Current risk of iatrogenic Creutzfeld–Jakob disease in the UK: efficacy of available cleaning chemistries and reusability of neurosurgical instruments
Current risk of iatrogenic Creutzfeld–Jakob disease in the UK: efficacy of available cleaning chemistries and reusability of neurosurgical instruments
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.
creutzfeld-jakob disease, risk assessment, sterilisation, surgical instruments
309-313
Hervé, R.
9baddc65-93cf-4a18-9388-088d60572b06
Secker, T.J.
16b0a878-984f-4272-bfaa-667c7c63023a
Keevil, C.W.
cb7de0a7-ce33-4cfa-af52-07f99e5650eb
August 2010
Hervé, R.
9baddc65-93cf-4a18-9388-088d60572b06
Secker, T.J.
16b0a878-984f-4272-bfaa-667c7c63023a
Keevil, C.W.
cb7de0a7-ce33-4cfa-af52-07f99e5650eb
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), .
(doi:10.1016/j.jhin.2010.01.024).
(PMID:20451298)
Abstract
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.
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e-pub ahead of print date: 6 May 2010
Published date: August 2010
Keywords:
creutzfeld-jakob disease, risk assessment, sterilisation, surgical instruments
Organisations:
Centre for Biological Sciences
Identifiers
Local EPrints ID: 209303
URI: http://eprints.soton.ac.uk/id/eprint/209303
ISSN: 0195-6701
PURE UUID: 4a7788c1-6b43-42e3-a90c-5d422e08bb67
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Date deposited: 31 Jan 2012 12:01
Last modified: 15 Mar 2024 03:17
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