Infection Control Today - 04/2003: IC Community

IAHCSMM Adopts Practice-Based Format for CRCST Examination

CHICAGO--The International Association for Healthcare Central Service Materiel Management (IAHCSMM) has embarked on a redesign of the Certified Registered Central Service Technician (CRCST) exam.

Approximately 20 carefully selected professionals with varying Central Service Materiel Management titles and backgrounds (from technicians and educators to materiel managers and managers), were asked to participate in a Job Task Analysis to review and restructure the current CRCST exam. The members, led by consulting psychologist Gerald Rosen, convened Nov. 1, 2002, for an intensive two-day meeting in San Antonio, just prior to IAHCSMM's 2002 fall meeting.

The new exam format will follow a practice-based approach; that is, using questions based on subject matter that has been defined by experts in the field for safe and effective practice, as opposed to knowledge that comes entirely from the pages of a textbook. IAHCSMM emphasizes that the textbook will still serve as a source upon which exam questions are based, and therefore, will continue to play a vital role in the preparation of the CRCST exam.

"Essentially, this means that IAHCSMM will be shifting from a pure training course curriculum to one that is more (task-specific)," Rosen explained.

The concept of a practice-based examination is not a new one. Most professional organizations, regardless of the discipline they serve, follow a practice-based testing method. The reason for adopting such a method is multi-pronged. Not only does it create an opportunity to more accurately assess professional skills from an actual practice or task perspective, it will enable IAHCSMM to prioritize and the importance of specific central service materiel management tasks according to their overall impact on quality of care and safety.

Rather than studying solely from a textbook and memorizing terms and procedures just for the purpose of passing an examination, IAHCSMM believes it would be in the best interest of the profession to shift its testing focus to a format that would allow those taking the exam to demonstrate not only how certain functions should be performed, but also how failure to follow appropriate procedure could impact patient care and overall quality.

"Many individuals may have all the basic knowledge related to sterile processing, such as the steps involved with decontamination and sterilization, and can even tell you the biological used for monitoring sterilization effectiveness," noted taskforce member Joyce Burris. "The fact is, though, that many of these same people don't know how to operate a sterilizer or washer, and may not know how to read the results of that biological indicator. After being in this profession for many years, I can see the need for a practice-based exam that focuses more on the actual tasks and skills necessary to perform the job effectively, vs. the (less dimensional) knowledge needed to pass the exam."

Burris is confident the enhanced emphasis on actual tasks and outcomes will help justify to administrators the inherent value of certification an area she admits has not always been easy, particularly when new staff members pass the exam, yet still lack the cognitive skills to perform their duties most effectively.

The idea, Rosen added, is to define a certification-level technician as a person who has "sufficient training and experience to be eligible to sit for the CRCST examination."

Further adding to the exam's value is the fact that IAHCSMM is the only association for CSMM professionals to offer a secure, computer-based certification exam that helps ensure confidentiality and reduce the likelihood for error. What's more, those wishing to sit for the exam can do so at virtually any time, seven days a week, without waiting for a designated testing day or site.

In examining the broad range of tasks imposed upon CSMM professionals -- each of which play a critical role in overall quality delivery -- it becomes apparent that certain responsibilities more directly impact patient-care delivery and safety than others. In light of those differences, it became the objective of the job task members to prioritize goal-directed work activities or groups of closely related work activities related to the CSMM profession, and determine how the test questions should be weighted.

The members took specific sections, such as sterile processing, and then broke them into different categories (i.e., decontamination, assembly, sterilization) and tasks required for each category, weighting them according to the knowledge required for safe and effective performance of each task. From there, the members were asked to assign each section with a percentage to determine which areas should be more greatly represented on the exam. Upon careful analysis of each section and task, the group set a weight of 70 percent for sterile processing and 30 percent for distribution of manufactured goods.

"That means that 70 percent of questions on the CRCST examination will relate to sterile processing, with the remainder pertaining to distribution of manufactured goods," explained educator and job task member Cheri Ackert-Burr.

According to Rosen, the next step in the process is the validation phase, whereby IAHCSMM members and stakeholders are asked to review the content of the practice analysis and complete a survey to suggest any changes, additions or revisions. Final approval is expected in the coming months, with implementation of the practice-based exam expected shortly thereafter.

FDA Continues to Investigate Particulate Matter in Blood

The Food and Drug Administration (FDA) is conducting an ongoing investigation of reports of unusual particulate matter in some blood components, primarily red blood cells (RBCs). Although the cause of the particulate matter is not yet fully explained, there is no evidence it poses a threat to blood safety at this time.

Findings to date indicate that the particles are composed of normal blood substances and that rates of adverse reactions to transfusions have not increased since the blood particles have been observed. All analyses to date of possible infectious agents, chemical contaminants, or blood bag defects have found no abnormalities that indicate a public health risk. Increasing evidence suggests that many of the particles observed may be explained by the use of certain standard, accepted procedures for preparation of red blood cells for transfusion.

Reports of unusual particles initially came from two regions of the American Red Cross (ARC) and involved blood bags from only one manufacturer. However, additional surveillance resulted in similar reports from other ARC and non-ARC centers in many parts of the country and in collection bags from several manufacturers.

Early reports of adverse events in patients who received blood that might have conceivably contained such particles raised the question of whether they could be harmful. However, follow up investigations by the blood centers have so far failed to provide any evidence of any increase in adverse reactions among patients who may have received potentially implicated blood transfusions.

In addition, testing by the Centers for Disease Control and Prevention (CDC) found no evidence of infectious agents or increased levels of a limited number of chemicals. Baxter Healthcare Corporation, a major blood bag manufacturer, in cooperation with the ARC and FDA, has extensively tested their processes and materials, and these tests have identified no unexpected materials or conditions. FDA laboratories have also independently tested some collection bags of the type for which questions of particulates were raised, and have detected normal contents in the blood bags and no contaminants or unexpected chemicals to date.

Studies on both the safety and on the cause of the particulates are ongoing. The FDA, CDC, National Institutes of Health (NIH), American Association of Blood Banks (AABB), ARC, America's Blood Centers, state health departments and a number of individual blood centers are all sharing information and many are conducting studies to try to determine why these blood particles are being seen and to detect any possible risk to blood safety.

Dependent on further studies of the particulate matter, FDA may issue guidance to the blood industry on appropriate measures needed to keep the blood supply as safe as possible while not unnecessarily affecting the availability of blood products, which are vital to public health.


APRIL 2003

Society for Healthcare Epidemiology of America, Inc. (SHEA)
Annual meeting, Arlington, Va.

International Association of Healthcare Central Services Materiel Management (IAHCSMM)
Annual meeting, Branson, Mo.

JUNE 2003

OR Business Management Conference
Capitol Hilton, Washington, D.C.
(800) 442-9918 or

Association for Professionals in Infection Control and Epidemiology (APIC)
Annual meeting, San Antonio, Texas

Association for Healthcare Resource and Materials Management (AHRMM)
Annual meeting, San Diego

Managing Today's OR Suite
Annual meeting, San Diego

Infectious Diseases Society of America (IDSA)
Annual meeting, San Diego

American Society for Healthcare Central Sterile Service Professionals (ASHCSP)
Annual meeting, Grand Rapids, Mich.

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