Current risk of iatrogenic Creutzfeld–Jakob disease in the UK: efficacy of available cleaning chemistries and reusability of neurosurgical instruments

Hervé, R., Secker, T.J. and Keevil, C.W. (2010) Current risk of iatrogenic Creutzfeld–Jakob disease in the UK: efficacy of available cleaning chemistries and reusability of neurosurgical instruments. Journal of Hospital Infection, 75, (4), 309-313. (doi:10.1016/j.jhin.2010.01.024). (PMID:20451298).


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The initial cleaning of reusable surgical devices is critical to ensure the efficacy of the subsequent sterilisation process. Transmissible spongiform encephalopathies (TSEs) are incurable and fatal neurodegenerative diseases apparently transmitted simply by the absorption or ingestion of self-aggregating protease-resistant prions (PrP(Sc)), which are very resilient to most standard cleaning chemistries and heat-based decontamination techniques. Therefore there is a risk of iatrogenic transmission from reusable surgical devices if these are allowed to retain potentially infectious material after standard reprocessing through sterile service departments (SSDs). We aimed to assess the current state of surgical instrument decontamination with the collaboration of anonymous SSDs. Surgical stainless steel surfaces were spiked with prion-infected brain homogenates, and episcopic differential interference contrast/epifluorescence (EDIC/EF) microscopy was applied to quantify the amount of residual prion amyloid and other proteins remaining after decontamination with enzymatic cleaners currently employed by SSDs. Reusable instruments deemed 'clean and ready to use' were also stained for comparison with our findings in the laboratory. All cleaning chemistries were only partially effective under the recommended conditions. More importantly, PrP(Sc) constituted the main fraction of the remaining contamination left on these surfaces. The neurosurgery instruments also harboured amyloid and general protein contamination. This study shows that currently marketed cleaning chemistries and recent decontamination protocols do not completely suppress the threat from iatrogenic CJD. These findings should be taken into account for risk assessment purposes and re-evaluating instrument handling and decontamination practices.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1016/j.jhin.2010.01.024
ISSNs: 0195-6701 (print)
Keywords: creutzfeld-jakob disease, risk assessment, sterilisation, surgical instruments
Subjects: Q Science > QR Microbiology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RB Pathology
Divisions : Faculty of Natural and Environmental Sciences > Biological Sciences
ePrint ID: 209303
Accepted Date and Publication Date:
August 2010Published
6 May 2010Made publicly available
Date Deposited: 31 Jan 2012 12:01
Last Modified: 31 Mar 2016 13:49

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