Infection Control Today - 04/2003: IC Community

IAHCSMM Adopts Practice-Based Format for CRCST Examination

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

Approximately 20 carefully selected professionals with varying CentralService Materiel Management titles and backgrounds (from technicians andeducators to materiel managers and managers), were asked to participate in a JobTask Analysis to review and restructure the current CRCST exam. The members, ledby consulting psychologist Gerald Rosen, convened Nov. 1, 2002, for an intensivetwo-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, usingquestions based on subject matter that has been defined by experts in the fieldfor safe and effective practice, as opposed to knowledge that comes entirelyfrom the pages of a textbook. IAHCSMM emphasizes that the textbook will stillserve as a source upon which exam questions are based, and therefore, willcontinue to play a vital role in the preparation of the CRCST exam.

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

The concept of a practice-based examination is not a new one. Mostprofessional organizations, regardless of the discipline they serve, follow apractice-based testing method. The reason for adopting such a method ismulti-pronged. Not only does it create an opportunity to more accurately assessprofessional skills from an actual practice or task perspective, it will enableIAHCSMM to prioritize and the importance of specific central service materielmanagement tasks according to their overall impact on quality of care andsafety.

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

"Many individuals may have all the basic knowledge related to sterileprocessing, such as the steps involved with decontamination and sterilization,and can even tell you the biological used for monitoring sterilizationeffectiveness," noted taskforce member Joyce Burris. "The fact is,though, that many of these same people don't know how to operate a sterilizer orwasher, 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 apractice-based exam that focuses more on the actual tasks and skills necessaryto perform the job effectively, vs. the (less dimensional) knowledge needed topass the exam."

Burris is confident the enhanced emphasis on actual tasks and outcomes willhelp justify to administrators the inherent value of certification an area sheadmits has not always been easy, particularly when new staff members pass theexam, yet still lack the cognitive skills to perform their duties mosteffectively.

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

Further adding to the exam's value is the fact that IAHCSMM is the onlyassociation for CSMM professionals to offer a secure, computer-basedcertification exam that helps ensure confidentiality and reduce the likelihoodfor error. What's more, those wishing to sit for the exam can do so at virtuallyany time, seven days a week, without waiting for a designated testing day orsite.

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

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

"That means that 70 percent of questions on the CRCST examination willrelate to sterile processing, with the remainder pertaining to distribution ofmanufactured 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 thepractice analysis and complete a survey to suggest any changes, additions orrevisions. Final approval is expected in the coming months, with implementationof 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 investigationof reports of unusual particulate matter in some blood components, primarily redblood cells (RBCs). Although the cause of the particulate matter is not yetfully explained, there is no evidence it poses a threat to blood safety at thistime.

Findings to date indicate that the particles are composed of normal bloodsubstances and that rates of adverse reactions to transfusions have notincreased since the blood particles have been observed. All analyses to date ofpossible infectious agents, chemical contaminants, or blood bag defects havefound no abnormalities that indicate a public health risk. Increasing evidencesuggests that many of the particles observed may be explained by the use ofcertain standard, accepted procedures for preparation of red blood cells fortransfusion.

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

Early reports of adverse events in patients who received blood that mighthave conceivably contained such particles raised the question of whether theycould be harmful. However, follow up investigations by the blood centers have sofar failed to provide any evidence of any increase in adverse reactions amongpatients 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 numberof chemicals. Baxter Healthcare Corporation, a major blood bag manufacturer, incooperation with the ARC and FDA, has extensively tested their processes andmaterials, and these tests have identified no unexpected materials orconditions. FDA laboratories have also independently tested some collection bagsof the type for which questions of particulates were raised, and have detectednormal contents in the blood bags and no contaminants or unexpected chemicals todate.

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 BloodBanks (AABB), ARC, America's Blood Centers, state health departments and anumber of individual blood centers are all sharing information and many areconducting studies to try to determine why these blood particles are being seenand to detect any possible risk to blood safety.

Dependent on further studies of the particulate matter, FDA may issueguidance to the blood industry on appropriate measures needed to keep the bloodsupply as safe as possible while not unnecessarily affecting the availability ofblood 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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