By Matt Skoufalos
Patients served at St. Joseph’s Hospital and Medical Center in downtown Phoenix, Arizona, a 586-bed Level I trauma center with 36 operating rooms and four GI procedure rooms, rely upon the facility for a number of services. At the heart of its surgical lines are services ranging from gynecological, colorectal, and orthopedic procedures to neurosurgery, cardiovascular/thoracic, transplants, and robotics. Underpinning the OR teams that perform those duties is a sterile processing unit headed up by Robby Miller.
Miller’s role as manager of the sterile processing department includes oversight of medical device reprocessing on campus, including sterilization and high-level disinfection. As a subject matter expert in medical device reprocessing, he also co-chairs several councils within the CommonSpirit Health enterprise, the second-largest nonprofit hospital system in the United States.
For all his expertise in the field, Miller describes his entry into it as incidental to his pursuit of a career in firefighting. In pushing towards that goal, he became an EMT while working at St. Joseph’s Hospital as a patient transporter. After a time, Miller transferred into sterile processing as a technician, learning the trade as he continued. His growing enjoyment of sterile processing soon diverted his focus, especially against the backdrop of dramatic competition in the career of fire service.
“I was working here as a technician and fell in love with the work, its impact on patient care, and what we do as far as process,” Miller said. “With hard work, commitment to becoming certified and a health administration degree, I got promoted into a supervisory role, and then a management role, and just stayed here. Twenty-five years later, I’m still here enjoying my work and have a great passion for what I do.”
“Ultimately, it was just about the passion, the people and the work,” he said. “Sterile processing is an unknown role in health care; there’s not a huge awareness of what it takes to keep an operating room going from an instrument processing perspective. This is where I belong, and this is where I’ve stayed. I continued to advance my skill set, sustain my commitment to learning, education, and knowledge; and support my personal patient advocacy by sharing my knowledge with my colleagues and others in my industry.”
Miller’s passion for instrument processing led to his continued expertise in the field and the length of his career in it. Throughout that time, he’s observed how sterile processing has gained in significance, even within the health care space. Awareness of patient safety, risk levels and the impact of sterile processing on patient care outcomes have all gained traction even in the past decade, he said. Miller believes this is partly because of nationally reported adverse events associated with reprocessing medical devices, which has resulted in increased attention from accreditation surveyors; and partly because of standards developed by and with federal regulatory bodies, from the FDA, CDC and OSHA, as well as with the insight of professional surgical specialty associations like AORN and AAMI.
“The world that we’re working in today is geared towards preparing invasive devices to be safe for use on patients,” Miller said. “A vast majority of devices used in surgery are reused from one patient to the next. It’s very important that they’re taken care of in accordance with manufacturer’s instructions for use. The regulatory bodies out there are really coming into alignment, but also providing much more clear guidance on what’s appropriate and what’s not appropriate as far as keeping patients safe. Invasive medical devices and instruments used today have become incredibly complex; it’s wonderful that it’s helping produce great patient care outcomes.”
However, as technologies are developed and surgical devices become more complex, so too do the procedures for reprocessing them. Evolving standards offer meaningful clarity on how the expanding functions of surgical technology and surgical reprocessing technology offer additional possibilities for its application and management. Some of the most significant challenges are related to understanding the complexity of the devices and the various processes required to reprocess a contaminated instrument before it’s safe to be used on the next patient.
“The technologies and processes we’re using in sterile processing units are incredibly complex, as are the documentation that’s necessary for sterilization and high-level disinfection,” Miller said. “I’ve heard it a number of times in my career that we’re ‘washing dishes.’ These devices are a lot more complex than washing dishes. The regulatory focus and the risk associated with not doing it correctly not only demand significant time and planning, but competency of staff who are doing it in today’s environment.”
Developing staff competency requires continuous and ongoing education ranging from professional certifications to compliance with state and federal laws. For those reasons, Miller describes sterile processing as a career profession that requires a passion for working in perioperative services, sharp critical thinking skills, and an ability to confer with professionals in roles from technicians to providers.
“We’re one group working to provide care to our patients, and we’ve got to work together to be successful at it,” Miller said; “managing start times, turnover times, having instruments available, having enough assets on hand to meet the demands of the schedule. We’ve got to have instruments present to successfully perform the procedure that the patient needs.”
For sterile processing departments to continue to grow and develop in the future, Miller believes they need support to grow technologically as well as professionally. In the aftermath of the novel coronavirus (COVID-19) pandemic, staffing is at a premium, and recruitment and retention remain among the top challenges for departments of all stripes and sizes, including sterile processing.
“I think the biggest thing SPDs need to advance their departments is technology,” Miller said. “You need to be deploying tracking systems, tracking equipment, adequate automated equipment; you need steam and low-temp modalities for sterilization. And we really need to recruit talent in the field. Adapting to the rapid evolution of health care when it comes to technology itself impacts all of us in being prepared to manage that technology, keep it patient-ready and patient-safe. These are going to be enormous challenges in this landscape.”
When he’s not at work, Miller enjoys playing competitive baseball as an infielder with the Arizona Astros of the Arizona Premier League. He also enjoys spending time with his family in the outdoors, traveling, fishing, hiking and camping in Arizona Rim Country.
Professional Spotlight Nomination
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