Search

The prevalence of variant Creutzfeldt-Jakob disease (vCJD) in the population remains uncertain, although it has been estimated that 1 in 2000 people in the United Kingdom are positive for abnormal prion protein (PrPTSE) by a recent survey of archived appendix tissues. The prominent lymphotropism of vCJD prions raises the possibility that some surgical procedures may be at risk of iatrogenic vCJD transmission in healthcare facilities. It is therefore vital that decontamination procedures applied to medical devices before their reprocessing are thoroughly validated. A current limitation is the lack of a rapid model permissive to human prions. Here, we developed a prion detection assay based on protein misfolding cyclic amplification (PMCA) technology combined with stainless-steel wire surfaces as carriers of prions (Surf-PMCA). This assay allowed the specific detection of minute quantities (10-8 brain dilution) of either human vCJD or ovine scrapie PrPTSE adsorbed onto a single steel wire, within a two week timeframe. Using Surf-PMCA we evaluated the performance of several reference and commercially available prion-specific decontamination procedures. Surprisingly, we found the efficiency of several marketed reagents to remove human vCJD PrPTSE was lower than expected. Overall, our results demonstrate that Surf-PMCA can be used as a rapid and ultrasensitive assay for the detection of human vCJD PrPTSE adsorbed onto a metallic surface, therefore facilitating the development and validation of decontamination procedures against human prions.

Potential Creutzfeldt-Jakob disease instrument-contamination events continue to occur, causing widespread hospital and patient concern. We propose the use of a combination of diagnostic tests (ie, spinal fluid for 14-3-3 protein or nasal brushing for misfolded prion protein) and instrument handling procedures (ie, using a regional set of dedicated instruments), which if applied to all patients admitted with symptoms of either dementia or cerebellar disease, should eliminate the risk of iatrogenic instrument infection.

Reusable surgical instruments provide a potential route for the transmission of pathogenic agents between patients in healthcare facilities. As such, the decontamination process between uses is a vital component in the prevention of healthcare-associated infections. This article reviews reported outbreaks and incidents associated with inappropriate, inadequate, or unsuccessful decontamination of surgical instruments, indicating potential pitfalls of decontamination practices worldwide. To the author's knowledge, this is the first review of surgical instrument decontamination failures. Databases of medical literature, Medline and Embase, were searched systematically. Articles detailing incidents associated with unsuccessful decontamination of surgical instruments were identified. Twenty-one articles were identified reporting incidents associated with failures in decontamination. A large proportion of incidents involved the attempted disinfection, rather than sterilization, of surgical instruments (43% of articles), counter to a number of national guidelines. Instruments used in eye surgery were most frequently reported to be associated with decontamination failures (29% of articles). Of the few articles detailing potential or confirmed pathogenic transmission, Pseudomonas aeruginosa and Mycobacterium spp. were most represented. One incident of possible variant Creutzfeldt-Jakob disease transmission was also identified. Limitations of analysing only published incidents mean that the likelihood of under-reporting (including reluctance to publish failure) must be considered. Despite these limitations, the small number of articles identified suggests a relatively low risk of cross-infection through reusable surgical instruments when cleaning/sterilization procedures are adhered to. The diverse nature of reported incidents also suggests that failures are not systemic., (Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Cases of the new variant Creutzfeldt-Jakob disease (vCJD) in human beings have to be anticipated in Germany. In subclinical vCJD, the accumulation of prions in lymphoid tissue has been identified prior to their manifestation in cerebral tissue. The remarkable resistance of prions to standard methods of sterilisation questions the safety of reusing metallic surgical instruments. The transmission of vCJD via such reusable surgical instruments in tonsillectomies and adenoidectomies cannot be excluded. In this study, 96 tonsillectomies and adenoidectomies were performed with disposable instruments made of a high performance polymer (Aesculap, Tuttlingen). No increase in the number of intra- or postoperative complications was evident. These disposable instruments may represent an alternative to reusable metallic surgical instruments in potentially infected patients or in patients desiring the use of disposable instruments during their operation for safety reasons.

The Creutzfeldt-Jakob disease (CJD) belongs to the so-called prion diseases or transmissible spongiform encephalopathies. The iatrogenic transmission of the pathogen by direct contact with infectious tissue, tissue extracts and surgical instruments has been demonstrated. CJD is not an infectious disease in the usual sense. Transmission is not possible by normal social contact nor by nursing measures just as CJD can not be transferred by normal skin contact or contact with blood, serum or other patient' secretions. Therefore, CJD patients do not have to be isolated, because strict conformity to the generally recognized rules of hygiene is completely sufficient. The high resistance of prions to environmental influences requires the combination of different disinfection and sterilization measures before inactivation of the pathogen occurs and it is possible to exclude transmission by medical products.

Purpose of Review: Prion diseases such as Creutzfeldt-Jakob disease represent a unique infection control problem because prions exhibit an unusual resistance to conventional chemical and physical decontamination methods. This paper reviews the recent literature and provides recommendations for the prevention of nosocomial transmission of prion agents., Recent Findings: Recommendations to prevent the cross-transmission of infection from medical devices potentially contaminated with prions have been based primarily on prion inactivation studies. Newer recommendations consider inactivation data, but also use epidemiological studies of prion transmission, the infectivity of human tissues, and the efficacy of removing microbes by cleaning. Prion-specific disinfection/sterilization is required in only limited settings. Healthcare workers are not at risk of acquiring transmissible spongiform encephalopathies. Blood or blood products have not been demonstrated to be vehicles for transmission., Summary: On the basis of scientific data, only critical (e.g. surgical instruments) and semicritical devices contaminated with high-risk tissue (i.e. brain, spinal cord, eye) from high-risk patients (e.g. with known or suspected Creutzfeldt-Jakob disease) require special treatment.

Objectives: Breaking the skin when applying scalp electroencephalographic (EEG) electrodes creates the risk of infection from blood-born pathogens such as HIV, Hepatitis-C, and Creutzfeldt-Jacob Disease. Modern engineering principles suggest that excellent EEG signals can be collected with high scalp impedance ( approximately 40 kOmega) without scalp abrasion. The present study was designed to evaluate the effect of electrode-scalp impedance on EEG data quality., Methods: The first section of the paper reviews electrophysiological recording with modern high input-impedance differential amplifiers and subject isolation, and explains how scalp-electrode impedance influences EEG signal amplitude and power line noise. The second section of the paper presents an experimental study of EEG data quality as a function of scalp-electrode impedance for the standard frequency bands in EEG and event-related potential (ERP) recordings and for 60 Hz noise., Results: There was no significant amplitude change in any EEG frequency bands as scalp-electrode impedance increased from less than 10 kOmega (abraded skin) to 40 kOmega (intact skin). 60 Hz was nearly independent of impedance mismatch, suggesting that capacitively coupled noise appearing differentially across mismatched electrode impedances did not contribute substantially to the observed 60 Hz noise levels., Conclusions: With modern high input-impedance amplifiers and accurate digital filters for power line noise, high-quality EEG can be recorded without skin abrasion.

Creutzfeldt-Jakob Disease (CJD) is an infectious, progressive, degenerative neurological disorder. Unique CJD Precautions must be adhered to as the infectious agent is difficult to destroy. A regional group in Hamilton-Burlington Ontario developed CJD guidelines based on critical review of the current evidence of transmission in a Canadian healthcare environment, current published standards of practice in North America, the United Kingdom and Australia; and principles of laboratory and patient care safety as well as expert opinion.

Patients with infectious diseases have special implications for infection control in the operating room. The increased use and abuse of antibiotics has ushered in a category of resistant organisms. These multiresistant organisms are spread by direct or indirect contact, primarily from the hands of caregivers or contact with contaminated environmental surfaces. Another category of infectious diseases is prions (pronounced pree-ons). Unlike other infectious diseases, human prions diseases are not spread through routine exposures such as direct contact, droplet, and airborne routes. The causative agent is highly resistant to traditional disinfecting and sterilization processes. This article provides an overview of the multiresistant infections of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Staphylococcus aureus with reduced susceptibility to vancomycin along with the human prions diseases Creutzfeldt-Jakob disease, German-Straüssler-Scheinker syndrome, kuru, and fatal familial insomnia. We provide a template of precautions that can be used in developing operating room and anesthesia infection control protocols for this patient population.

Safety of endoscopic procedures has been a major issue over the last 10 years. Outbreak of new infectious diseases (type C) hepatitis, Creutzfeldt-Jakob disease) underlines the necessity for strengthening cleaning and disinfection guidelines. Patients should be ensured that all endoscopic procedures are carried out with high-level disinfection endoscopes and with sterile or single-use accessories. Improvements from a hygienic point of view of both endoscopes and washer-disinfectors are important goals for manufacturers. Adequate training of endoscopic staff is one of the most crucial points to achieve the highest quality control standards in digestive endoscopy.

This communication is the third in a four-part series on nosocomial viral infections from the Strong Memorial Hospital. This third article discusses guidelines for prevention and control of exanthematous viruses, gastroenteritis, viruses, adenoviruses and the picornaviruses other than rhinoviruses. Several uncommonly seen viruses, such as the virus of Creutzfeldt-Jakob disease and Marburg, Ebola, and Lassa fever viruses, also are reviewed briefly.

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, fatal disease of the central nervous system. Premortem diagnosis may or may not be conclusive. Because the etiologic agent is virulent, definition of necessary precautions for medical staff associated with such patients is needed. Transmission of CJD in animals has been found to occur after inoculation with brain, spinal cord, liver, kidney, lung, and lymph node tissues in diminishing frequency. Effective methods of sterilization and disinfection for the etiologic agent are unknown. Thus, personnel associated with supposed-CJD patients should take precautions not unlike needle precautions for hepatitis B patients. A list of guidelines is given.