instructions for cleaning and reassembly of medical devices as
well as instructions for safe handling of chemicals should be
provided in a manner and language the employee understands.
If an employee cannot read or comprehend instructions,
written instructions have no value. Even literate, highly educated technicians and engineers have been known to ignore
written instructions or to interpret instructions incorrectly.
In the absence of clear, unambiguous instructions that can be
followed, technicians are likely to come up with creative, albeit
unsuitable modifications. In a healthcare setting, this is another
reason for supervisors and those involved in manufacturing
medical devices to base instruction on actual observation of
employee performance. Obviously, illustrations and photographs should accompany written instructions.
Conducting adequate training includes figuring out what the
employee actually understands; this requires skill and, sometimes,
tact. For example, a skilled technician had enviable manual dexterity but limited math skills. His job required him to measure a
component, using a technique he could not fathom. His way of
coping was to peer at the measuring instrument, then guess the
measurement by writing a decimal point with a string of zeros
that looked similar to what his colleagues achieved, followed by a
few numbers. Eventually, the guessing game was detected. Since
he was a skilled craftsperson, rather than removing him from the
job, the solution was to remove the metrics from his job. Could
an online quiz have caught the problem? Perhaps. Even better, in
the example of the mathematically challenged employee, observation of the technician and an assessment of his available skills and
talents was a more productive solution.
Who controls training?
Matthis makes compelling arguments for moving safety
training out of the hands of health and safety professionals
and into the hands of production management. He points out
that such a move eliminates the artificial boundary between
safety and productivity. It makes production management
responsible for employee safety. It would seem that there is an
important process in building and maintaining the training
program; and this involves setting up practical procedures. In
healthcare, this means a true collaboration among production
management, workers, product safety professionals, environmental professionals, facilities management, medical device
manufacturers, and manufacturers of cleaning agents and
disinfectants. Matthis advocates a culture of safe production.
Such a culture, it would seem to us, involves replacing training
with well-designed instruction and education.
If a culture of holistic quality sounds costly, consider the
costs of the status quo. Training in the healthcare setting can
be a matter of economic prosperity versus failure for the
facility, of success versus suffering for the patient, of life ver-
sus death for patients, families, and healthcare workers. The
unproductive heat of friction generated by department con-
flicts is costly. Changes in reimbursement policies put the onus
on the facility. The health, financial, and ethical consequences
of mistakes in healthcare are catastrophic.
1. Scott, R.D. The Direct Medical Costs Of Healthcare-Associated
Infections In U.S. Hospitals and the Benefits of Prevention.
Division of Healthcare Quality Promotion, National Center for
Preparedness, Detection, and Control of Infectious Diseases,
Coordinating Center for Infectious Diseases. Centers for Disease
Control and Prevention. March 2009.
2. Klevens RM, Edwards JR, Richards CL, Horan T, Gaynes R,
Pollock D, Cardo D. Estimating healthcare-associated infections in
U.S. hospitals, 2002. Public Health Rep 2007; 122:160-166.
3. Adapted from Haddix A.C. and Shaffer P.A. Prevention
Effectiveness: A Guide to Decision Analysis and Economic
Evaluation. Oxford University Press, 1996.
4. Fouke, E.G. “OSHA Training Standards Policy Statement,”
April 17, 2007.
5. Matthis, T.L. “Should the Safety Department Manage Safety?”
Industry Week, May 2013. http://www.industryweek.com/safety-dept
6. Stone, P. W. “Changes in Medicare reimbursement for hospi-tal-acquired conditions including infections,” Am J. Infect Control,
Nov. 2009, 17A – 18A.
7. Bilodeau, R. “Engineering a Culture of Safety,” Controlled
Environments Magazine, July/August 2013
Barbara Kanegsberg and Ed Kanegsberg (the Cleaning Lady and the
Rocket Scientist) are experienced consultants and educators in critical
and precision cleaning, surface preparation, and contamination control.
Their diverse projects include medical device manufacturing, microelec-
tronics, optics, and aerospace. Contact: email@example.com
Steve Derman has an extensive broad-base of experience in occupa-
tional health and safety, industrial hygiene, and biosafety with healthcare
applications. He is a nationally recognized speaker, technical expert, and
author on issues related to health, safety, environmental, and regulatory
affairs and serves on numerous occupational hygiene, healthcare, safety,
and regulatory committees. Contact: firstname.lastname@example.org