CORRECTED: States pushing efforts to require certification for cleaning medical instruments

Introduction

Correction, Feb. 29, 1:09pm: Due to incorrect information received from contributors to two bills before the New York State Assembly, the Center for Public Integrity inaccurately described a labor union’s opposition to requiring certification for central sterile processing workers. The bills would exempt current workers, and those who worked in the field two years prior to passage, from certification requirements. The 1099 SEIU Healthcare Workers East supports this legislation. A previous version of this story incorrectly stated that the bills would only exempt workers with two years of experience.

Reused surgical instruments are often dangerously dirty, a Center for Public Integrity investigation has revealed, but the workers charged with the high-stakes task of cleaning these complex devices face almost no state-mandated professional licensing or certification requirements.

Only New Jersey today has a law on the books that requires professional certification for central sterile technicians, the workers who clean and sterilize medical devices between procedures, most often in units located in hospital basements.

A professional association representing these central sterile workers is pushing certification legislation in three other states, but similar previous efforts have been stymied by labor unions, which argue that current workers should not be required to pass a written test to keep their jobs.

The stakes are potentially high. A Center for Public Integrity investigation published last week documented how advanced medical technology has created intricate medical tools that are difficult to clean and sterilize, a situation which experts say could put patients at increased risk for infection. Some hospitals, particularly those in large cities, have acted on their own to require central sterile workers to pass certification tests covering topics including microbiology, infection control, and sterilization techniques. Other hospitals do not, which industry leaders say creates uneven patient safety standards.

“The people who do your nails, they have to take an infection control course before they can apply for a license,” said Mary Olivera, the director of sterilization at a New York City medical facility and past president of the New York State Association of Central Service Professionals. “Same with a dog groomer. Yet the people who deal with lifesaving equipment, they are required to have zero education.”

As medical devices advance, the cleaning and disinfecting process has become much more technical and complex, said John Best, a central sterile processing unit manager at a Dayton, Ohio hospital, and president of the Buckeye Central Service Association. “There are so many methods of sterilization and so many high- dollar pieces of equipment that you have to understand. It’s more than the ‘day of the dishwasher,’ ” Best said.

Best said he hopes certification will ensure that workers learn new standards and keep their head in the job. “In the many places I have worked and seen, it’s amazing how people go on autopilot,” he said, adding that he often sees workers who don’t know correct cleaning processes.

In addition to pushing certification in Ohio, the Chicago-based International Association of Healthcare Central Service Materiel Management (IAHCSMM) is supporting certification bills in New York and is helping prepare legislation in Pennsylvania. Under these proposals, central sterile workers would have to pass exams prepared by IAHCSMM or the New Jersey based Certification Board for Sterile Processing and Distribution in order to work in hospitals.

Earlier this month, New York State Assemblyman Harry Bronson (D-Rochester) and Sen. Mark Grisanti (R-Buffalo) introduced identical bills that would require continuing education and professional certification for central sterile workers. The bills, however, exempt current workers from the certification requirement. In 2011, bills that would have required certification for workers with less than ten years of experience languished in the face of dissatisfaction by labor unions representing hospital workers.

“In New York, you need the unions to get the bill through,” said Jo Colacci, government affairs director at IAHCSSM, which is the main force behind the certification push in the states.

David Kranz, director of the professional and technical department at 1199 SEIU Healthcare Workers East, which represents healthcare workers from Massachusetts to Florida, said the union supports the 2012 bills in New York. The union opposed 2011 efforts.

In a 2011 letter to union members, Carmen Charles, president of the Healthcare Workers Local 420 in New York City, wrote that the union’s lobbyists stopped “proponents of this bill in their tracks.” Charles did not reply to calls for comment on the union’s position on the 2012 effort.

Colacci said IACHSMM is ready to compromise with the unions. But the grandfather clause in the current New York bills is difficult for many certification proponents to take.

“Seems like we are putting the unions ahead of the patients,” said Nancy Chobin, a sterile processing educator for the Saint Barnabas Health Care System in New Jersey and the executive director of the Certification Board for Sterile Processing and Distribution, an international non-profit certification board in the state.

At Saint Barnabas, Chobin said around ten people lost their jobs after New Jersey’s certification requirement went into effect in 2004. Chobin said those workers put off the test, took it at the last minute, and failed. “The truth is, if you cannot demonstrate minimum competency, you should not be working in the field,” she said.

In addition to unions, the move to require certification may run up against opposition from state hospital associations. In 2011, Pennsylvania State Representative Mauree Gingrich (R-Palmyra) announced she was preparing a certification bill. “It is critical that physicians be able to perform surgery without fear of patient safety and that patients can trust the equipment used will not complicate their circumstances for being hospitalized in the first place,” Gingrich wrote in a memo to House members.

Gingrich has not yet introduced the bill, but the measure already faces strong opposition from the state hospital association. Roger Baumgarten, a spokesman for the The Hospital and Healthsystem Association of Pennsylvania, said it opposes certification because hospitals have adequate sterilization protocols in place. “It is our contention that such a requirement is clinically unnecessary and would serve only to increase health care costs at a time when cost reduction and cost-effectiveness are critical to hospitals,” Baumgarten wrote in an email response to questions.

Gingrich said she is “not waiting for support from HAP” and will introduce the bill “within the next few weeks.”

To head off resistance in other states, Colacci said the association is trying to educate legislators about central sterile and the role it plays in infection control before introducing bills. In some states, she said that could take years. “Part of the problem is that when you go up against hospital associations, those associations have been in it for 50, 60, 70 years. They give a signification amount of money. They (the legislators) don’t know who we are.”