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					                      Summary of HSC 1999/178
         Variant Creutzfeldt-Jakob Disease (vCJD)


                 Minimising the Risk of Transmission



    All cases where CJD of any type is a possible diagnosis should be reported to
           the National CJD Surveillance Unit (CJDSU), www.cjd.ed.ac.uk



Instrument guidance

     Effective and thorough cleaning of surgical instruments to remove all organic
      debris before sterilisation makes a major contribution to risk reduction.


     Instruments designated for a single episode of use should be discarded after
      use and never reprocessed.


     Single-use kits should always be used for lumbar-punctures.


     Where practical options for using single-use instruments are available, which
      do not compromise clinical outcome, consideration should be given to using
      these for surgical procedures.


     Consideration should be given to the condition of surgical instruments in use.
      Decontamination equipment will work less efficiently on instruments that are
      difficult to clean, or are in a poor condition. Devices that cannot easily be
      cleaned should be identified, and where practicable within a planned
      programme, replaced with versions that are easier to clean.




                 Healthcare A2Z would like to thank Jane Dalling, Senior Health Protection Nurse,
                 Wiltshire Health Protection Team for supplying this document to www.healthcareA2Z.org
   Instruments and equipment used in the care of patients with confirmed CJD
    of any type should not be re-used and should be disposed of by incineration.


   Instruments used on patients suspected of having CJD of any type should be
    quarantined pending confirmation of a diagnosis (and should then be
    destroyed by incineration unless a definite alternative diagnosis is
    confirmed).


   Certain categories of patient should be regarded as presenting a potential risk:
    - recipients of hormones derived from human pituitary glands
    - recipients of human dura mater grafts
    - people with a family history of CJD.


   Single-use instruments and equipment should be used, wherever possible, in
    cases involving patients in a known risk category (as defined in the
    guidance).


   Instruments and equipment used in patient procedures involving brain, spinal
    cord or eyes carried out on a patient in a known risk category should be
    destroyed by incineration.


   Contact lenses issued to patients for trial wearing should not be re-used. The
    re-use of special complex diagnostic lenses, and other instruments used in
    ophthalmology departments, may continue to be used while under review by
    SEAC (Spongiform Encephalopathy Advisory Committee, www.seac.gov.uk ).



Blood products


   All blood donated after 31/10/99 will be leucodepleted.


   All major blood products (e.g. Factor VIII, immunoglobulins and anti-D for
    Rhesus negative pregnant women) are now made from non-UK plasma.


                 Healthcare A2Z would like to thank Jane Dalling, Senior Health Protection Nurse,
                 Wiltshire Health Protection Team for supplying this document to www.healthcareA2Z.org
Transplanted tissues and/or organs

There is a theoretical but unquantifiable risk of transmission of vCJD via
transplanted tissue/organs. Current procedures to minimise this potential risk
should be in line with the Microbiological Safety of Blood and Tissues for
Transplantation (MSBT) guidance which are under review, until then potential
donations should be rejected in the following circumstances:


   Recipients of pituitary derived hormones such as human growth hormone or
    gonadotrophins.
   People known or assumed to have had human dura mater implanted,
    including people who have had brain surgery or an operation for a tumour or
    cyst of the spine before August 1992.
   People diagnosed or suspected of suffering from CJD of any type, or with a
    family history of CJD.
   People with degenerative neurological disease of unknown causation.
   Recipients of corneal transplants.


The license for products derived from human dura mater was withdrawn in 1992
because of the high risk of transmission of CJD.


Until there is an effective screening test for vCJD, the decision on whether to
use an organ from a particular donor, particularly in the case of life-preserving
organ transplants, will depend on clinical need.


While systems for routine tracing of instruments are being developed, immediate
action should be taken to enable rapid tracing of flexible endoscopes in the case
of exposure to a possible case of CJD. All endoscopes should be recorded in
the endoscopy suite, theatre or outpatients department on every patient usage.
If it is not possible to identify the instrument used with certainty, there would be
a need to quarantine and possibly destroy all the endoscopes in the pool.




               Healthcare A2Z would like to thank Jane Dalling, Senior Health Protection Nurse,
               Wiltshire Health Protection Team for supplying this document to www.healthcareA2Z.org
Quarantined instruments

   Re-usable instruments should be:
    - washed to remove gross soiling
    - held below the surface of the water in a sink into which water is running
       and draining out continuously to avoid splashing and generating of
       aerosols.
                     Do not hold directly under a flowing tap


   The operative should wear protective gloves and either a visor or goggles
    and care must be taken to avoid penetrating injuries.
   Instruments should be placed in a disposable instrument tray and allowed to
    air dry.
   The instruments should then be placed in an impervious rigid plastic
    container with a close fitting lid.
   The lid should be sealed with heavy-duty tape (e.g. autoclave tape) and
    labelled with the patient’s name, hospital number, date of birth, and surgical
    procedure in which the instruments were used, along with the name of the
    responsible person (e.g. the theatre superintendent).
   The sealed box should be stored indefinitely in a suitable designated place
    until the outcome of any further investigation is known.
   The instrument tray should be disposed of by incineration.
   If the patient is confirmed as CJD, incinerate without further examination.
   If an alternative definitive diagnosis is confirmed, the responsible person (or
    a named deputy) may remove the instrument and send it to the Sterile
    Services Department (SSD) for processing in the usual way.
   Records must be kept of all decisions and the SSD must be told of the
    decisions before the instruments are sent for routine processing.
   Prolonged autoclaving or supplemental disinfection is not necessary.




                Healthcare A2Z would like to thank Jane Dalling, Senior Health Protection Nurse,
                Wiltshire Health Protection Team for supplying this document to www.healthcareA2Z.org

				
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