When conducting mock audits of hospital sterile processing departments, Charles Hughes' findings often leave clients shaking their heads.

"Hospitals are surprised by the 50 to 60 noncompliance observations that I routinely see," says Hughes, a consultant and general manager and lead educator for SPSmedical Supply Corp., Rush, N.Y., one of the nation's largest sterilization testing labs. "There's truly a lack of knowledge out there about compliance standards."

Nancy Chobin, R.N., another SPD consultant and executive director of the Certification Board for Sterile Processing and Distribution, says she often sees even higher levels of noncompliance in her audits.

What's going on? Hughes and Chobin say many technicians take shortcuts that undermine infection-prevention protocols. These can include failure to follow manufacturers' instructions for cleaning, disinfecting and sterilizing complex surgical instruments, wearing improper protective equipment and more. These breaches potentially can lead to postoperative infections, damage to costly surgical instruments and friction among surgeons and other operating room staff and their SPD partners. Surgery delays and cancellations also are common when instruments aren't properly sterilized.

"It's not that [SPD technicians] don't care, it's that they don't know the manufacturer's instructions for use and industry standards," Hughes explains.

National SPD organizations share these concerns. That's why the International Association of Healthcare Central Service Materiel Management and the CBSPD have renewed their calls for SPD certification requirements. The Association for the Advancement of Medical Instrumentation, the American National Standards Institute, and the Association for periOperative Registered Nurses are also on the certification soapbox.

"Certification has been adopted as [our] No. 1 legislative priority," says Josephine Colacci, who was hired last fall as the IAHCSMM's first government affairs director. Colacci is organizing grassroots campaigns to get states to enact legislation requiring SPD worker certification as a condition of employment. She's hoping that legislators in New York, Ohio and Pennsylvania will introduce bills this year. Meanwhile, legislative groundwork is ongoing in six other states: Arizona, California, Colorado, Maryland, Oregon and Washington. In 2004, New Jersey became the first and still only state in the nation to require SPD certification.

Just how many hospital SPD technicians there are nationally and how many have passed one or more of the various levels of certification offered is unknown. One unscientific magazine survey found that about 30 percent were certified, Chobin says. As of January 2011, about 88 percent of IAHCSMM's 15,424 members are certified.

Linda K. Groah , AORN executive director and CEO, hopes that hospital and health system executives as well as state hospital associations will support certification within their organizations, but she's convinced legislative action still is needed.

"The main message for the CEO is that care and handling of surgical instruments is an essential part of the successful perioperative practice and surgical outcomes. It is no longer acceptable to have on-the-job training," Groah says.