CRCST Self-Study Lesson Plan

Lesson No. CRCST 125 (Technical Continuing Education - TCE)
Sponsored by:
by Carla McDermott, RN, CNOR, CRCST
OBJECTIVE 1: NOTE FOUR GOVERN-
MENTAL AGENCIES THAT IMPACT
SAFETY ACTIVITIES FOR CSSD
There are several federal governmental
agencies that have enacted laws designed
to protect workers on their jobs, along
with healthcare patients and the environ-
ment. The U.S. Food and Drug Admin-
istration (FDA), Occupational Safety
and Health Administration (OSHA),
Environmental Protection Agency (EPA),
and the Agency for Healthcare Adminis-
tration (AHCA) enact statutes (laws) to
provide a reasonable degree of safety for
all healthcare workers, including CSSD
personnel. CRCST lesson 112 (May-June,
2010) provides a detailed description
of the specific areas impacted by each
of these agencies. Additionally, several
professional associations which have
published voluntary standards to enhance
healthcare safety and quality service are
discussed in that lesson. This information
is 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 to
preventing 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 University’s 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 University
provides grading services solely for CRCST and CIS
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.
T
HE VITAL WORK PERFORMED IN CENTRAL STERILE SUPPLY
Departments (CSSDs) has always required attention to details and safety.
Patients, surgeons, nurses and coworkers have always depended on skilled
and conscientious CSSD personnel to provide the necessary instrumentation
and equipment required to provide care for patients. The very nature of this work can
expose one or all of the parties to a wide variety of hazards. Acute awareness of these
hazards and the knowledge required to avoid injuries must be an integral part of the
basic education for CSSD personnel. In this lesson, several common safety concerns
will be explored.
Central Sterile Supply
Department Safety Practices
CRCST Self-Study Lesson Plan
OBJECTIVE 2: DISCUSS THE TYPES
OF SAFETY HAZARDS THAT CON-
FRONT CSSD PERSONNEL
A list of every safety hazard that CSSD
personnel might encounter would be
very lengthy. However, there are five
major types of hazards in the healthcare
workplace: biological, chemical, physical,
physiological, and social.
Biological hazards include bloodborne
pathogens, which may cause acquired
immune deficiency syndrome (AIDS) and
hepatitis, and have received a great deal of
attention in the media and in the work-
place. Only slightly less attention is given
to the multiple drug-resistant “super-bug”
bacteria that have evolved and become
extremely difficult to treat or manage with
medications. Commonly referred to by their
acronyms, these are multiple drug-resis-
tant staphylococcus aureus (MRSA) and
VRE (vancomyocin-resistant enterococ-
ci). The list of “super bugs” is growing,
and CSSD personnel must remain
vigilant as they perform their cleaning,
disinfection and sterilization duties.
Chemical hazards are also prevalent in
CSSDs. Chemicals take many forms, such
as concentrated liquids with extreme pH
levels, sterilization liquids and gases, plas-
ma vapors, and other disinfecting liquids
and aerosols. Chemical-resistant personal
protective equipment (PPE) is required
for CSSD personnel as they use these
products, as is training in and supervision
to ensure their safe use.
Physical hazards include the extremely
sharp surgical instruments with which
CSSD personnel must work. It is also
extremely difficult to maintain dry floors
in the decontamination area, so slips and
falls can occur. Surgical instrument sets
can be heavy, bulky and difficult to lift
properly, so muscle strains are possible.
Sterilizers generate heat and steam, which
presents burn hazards.
Pneumatic instruments must be man-
ually cleaned and tested, and this creates
a double hazard: the compressed gas
used for the testing, and a ruptured hose
that can fail the test. Some facilities are
fortunate enough to have medical air or
nitrous gas piped into the CSSD; however,
others still use large “H” size cylinders,
which are large and heavy, and a rolling
stand to transport them. OSHA requires
that they be secured while being moved
and when in use, and frequently, they are
chained to the wall. This creates a safety
hazard involving the tank’s neck and reg-
ulator. For example, if the tank falls over
and is damaged, the cylinder can act like
a torpedo and critically injure personnel
and cause extensive damage to the facility.
In the same way that rapidly escaping
gas can propel the cylinder, a hose being
tested can also explode and injure the
person holding it. The gas supply should
be in the ‘off ’ position before connecting
the hose to the gas supply. It should then
be visually inspected first for obvious
signs of excessive wear, bubbling or holes.
Likewise, the gas should be ‘off ’ and the
line pressure released by activating the
drill or saw hand piece before disconnect-
ing the hose.
Physiological hazards can occur with
the repetitive motions of instrument
assembly and wrapping items for steriliza-
tion. For example, these motions can cause
carpal tunnel syndrome of the wrist.
Also, computerization of the work flow
adds a new level of safety concern. When
computers are added to existing work
spaces, they can cause crowding of the
work space. This, in turn, results in the
need for additional and excessive turning
or twisting to view the monitor and the
work surface. Glare from the computer
screen can also strain eyesight.
There are additional safety hazards
in CSSD, as well. The environment can
be excessively cold or hot depending
on the facility’s location and the ability
to control the immediate environment.
Extended periods of standing or bend-
ing can cause muscle fatigue and strain.
Respiratory irritation can be caused by
“fiber flock” shedding from wrap mate-
rials. When CSSD personnel service the
Radiology area, Cardiac Cath Lab and
Surgery areas, they may be exposed to
X-rays, laser beams or chemicals other
than those routinely found in CSSD areas.
Knowledge is power and everyone
deserves to know what the potential hazards
are and how to avoid exposure to them. More
in-depth information about these topics
can be obtained by reviewing CIS Lesson
Plans 222 and 223. (November-Decem-
ber, 2010, and January-February, 2011).
A fifth category of hazards is those
that are less often considered until one of
them becomes an acute problem in the
CSSD. Social hazards include work-relat-
ed stress, burn-out and depression. While
these maladies seem very personal, the
effects impact the workplace. They are, in
Chemical hazards are also prevalent in
CSSDs. Chemicals take many forms, such as
concentrated liquids with extreme pH
levels, sterilization liquids and gases, plasma
vapors, and other disinfecting liquids
and aerosols.
CRCST SELF-STUDY LESSON PLAN
a sense, contagious and unless co-workers
or managers recognize the symptoms and
work to combat them, they will spread to
other personnel.
A few signs and symptoms to be alert
for include increased absenteeism,
extended breaks or lunches, and any
unusual changes in behavior patterns.
Pay attention to increased or unusual
emotional outbursts, belligerence,
threats, or changes in appearance and
attitude of a teammate. Share your
observations with and seek assistance
from a manager if these patterns become
apparent. Many workplaces have access to
Employee Assistance Programs that can
be very beneficial.
Other social hazards include various
forms of discrimination. For example, the
U.S. Equal Employment Opportunity
Commission (EEOC) enforces laws that
prohibit numerous types of discrimina-
tion that relate to age, disability, equal
pay/compensation, genetic information,
national origin, pregnancy, race/color,
religion, retaliation, sex, and sexual
harassment. These laws exist to protect
workers from the identified social hazards
and provide opportunities for CSSD
personnel to reduce these types of
workplace abuse.
OBJECTIVE 3: EXPLAIN WHY
SAFETY CONCERNS ARE CRITICAL
IN CSSDs
The impacts of safety hazards in the
workplace include bodily harm and
even death. They also include decreased
morale and productivity, and increased
absenteeism and the number and severity
of accidents. CSSD employees know that
patients, surgeons, nurses, and coworkers
are also at risk when safety hazards exist.
While accidents can “just happen,” these
are frequently other forces at work which
allow them to occur. Sometimes there are
human factors and attitudes that can lead
to injuries. It may be as simple as thinking
“It can’t (or won’t) happen to me,” or “I’ve
never seen that happen.” CSSD personnel
can influence the human dynamics of
safety and decrease the frequency and
severity of accidental injuries in their
department.
1
For example, if employers
are away from work recovering from
injuries, they cannot protect their patients
or each other, and this adds to the stress
and workload of their coworkers.
OBJECTIVE 4: EVALUATE THE BEN-
EFITS OF SAFETY AUDITS IN CSSDs
Safety audits can help to identify and
reduce risks in CSSD. One common tactic
is to analyze the last five CSSD audits that
have occurred. 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 work in the area with the same
equipment and instruments every day.
Invite someone from another department
to perform the audit. For example, when a
public university hospital invited a
Preliminary Risk Analysis (PRA) team to
audit their CSSD, the results were astound-
ing. The team identified 416 hazardous
situations with 81 listed first in priority
leading to 141 risk scenarios. The PRA
team helped to develop 23 follow-up
actions and preventive measures and 13
safety parameters.
2
Take the challenge
and invite a Safety or Risk Manager in
your facility to perform an audit or invite
a colleague from another facility to tour
the CSSD. Any risk or hazard that is
eliminated will improve the functioning
and safety of the department.
OBJECTIVE 5: DESCRIBE A PROAC-
TIVE APPROACH TO PREVENTING
WORKPLACE VIOLENCE
Workplace violence is on the rise in the
United States. Contributing factors to a
nearly three-fold increase in this type of
violence include a weak economy and
labor markets. Stress is everywhere and
appears to be coming from all direc-
tions. For example, family, friends and
coworkers deployed in the military, the
banking and healthcare crises, recession,
and massive unemployment all contrib-
ute to stress levels. Those who attempt to
further their education and secure gainful
employment face an uphill battle, as well.
Working full-time, attending college and
maintaining a family can be exhausting.
When the candle is burning at both ends
Safety audits can help to identify and reduce
risks 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 work
in the area with the same equipment and in-
struments every day.
CRCST Self-Study Lesson Plan
without relief, a meltdown is almost a
sure thing (pun intended!), and violence
can erupt. Healthcare- and hospital-based
jobs are not immune from these forces.
The National Institute for the Prevention
of Workplace Violence defines workplace
violence as: “Acts of aggression or violence
that 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 fear
for one’s safety or entail a perceived risk
of harm to individuals, or damage to an
organization’s resources or capabilities.”
3
This is a rather broad definition be-
cause it includes any action that makes
another person feel fearful, and it includes
anyone in the workplace who is physically
or emotionally injured. All CSSD person-
nel must be able to recognize and report
potential risks for workplace violence and
know what should be done if an incident
occurs. The CSSD workplace is a stressful
environment, and there are physical haz-
ards that must be avoided every day. The
job requires acute attention to detail.
Sometimes the smallest of things can
push a person to violence just like the
story of “the straw that broke the camel’s
back.” Employees can note any unusual
changes in behavioral patterns as they
interact with coworkers and report the
changes to the manager. Discussing the
issue with the manager is typically better
than discussing it with the employee be-
cause the manager may have knowledge
of personal or other matters that have not
been shared with coworkers. Additional
information, recommendations and ac-
tion plans are available from OSHA and
The National Institute for the Prevention
of Workplace Violence.
IN CONCLUSION
CSSD personnel should be congratulated
for consistently doing the right things
every shift and every day. Their diligent
attention to detail and willingness to do
what is required ensures that patient care
products are safe to use. Their actions,
including continuing education, safety re-
views, and team-building activities, help
to ensure that coworkers and patients do
not 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 Central
Service Materiel Management. Certified Regis-
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 the
following two CSSD professionals who reviewed
this lesson plan:
LISA HUBER, BA, CRCST, ACE, FCS; Sterile
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
JULY / AUGUST 2012 Communiqué 53 www.iahcsmm.org
CRCST Self-Study Lesson Plan Quiz -
Central Sterile Supply Department Safety Practices
Lesson No. CRCST 125 (Technical Continuing Education - TCE) • Lesson expires July 2015
OBJECTIVE 1
1. Professional associations publish ________
standards to enhance healthcare safety
and quality.
a. Mandatory
b. Voluntary
OBJECTIVE 2
2. Bloodborne pathogens are an example of
which type of healthcare workplace hazard?
a. Chemical
b. Physical
c. Physiological
d. Biological
3. “Super-bug” bacteria are creating significant
challenges 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 and
tested with automated equipment.
a. True
b. False
6. A cylinder hose used to test pneumatic
equipment should not be connected to the
gas supply when the test is done.
a. True
b. False
7. Viewing a computer can cause carpal tunnel
syndrome of the wrist.
a. True
b. 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-out
c. Depression
d. All the above
10. Employee assistance programs can be
beneficial when addressing what category of
safety hazard in CSS departments?
a. Biological
b. Physical
c. Psychological
d. Social
11. Which form of discrimination is not prohibited
by the U.S. Equal Employment Opportunity
Commission (EEOC)?
a. Age
b. Weight
c. Pregnancy
d. Religion
OBJECTIVE 3
12. Employee attitudes can lead to injuries in
CSS departments.
a. True
b. False
13. The impact(s) of safety hazards in the work
place may include:
a. Decreased morale
b. Decreased productivity
c. Increased absenteeism
d. A and B above
e. All the above
OBJECTIVE 4
14. How many CSSD safety audits are commonly
analyzed to help identify and reduce risks in
CSSDs?
a. One
b. Three
c. Five
d. Seven
15. CSSD safety audits performed by a CSSD
employee are probably the best type of safety
audits that can be performed because
employees know about safety concerns.
a. True
b. False
16. Any risk or hazard that is eliminated because of
a CSSD safety audit will improve the functioning
and safety of the department.
a. True
b. False

OBJECTIVE 5
17. Stress is a common cause of workplace violence.
a. True
b. False
18. What type of aggression or violence is classified
as workplace violence?
a. Intentional
b. Reckless
c. A and B above
d. It depends upon the situation
19. Any action that makes another person feel
fearful is considered workplace violence.
a. True
b. False
20. Employees who note unusual behavior of a
coworker should discuss this immediately with
that coworker.
a. True
b. False
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