3/28/16

Instrument Sterilization for Prevention of Creutzfeldt-Jakob Disease Transmission


By on 9:10 AM

The Arkansas Department of Health (ADH) announced last week that in December 2015, Washington Regional Medical Center in Fayetteville performed surgery on a patient who was later diagnosed with possible Creutzfeldt-Jakob Disease (CJD).

The timeframe for risk of exposure to this disease for a select group of patients who also had surgery at Washington Regional began December 16, 2015, and ended before March 16, 2016.

CJD is a rare, degenerative, invariably fatal brain disorder affecting about one person in every one million people per year worldwide. In the United States, there are about 300 cases annually. CJD occurs when a normal brain protein changes into an abnormal form called a "prion" and accumulates in brain cells. CJD can occur sporadically, from genetic mutation, or it can be acquired.

According to the Centers for Disease Control and Prevention (CDC), iatrogenic transmission of the CJD agent has been reported in over 250 patients worldwide. These cases have been linked to the use of contaminated human growth hormone, dura mater and corneal grafts, or neurosurgical equipment. Of the six cases linked to the use of contaminated equipment, four were associated with neurosurgical instruments, and two with stereotactic EEG depth electrodes.

While there has not been a reported case of CJD transmitted by surgical instruments since 1976, it is imperative for organizations to properly sterilize equipment and instruments used on a known or suspected case. According to the CDC, normal sterilization procedures such as cooking, washing and boiling do not destroy prions. Enhanced sterilization procedures are recommended for CJD.

The National Institute of Neurological Disorders and Stroke advises healthcare workers to take the following precautions when they are working with a person with CJD:
  • Cover cuts and abrasions with waterproof dressings.
  • Wear surgical gloves when handling a patient’s tissues and fluids or dressing the patient’s wounds.
  • Avoid cutting or sticking themselves with instruments contaminated by the patient's blood or other tissues.
  • Use disposable bedclothes and other cloth for contact with the patient.  If disposable materials are not available, regular cloth should be soaked in undiluted chlorine bleach for an hour or more, and then washed in a normal fashion after each use.
  • Use face protection if there is a risk of splashing contaminated material such as blood or cerebrospinal fluid.
  • Soak instruments that have come in contact with the patient in undiluted chlorine bleach for an hour or more, then use an autoclave (pressure cooker) to sterilize them in distilled water for at least one hour at 132-134 degrees Centigrade.
Here are some additional resources on CJD infection control and prevention:

 

Phenelle Segal, RN, CIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.

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