how we approach setting policy in sterile processing. A d d i t i o n a l l y, professional groups influence the state-of-the-art sterilization practice by helping us keep up with technology and its application. Two significant documents have raised the bar for hospital and outpatient center medical device sterilizationrelated practices. AORN published 2007 Recommended Practices for Sterilization in Perioperative Practice S e t t i n g s and ANSI/AAMI published ST79:2006 C o m p rehensive guide to steam sterilization and sterility assurance in health care facilities. This later document incorporates five previously published AAMI sterilization documents into one volume, available in a three-ring binder that will be easily updated in future years. 1 Maintaining Current Policies and Procedures Ensuring that there is effective cleaning, disinfection and/or sterilization for each medical device is the sterile processing contribution to providing efficacious and safe clinical practice. While we have no control over the conditions in surgery or at the patient bedside, or over how medical devices are handled by the users, sterile processing responsibility does include ensuring that all reprocessed devices meet the quality standards defined in our policies and procedures. Typically, we base policies on the expectations of the regulating agencies and recommended practices of professional groups. It is definitely a challenge to stay current with their changes and updates. Updating our sterilization-related procedures takes effort and time; in reality, updating policies and procedures to meet our organization s objectives must be an ongoing process. While an annual policy and procedural review is recommended; reviews should also occur whenever updates are made by regulatory agencies. Additionally, we have a moral obligation to incorporate the recommendations of professional societies and technical groups that provide best practice standards. Maintaining high quality standards requires continuous monitoring to ensure personnel safety and the desired process outcomes. Use of Continuous Quality Improvement (CQI) is recommended to objectively monitor our processes and ensure that the outcomes meet standards. While there are several ways to monitor quality, ANSI/AAMI endorses the CQI approach. Its advantages include observation and review of the entire scope of the processes (decontamination, assembly, packaging, sterilization, quality control, storage and distribution) and it involves both clinical users and technicians who perform the work. 1 Components of Quality Quality, and definitions of quality in a service industry, seems to vary widely. In all walks of life, each day, one can 88 MANAGING INFECTION CONTROL

overhear discussions related to quality. Long lines at the grocery store checkout, a less-than-clean hotel room, an over-priced lunch of questionable nutritional value are just a few examples of common quality issues. Why is it so hard to come to a common definition of quality? Why does it frequently seem illusive, and why doesn t quality stay put once it s established? The answers to these questions may be due in part to the subjective interpretation of quality by each of us, and the many interrelated components involved in its maintenance. T h i s happens in sterile processing, too. Our customers are varied and may have different expectations for our quality and service. We, in turn, may not understand their needs and expectations. So, for the purposes of our discussion, this article focuses on four key quality components for sterile processing: Quality in the processes we use; Quality in the service we provide; Quality in the products we produce; and Quality in our work life. Quality Processes The critical processes of our work include cleaning, disinfecting, preparing devices for sterilization, sterilization, sterile storage and distribution. These steps are all interrelated and an orderly progression of tasks needs to occur in a timely manner. For example, unless lumens are flushed and rinsed properly, ineffective cleaning will result. 1 If an item is not clean, it can not be sterilized eff e c t i v e l y. 1 Quality processes start with an understanding of both theory and application. Good science must be applied to sterile processing s policies and procedures to make them believable by those who will use them. For example, an understanding of microbiology, and its application to handwashing policies and procedures, helps individuals comply with restrictions that may be radically different from their previous training or home experience. Proper maintenance of the decontaminating and sterilizing equipment is vital to the quality outcome of our processes. 1 Regular preventive maintenance is best accomplished by properly trained engineers who feel part of the team, and who share their concerns with sterile processing technicians and leaders. Improper MANAGING INFECTION CONTROL 89

use of this expensive equipment must be brought to the attention of the operators so retraining can occur and errors related to equipment use can be prevented. Quality processing starts with an understanding of both the details of the individual tasks and appreciation for the bigger picture. Constructive criticism and periodic feedback are important, but so are cross training and observation of the users in their environment. When sterile processing staff are able to see how a complex medical device is actually used in surgery, and realize the expectations of the surgical team, there is both an appreciation for the details of the task and a sense of contributing to positive patient outcomes. An analysis of problems related to any aspect of the steam sterilization processing involves identification of the problem (equipment malfunction, incorrect procedure, human error, etc.), taking steps to resolve it and follow-up observation to verify that the problem really has been corrected. Additionally, use of a planned, systematic, objective and ongoing process to monitor compliance and procedures is the basic foundation of CQI. Quality processes can be enhanced by audits that are conducted on a regular basis. Accurate data collection, thoughtful analysis, and clear dissemination of the findings both to the team and to those individuals performing the work are the keys to this process. 1 When the CQI program data collection identifies that results are below the pre-established level of quality for the sterilization process, it is time to analyze all of the issues involved and set up an improvement plan. If the sterilization processes are uncontrolled or highly variable, it will require increased process monitoring and documentation to bring them back under control. 1 Sterilization monitoring is a vital quality assurance (QA) process. We have tools (physical monitors, biological indicators [BI s] and chemical indicators [CI s]), but they are not always used properly or interpreted correctly. The ANSI/AAMI ST79:2006 recommended practices document provides excellent discussion of these issues. 1 It is important to understand that sterilization monitors are not designed to monitor cleaning effectiveness, but are practical tools to help us meet both our work and quality goals. To meet our work goals related to effective sterilization, it is critical to have reproducible results day-after-day that match the quality process standards set by the team. We achieve this when team members care about the outcomes and have available well documented procedures which are detailed, specific, step-by-step and easy to follow. Efficient processes avoid work-a-rounds and do not have extra steps that waste time. Working smarter not harder, is a key to implementing quality processes. Quality Service Quality service means no delays. We want to have correctly processed materials ready and available b e f o re t h e y are needed. In today s environment of increased surg i c a l implant reprocessing, this goal has become highly frustrating for many organizations. The volume of complicated, and expensive, medical devices that specialty surgery requires means communication is needed on more levels than ever before. We are not talking about simple retractors, scissors or clamps. In the past, instrument shortages would somehow be handled by borrowing from a nearby organization, rearranging the schedule, opening a different set, relying on flash sterilization, etc. But, these approaches are frequently inadequate and do not produce quality results, especially for implantables. 1 Medical device manufacturers, administrators, loaner instrument reps, surgeons, managers and technicians all share responsibility for communicating their needs. But, too often, u n f o r t u n a t e l y, the unequal balance of power that exists in the o rganization drowns out the sterile processing voices. Quality service must be jointly defined and a valued goal for all of the stakeholders. Unless quality service is the org a n i z a t i o n s goal, and is accompanied by the appropriate sterile processing and surgical services resources, it is unlikely that it will be accomplished. Customer needs must be met with an appropriate sterilized instrument turn-around time and in a courteous manner. The customer comes first is the type of service you expect as an individual; it s also what every patient needs. Quality Products Medical devices must be handled with care by both those processing and those using them to ensure that they will function properly. When devices are inadequately cleaned they loose function; even instrument box locks become sticky and break with the additional force required to open them. The OR and other clinical users can assist the sterile processing team by starting the prep after the procedure is completed. 1 Inexpensive enzyme gel or foam products, applied at the point of use, keep organic debris moist until it can be removed in a controlled environment. When blood and proteins dry on instruments it increases both the cleaning time and the likelihood of ineffective cleaning. 1 Rough handling of delicate instruments, especially when they are loaded in case carts under heavier instruments, increases breakage. Immersing medical devices that can not be cleaned in this manner has ruined many lensed instruments. Damaged, rusted, malfunctioning or incomplete instruments will never be quality products, no matter how sterile they are. Product testing has become a focus of the new A N S I / AAMI ST79:2006 recommended practices. Periodic quality assurance testing is recommended for routinely processed items. 90 MANAGING INFECTION CONTROL

When major changes are made in packaging, wraps or load configuration (dimensions or weight of an instrument set), or changes occur in the type of material used in packaging, it is time to do product testing. 1 Product testing should also be done on loaner sets to verify effective sterilization according to the medical device manufacturers instructions. Product testing is accomplished by processing actual product test samples (packs, trays or containers) which are then opened up, examined and the results documented, but which are not used for patient care. 1 The test program includes both biological and chemical indicators, and an evaluation of the post-sterilization moisture content. The number of BI and CI tests will vary depending upon the size and type of the package, and layers of the containment device. The test protocol (including location of BIs and CIs), results and any corrective actions, should be documented and maintained as part of your QA program data. Product reprocessing use should be discontinued until all problems are resolved. 1 Due to the weight and complexity of today s instrument sets (including loaner sets) it can not be assumed that the standard 4-minute dynamic-air-removal steam sterilization cycle of 273 F will be effective. Medical device manufacturers are now stepping up to define sterilization parameters for their heavier and/or more complex products. Documentation of the cleaning and sterilizing parameters must be on file for every set and medical device processed by sterile processing. 1 A d d i t i o n a l l y, product testing in your environment will establish for your particular equipment the effective processing requirements for time, temperature and sterilizing method. This starts by making sure that instrument sets are a manageable size (sets, including containment devices, should not weight more than 25 pounds). So, get a scale, start weighing the instruments sets (including loaner sets) and then make time each week to do appropriate product testing. 1,2,3 This need will not go away, and it is vital to know that your sterilization parameters result in the highest quality products, every time, for every set. Quality In Our Work Life Many fulltime workers spend more time traveling to, and being at, their place of employment than they do at home, and MANAGING INFECTION CONTROL 91

interact more frequently with coworkers than with family or friends. Consequently, the older one gets the more one appreciates a positive work environment. Unhealthy emotional climates create unhealthy work environments and toxic work environments can make you sick. Stories of conflict between persons in surgery and sterile processing are heard too frequently. A key to our own health and well-being is the ability to accept personal responsibility for fostering good working relationships with both customers and coworkers, too. Humans are goal oriented and want the satisfaction of accomplishing meaningful work. Harmony, low stress and teamwork produce better results. When folks come home day after day depleted of energy and spirit, they are more likely to suffer burnout and develop physical maladies. We don t want to spend our time away from work mentally rehashing the conflicts of the day or worrying about tomorrow. Integrity matters! Some components of integrity include being true to yourself, taking the high road, telling the truth, being honest in your dealings with others and accurate in your work and not short-changing the patient. Many Factors Influence Our Success and Ability To Meet Work Goals In addition to the sequential nature of the steps required in completing the reprocessing work itself, we are dealing with a microscopic enemy. Since we can t see the microbes (or the patients, for that matter), it is easy to lose sight of the reasons for all of the various details required in the safe handling of sterilized medical devices. On those days when the sterile processing work seems harder, stop by the s u rgery waiting room or hospital admissions on your work break to return your focus to the people your conscientious efforts will serve. Here are a few other work goal saboteurs: Inventory Issues and Turnaround Time Expectations Do you have enough sterilized instruments in inventory to get through the surgery day? Since no workday is ever the same in sterile processing or surg e r y, the answer is usually NO. Preparation of loaner instruments must be factored into the decontamination and sterilization workload. Surgeons like to schedule the same type of cases (requiring the same type of instruments) during their workday. It takes prior planning to manage short procedures that reuse the same equipment. Lack of terminally-sterilized instrument inventory means a fast track decontamination process, followed by flash sterilization expected by surg e r y. The Association of perioperative Registered Nurses (AORN), however, does not endorse flash sterilization as a substitute for i n s u fficient inventory. 4 Unscheduled emergencies will always occur to rearrange priorities and use precious inventory. However, unrealistic customer expectations can be changed if everyone is aware of the time it takes to correctly process medical devices (especially in automated equipment). Educating administration and the s u rgery team on this issue can be a practical result of sharing sterile processing CQI program data. Device Construction and Complexity The category and type of medical device dictates the type of processing required (manual or automated cleaning/disinfecting processes). If medical device manufacturers supply written instructions for all processing steps for each device they sell, this will ensure you have the correct information to avoid improper handling and damage. Make the medical device manufacturer s written instructions available to staff in both the decontamination and sterilization areas. 1 You may also refer to the A m e r i c a n Society of Healthcare Central Service Processing (ASHCSP) Web site (ashcsp.org) for processing instructions (sent in by members) for many commonly used devices until you have obtained the current medical device manufacturer s written instructions. 1 Complicated device design, variations in manufact u r e r s processing recommendations, lack of product documentation, heavy and complex devices, specialized containers, and lack of training all contribute to questionable cleaning and ineffective sterilization. Don t be caught in the middle without correct product information. Processing Equipment Capacity Use of the correct sterilizing method and cycle time can not be overemphasized. In older facilities there may be a shortage of processing equipment to meet today s work volume. If processing equipment is not keeping up 92 MANAGING INFECTION CONTROL

with demand, or there is inefficiency in work flow or equipment operation, people feel pressured, frustrated and make mistakes. Inadequate processing equipment capacity can also result in decreased service, too. It s best to anticipate and control breaks in the chain of aseptic control that may/can happen when people take short cuts to avoid falling behind in the work schedule. The Human Factor Variable The human factor is perhaps the most interesting, but difficult to manage, variable in the often stressful work environment of sterile processing. Leaders are challenged to motivate a diverse group of people to consistently produce successful sterilization outcomes. Attitudes and emotions, the work in sterile processing, an aging workforce, adult learning styles, the work values of multiple generations, reactions to change, language and emotional intelligence influence our team s ability to meet the overall work goals each day. Attitudes and Emotions Our attitudes stem from our beliefs about ourselves, the world around us and how we view the circumstances of our day. No one is at their best every work day, but consistent negative attitudes and emotions disrupt team effectiveness, and lead to higher errors and stressful working environments. Since we work in such close proximity as a team in sterile processing and surgery, it is important that we go out of our way to maintain positive coworker relationships. If people s emotions are pushed toward enthusiasm, performance can soar; if people are driven toward rancor and anxiety, they will be thrown off stride. 5 Is Sterile Processing Work an Issue? The work itself (retrieving soiled equipment, cleaning, disinfecting and sterilizing), often performed by low-wage staff, may be underappreciated by other team members. Sometimes this is a variable in our ability to meet our work goals. For example, working in decontamination is cumbersome with personnel protective equipment (PPE) that is hot and uncomfortable. Some find it distasteful to handle the blood and guts work. And, from a psychological standpoint, sterile processing work occurs in an isolated environment with a rigid structure and attire (especially in decontamination) that can be interpreted as limiting freedom, mobility, personal expression and individuality. Some younger persons, used to high socialization, find this environment particularly challenging. An Aging Workforce The U.S. Bureau of Labor Statistics expects the total labor force to reach 162.3 million people in 2012; this is an increase of 17% from 2000. No matter our age we are destined to be part of an aging workforce. Workforce projections for 2012 place the median age of a worker at 41.4 years. This will be the highest ever recorded. Sixty-five percent (65%) of the 55 64 age group and 23.6% of the 65 74 age group will still be working. 6 Due to a variety of factors, many related to financial pressures, people will be working in sterile processing past the time when the work is physically comfortable for them. Ergonomics (or human factors) applies scientific information concerning humans into the design of objects, systems and our work environments. It is important to design tasks and work areas to maximize efficiency and work MANAGING INFECTION CONTROL 93

quality. Reducing operator fatigue and discomfort will become increasingly important for an older work force, especially as our hands, joints, backs, eyesight and hearing change. 7 Adult Learning Styles and Training Adult learning needs to be experiential to be successful. For adults to succeed at learning something new it must be an experience, not a visual, auditory or paper exercise. One must be engaged in the learning; this involves risk, vulnerability and a joy in the journey (not mere fascination with results). 8 Use of a see-do-teach process is the most effective style for adult learners, especially for hands-on work like that required in sterile processing. Expecting employees to become comfortable with a new work task if they have only read the procedures is not as effective as demonstrating it, expecting a return demonstration, and then helping them teach someone else what they have learned. Once an adult has accomplished these steps you know he or she has effectively learned the new task. Language In many areas of the United States, English is a second language. According to the census projections, Hispanics will become the largest minority group in the labor force by 2012. 6 Verbal directions and written policies and procedures must accommodate this change or errors will result. Change Constant in both life and work, change is often unsettling, even if we were expecting it. Personal conflict increases when a worker is dealing with overwhelming changes both at home and in the work environment. Resistance to change can be ugly, as many a leader can attest. The power of long-standing collective habits and a sense of what is important to a group can not be overlooked by leaders, especially if they expect significant change to be accepted. 6 Emotional Intelligence Emotions and moods are not trivial from a business viewpoint; they have real consequences for getting work 94 MANAGING INFECTION CONTROL

done. Good moods equal good work. Both individual and group emotional intelligence require these four capabilities: self awareness, self management, social awareness and relationship management. 5 Self awareness means being attuned to your inner signals, and recognizing how your feelings affect you and your job performance. Do you know your limitations and strengths? Do you know the limitations and strengths of the sterile processing and surgery team? 5 foster a climate of service and feedback, they will rate high on this aspect of the emotional intelligence scale. 5 Relationship management means being able to live what you ask of others; being an effective team member; resolving conflicts by acknowledging feelings but being able to redirect the energy toward the shared activity or goal; and being able to influence and support others on the team. 5 Self management means exerting self control. Employees who can stay calm in a crisis are exerting a high degree of emotional intelligence. Traits like flexibility and adaptability, openly admitting mistakes and being able to handle the ambiguity of life in sterile processing are other hallmarks of higher emotional intelligence. 5 Social Awareness means being attuned to the emotional signals of other people, especially if they are unsaid. If your leaders are available to others when needed and Generation Differences Baby boomers and generations X and Y all have different approaches to working and different values for life and work. Listed below are some of the characteristics and differences of these groups: Baby Boomers: This term is applied to the 78 million people born between 1946 and 1964. Post WWII, they were greatly influenced by the 1960s (flower children, hippies, tie-dyed shirts, the Rolling Stones, Elvis, the Beatles) and the notion they would not grow old. This way MANAGING INFECTION CONTROL 95

Quality processes start with an understanding of both theory and application. of thinking was new for their parents (many of whom were manual laborers or stay-at-home moms). It is fun to think that the baby boomers declared to the world that they would stay young forever and are now moving into their 6 0 s. 9 Many older boomers are not comfortable with technology, especially if they have accomplished a task manually for many years. Generation X: Born between 1965 and 1979/80, generation Xers are 27-42 and usually judged by characteristics assigned to them by the media. This generation is comfortable with technology as they were brought up on television, Atari 2600s and personal computers. T h o s e raised in the 1970s and 1980s saw the United States undergo a selfish phase that they say they do not want to repeat. Gen X generally describes a group of people who want to pull away from class and status in society. 10 You can ask a gen Xer to help you understand your computer, program the VCR and fix the hand-held scanner. Generation Y: Born after 1980, and unlike generations that preceded them, generation Y has been pampered, nurtured and programmed with a slew of activities since they were toddlers. As a result they are both highperformance and high-maintenance. Now in the workforce in their 20s, gen Yers believe in their own worth. Generation Y is much less likely to respond to the traditional command-and-control type of management still popular in much of today s workforce, says Jordan Kaplan, an associate managerial science professor at Long Island University-Brooklyn in New York. They ve grown up questioning their parents, and now they re questioning their employers. They don t know how to shut up, which is great, but that s aggravating to the 50-year-old manager who says, Do it and do it now. 11 Implications For Sterile Processing It s a wonder we accomplish as much as we do when you think of all of the constraints and human factor variables mentioned above! The complexity of the devices, the constraints of time, nature of the work in sterile processing, language skills and adult learning styles all play their parts in influencing our work quality. However, those factors that trigger our emotions (reactions to change, our attitudes, differences in the generations and emotional intelligence) are the human factor variables that most frequently disrupt the team s ability to meet its goals and work together harmoniously. Moving forward, it s important to acknowledge that the aging work force (with its subsequent health and strength issues) will more significantly affect our work and quality goals in the future as people stay longer in the workforce. Use of ergonomics in the sterile processing workplace, and applied human factors engineering will assist older workers to be healthy and productive. 7 It s fun to identify the attributes of living with, and being part of, a multigenerational workforce. But, hopefully your team is open to discussing ideas such as How do we all work together as a team without resentment? How do we value each other and use the strengths of each generation to advance our goals? And, How can we help each other understand that it is OK to have differing values and needs, but that we must come together to define our quality and work life goals and accomplish them. Summary H o p e f u l l y, our attention to the sterile processing goals of quality in our processes, service, products, and work life will help us be part of the solution to the growing number of medical malpractice incidents. The many constraints and human factor variables provide both great conversation and great frustration for the sterile processing and surgery team. They certainly influence and can interfere with the consistency needed to meet our quality goals for sterilization. Using the sterilization recommended practices of ANSI/AAMI and AORN helps sterile processing departments maintain state-of-the-art policies and procedures. And effective sterilization monitoring assists us in meeting the quality and work goals of sterile processing, especially in the face of the many variables encountered in the workplace, each day. Our patients depend upon it! References 1. Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST79:2006. 2. Association for the Advancement of Medical Instrumentation. Containment devices for resuable medical device sterilization. ANSI/AAMI ST77:2006. 3. Recommended Practices of Selection and Use of Packaging Systems for Sterilization. AORN Standards, Recommended Practices, and Guidelines. 2007. 4. Recommended Practices for Sterilization in Perioperative Practice Settings. Association of perioperative Registered Nurses. A O R N Standards, Recommended Practices, and Guidelines. 2007. 5. Goleman, et.al. Primal Leadership: Realizing the Power of Emotional Intelligence. Harvard Business School Press. 2002. 96 MANAGING INFECTION CONTROL

6. Toossi, M. Employment Outlook: 2002-12. Monthly Labor Review. Feb. 2004. 7. h t t p :// e n. w i k i p e d i a. o rg / w i k i / E rg o n o m i c s. 8. Berwick, D., Seeking Systemness. Healthcare Forum Journal, March/ April 1992. 9. Stark, L. and M Carpenter. Baby Boomers Challenge Notion of Retirement. Aging Population Lives L o n g e r, Works Harder, Stays A c t i v e. W N T. Jan. 10, 2006. 10. Jochim, J. Generation X Defies Definition. Nevada Outpost. 2006. 11. A r m o u r, S. Generation Y: T h e y v e Arrived at Work With a New Attitude. USA TODAY. 2006. Cynthia (Hunstiger) Hubbard, RN, BS, is a published author and program presenter. Her nursing experi - ence includes ER and occupational health nursing at Saint Marys Hospital Mayo Clinic in Rochester, Minn. She was assistant director of materials management and a central serv i c e director/sterile processing manager in Minnesota and Washington. Cynthia s outpatient experience includes GI, cardiology and community health. For 11 years Cynthia was a senior consultant with Lerch Bates Hospital Group of Littleton, Colo., on national and international design projects related to materials and waste management, t r a n s p o rt and sterile processing. A graduate of Saint Mary s School of Nursing, she has a BS from the College of St. Francis. Cynthia is a Fellow Member and served on the A S H C S P board of directors. She is a recipient of the A S H C S P Thomas Samuels and Educator of the Year awards. Sterile Process and Distribution CEU Information CEU Applicant Name Address City State Zip Code The CBSPD (Certification Board for Sterile Processing and Distribution) has pre-approved this inservice for one (1) contact hour for a period of five (5) years from the date of publication and to be used once in a recertification period. Successful completion of the lesson and post test must be documented by facility management and those records maintained by the individuals until recertification is required. DO NOT SEND LESSON OR TEST TO CBSPD. For additional information regarding Certification, contact: CBSPD, 2 Industrial Park Road, Suite 3, Alpha, NJ 08865 or call 908-454-9555 or visit the Web site at www. sterileprocessing.org IAHCSMM has awarded 1.5 Contact Points for completion of this continuing education lesson toward IAHCSMM recertification. Nursing CEU Application Form 3M Health Care Provider Approved by the California Board of Registered Nurses, CEP 5770 for one (1) contact hour. This form is valid up to five (5) years from the date of publication. 1. Make a photocopy of this form. 2. Print your name, address and daytime phone number and position/title. 3. Add your social security number or your nursing license number. 4. Date the application and sign. 5. Answer the CE questions. 6. Submit this form and the answer sheet to: Workhorse Publishing Managing Infection Control PO Box 25310, Scottsdale, AZ 85255-9998 7. For questions or follow-up, contact craig@manageinfection.com. 8. Participants who score at least 70% will receive a certificate of completion within 30 days of Managing Infection Control s receipt of the application. Application Please print or type. Name Mailing Address City, State, Country, Zip Daytime phone ( ) P o s i t i o n / Ti t l e Social Security or Nursing License Number Date application submitted ANSWERS 1. T 2. T 3. T 4. F 5. T 6. T 7. T 8. T 9. T 10. F Signature _ On a scale of 1-5, 5 being Excellent and 1 being Poor, please rate this program for the following: 1) Overall content 2) Met written objectives 3) Usability of content Offer expires September 2012 Reprint with permission from Workhorse Publishing L.L.C. Copyright 2007/Workhorse Publishing L.L.C./All Rights Reseved. <09/07> 70-2009-8669-6 MANAGING INFECTION CONTROL 97