the responsibility for performing chemical high -level

ASSESSING STAFF COMPETENCIES FOR STERILE PROCESSING Lisa Huber BA, CRCST, FCS, ACE THE JOINT COMMISSION HOSPITAL ACCREDITATION STANDARDS HR.01.06.01 “Staff are competent to perform their responsibilities” EP1 – The hospital defines the competencies it requires of its staff who provide patient care, treatment or services EP2 – The hospital uses assessment methods to determine the individual’s competence in the skills being assessed AAMI STANDARDS AND RECOMMENDED PRACTICE AAMI ST79 (2012) 4.2.2 Sterile Processing Personnel The responsibility for Sterile Processing should be assigned to qualified individuals who have demonstrated competence in all aspects of sterile processing… AAMI ST58 (2013) 4.2.2 Processing Personnel The responsibility for performing chemical high-level disinfection and sterilization processes should be assigned to qualified individuals who have knowledge of all aspects of disinfection and sterilization procedures and safety precautions….Suggested minimum personnel qualifications include a) Demonstrated knowledge of and documented competence in the principles of chemical sterilization… WHAT COMPETENCIES SHOULD I MEASURE? • Routine but multi-stepped tasks – i.e. the operation of a sterilizer • New devices, equipment, procedures in the department • High risk/low volume devices, equipment, or procedures • Complex tasks – i.e. cleaning an endoscope or robotic instruments • Issues identified during quality checks TWO LEVELS OF COMPETENCY ASSESSMENT Initial Competency Assessment Upon installation of new equipment, delivery of new device or change in process or procedure Assessed by trainer from the providing company or department manager or educator Annual Competency Assessment Assessed by manager, educator or other qualified staff member “Super-user” Must be documented and retained in employee file HOW DO I DOCUMENT STAFF COMPETENCY? Customize the method to the task and to your facility – for example: Testing – develop a test (multiple choice or fill-in-the- blank will work) to determine staff knowledge of a complex concept such as sterilization load monitoring Return Demonstration – use a checklist to ensure each step in followed while a technician cleans an endoscope Observe - a technician to ensure he/she is following established procedure for assembling an instrument tray YOU AREN’T ALONE… Many companies have developed competency assessment tools for their equipment or devices – just ask! Share competencies with colleagues at an IAHCSMM local chapter meeting – everyone comes away with more than they had! Have “super-users” help develop competencies – no one knows the process better than those who do it everyday! STERILE PROCESSING ANNUAL COMPETENCY ASSESSMENT Core Competencies Suggested Resources Desired Behavior Met Not Met Date/Signature/ Comments Record Keeping a. Sterilizer load records b. Checklists c. Recalls d. Scanning Procedure review/Demonstration/ Observation •Records are complete and accurate •Checklists are complete and accurate •Recall procedure reviewed •Scanning is complete and accurate (if applicable) Sterilizers a. Loading & unloading b. Cycles – times and temperatures c. Performance testing (Bowie-Dick, BI, CI, PI) d. Operation of: Steam ETO Vaporized Hydrogen Peroxide Procedure review/Demonstration/ Observation •Sterilizers are loaded/unloaded according to policy •Cycle times and temperatures are properly chosen •All performance tests are properly interpreted and documented •Steam sterilizers operated according to procedure •ETO sterilizer operatied according to procedure •Vaporized H2O2 sterilizer operated according to procedure TAKING THE GUESS-WORK OUT OF STAFF COMPETENCIES ENSURES A SAFER ENVIRONMENT FOR OUR PATIENTS

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Page 1: The responsibility for performing chemical high -level

ASSESSING STAFF COMPETENCIES FOR STERILE PROCESSING

Lisa Huber BA, CRCST, FCS, ACE

THE JOINT COMMISSION HOSPITAL ACCREDITATION STANDARDS

HR.01.06.01 “Staff are competent to perform their responsibilities”EP1 – The hospital defines the competencies it requires

of its staff who provide patient care, treatment or services

EP2 – The hospital uses assessment methods to determine the individual’s competence in the skills being assessed

AAMI STANDARDS AND RECOMMENDED PRACTICE AAMI ST79 (2012)

4.2.2 Sterile Processing Personnel The responsibility for Sterile Processing should be assigned to qualified

individuals who have demonstrated competence in all aspects of sterile processing…

AAMI ST58 (2013) 4.2.2 Processing Personnel The responsibility for performing chemical high-level disinfection

and sterilization processes should be assigned to qualified individuals who have knowledge of all aspects of disinfection and sterilization procedures and safety precautions….Suggested minimum personnel qualifications include

a) Demonstrated knowledge of and documented competence in the principles of chemical sterilization…

WHAT COMPETENCIES SHOULD I MEASURE?• Routine but multi-stepped tasks – i.e. the operation of a

sterilizer

• New devices, equipment, procedures in the department

• High risk/low volume devices, equipment, or procedures

• Complex tasks – i.e. cleaning an endoscope or robotic instruments

• Issues identified during quality checks

TWO LEVELS OF COMPETENCY ASSESSMENT

Initial Competency AssessmentUpon installation of new equipment, delivery of new

device or change in process or procedure Assessed by trainer from the providing company or

department manager or educator

Annual Competency Assessment Assessed by manager, educator or other qualified

staff member “Super-user”Must be documented and retained in employee file

HOW DO I DOCUMENT STAFF COMPETENCY?

Customize the method to the task and to your facility – for example:Testing – develop a test (multiple choice or fill-in-the-

blank will work) to determine staff knowledge of a complex concept such as sterilization load monitoring

Return Demonstration – use a checklist to ensure each step in followed while a technician cleans an endoscope

Observe - a technician to ensure he/she is following established procedure for assembling an instrument tray

YOU AREN’T ALONE…

Many companies have developed competency assessment tools for their equipment or devices – just ask!

Share competencies with colleagues at an IAHCSMM local chapter meeting – everyone comes away with more than they had!

Have “super-users” help develop competencies – no one knows the process better than those who do it everyday!

STERILE PROCESSING ANNUAL COMPETENCY ASSESSMENT

Core Competencies Suggested Resources Desired Behavior Met Not Met Date/Signature/Comments

Record Keepinga. Sterilizer load

recordsb. Checklistsc. Recallsd. Scanning

Procedure review/Demonstration/Observation

•Records are complete and accurate•Checklists are complete and accurate•Recall procedure reviewed•Scanning is complete and accurate (if applicable)

Sterilizersa. Loading & unloadingb. Cycles – times and

temperaturesc. Performance testing

(Bowie-Dick, BI, CI, PI)

d. Operation of:SteamETO

Vaporized Hydrogen Peroxide

Procedure review/Demonstration/Observation

•Sterilizers are loaded/unloaded according to policy•Cycle times and temperatures are properly chosen•All performance tests are properly interpreted and documented•Steam sterilizers operated according to procedure•ETO sterilizer operatiedaccording to procedure•Vaporized H2O2 sterilizer operated according to procedure

TAKING THE GUESS-WORK OUT OF STAFF COMPETENCIES ENSURES A SAFER ENVIRONMENT FOR OUR PATIENTS

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