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From: TSS ()
Subject: Hospitals 'fail over vCJD safety' by BBC and BBC fails public, WHAT ABOUT SPORADIC CJD SAFETY???
Date: July 7, 2006 at 6:32 am PST

Friday, 7 July 2006, 13:26 GMT 14:26 UK

Hospitals 'fail over vCJD safety'

Prions cling to surgical equipment
Hospitals are failing to take the necessary safety precautions to stop the spread of fatal infections such as vCJD, NHS advisers say.
The National Institute for Health and Clinical Excellence warned equipment at risk of contamination was being mixed up with other instruments.

NICE said proper records must be kept to ensure sets were maintained together during certain brain and eye surgery.

If this could not done, it recommended the use of disposable equipment.

Some 39 types of brain and eye surgery are covered by the recommendations, which are being consulted on until August.

It is most important that systems are put in place to ensure no instruments are swapped between set in high-risk procedures

NICE spokesman

The draft guidance has been drawn up because of fears over vCJD transmission, the human form of bovine spongiform encephalopathy (BSE), also known as 'mad-cow disease'.

Over 150 people have died from vCJD since 1996.

New rules were introduced six years ago by the Department of Health to improve cleaning, tracing and quarantining of equipment.

They said equipment that is being used must be kept together - to help minimise the risk of future infection and allow equipment to be traced if a patient is diagnosed with an infection later on.

But advisers warned these safety precautions were not being followed as they estimated instruments become mixed up, mostly during the cleaning process, about 50% of the time.

No system of decontamination will yet completely removed the prion proteins associated with vCJD, but high pressure sterilising and brushing does lower the risk. It is not known what the risk of transmission is.

NICE said: "It is most important that systems are put in place to ensure no instruments are swapped between set in high-risk procedures and that the effectiveness of these systems is demonstrated through regular audit."

A Department of Health spokesman said government advice should be followed, adding "bad practice should not happen".

HOW deceiving can you get. sCJD kills much faster than nvCJD and is also 100% fatal. sCJD, NOT nvCJD, has been the only documented human TSE to transmit the agent via surgical instruments to date, to kill, that has been documented. SO, why no mention of the sCJD as being part of this surgical death sentence??? WE must get around this ukbsenvcjd only mentality, and move forward with proper safety protocols for all human and animal TSE.

NOW, for a more accurate arcticle about this, here's one from James Meikle of THE Guardian ;

Surgical instruments may put lives at risk

James Meikle
Friday July 7, 2006
The Guardian

Hospitals are putting lives in danger by failing to implement rules designed to minimise the risk of patients accidentally contracting fatal infections through surgical instruments contaminated in previous operations, NHS advisers reveal.
Surgical teams are failing to keep instruments in sets that can be easily traced if infection does spread in this way, and are swapping pieces of kit between sets.

The consequences could be fatal in high-risk operations such as under the protective lining between skull and brain or on the back of the eye where there are easy routes for spreading neurological disease. More than 50,000 such operations take place in England and Wales each year.

Experts, who want new checks to ensure the rules are not flouted, believe cleaning and decontamination of instruments is also still substandard, despite attempts by the Department of Health to close this avenue of spreading diseases.

It introduced rules to improve cleaning, tracing and quarantining of equipment in 2000, and tightened them in 2003 after a CJD scare at Middlesbrough general hospital. It also encourages the use of disposable instruments where possible. Checks before Middlesbrough suggested that cleaning in the 250 English hospitals with sterile services units was at least acceptable, after earlier spot checks had revealed severe shortcomings. These had also shown problems with tracing equipment, but measures such as bar-coding were meant to bring improvements.

But advisers drawing up draft guidance on preventing cross-infection with CJD diseases found hospitals were still failing to keep separate instrument sets. Their report for the National Institute for Health and Clinical Excellence (Nice), completed last month, said it was "most important that systems are put in place to ensure no instruments are swapped between sets in high-risk procedures and that the effectiveness of these systems is demonstrated through regular audit".

The advisers found limited information on the extent of instrument swapping but that available suggested there was a 50% chance of at least one instrument ending up in a different set after each operation. No system of decontamination will yet completely remove the prion proteins associated with CJD infections but proper cleaning, brushing and high pressure sterilisation can lower infection risks substantially for high-quality instruments not available in disposable form.

Separate instrument sets were also needed for children never exposed to the risk of human BSE through eating meat at the height of the cattle BSE epidemic. Officials are urgently calculating how much the package will cost.

A Department of Health spokeswoman said it took "instrument migration" seriously and had stressed the need for "rigorous implementation" of washing, decontamination and general hygiene, which were now included in the assessment of NHS trusts.

Graham Steel of the CJD Alliance, a group including relatives of patients, said: "It is far from reassuring to learn that in real terms nothing has changed."

Four cases of CJD spread through contaminated surgical instruments have happened in Britain, all over 30 years ago. No similar cases have come to light recently, but there are persistent worries that variant CJD, the human form of BSE, can spread the same way, and that there are thousands of unknowing carriers of the long-incubating disease.,,1814723,00.html

1: J Neurol Neurosurg Psychiatry 1994 Jun;57(6):757-8

Transmission of Creutzfeldt-Jakob disease to a chimpanzee by electrodes contaminated during neurosurgery.

Gibbs CJ Jr, Asher DM, Kobrine A, Amyx HL, Sulima MP, Gajdusek DC.

Laboratory of Central Nervous System Studies, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892.

Stereotactic multicontact electrodes used to probe the cerebral cortex of a middle aged woman with progressive dementia were previously implicated in the accidental transmission of Creutzfeldt-Jakob disease (CJD) to two younger patients. The diagnoses of CJD have been confirmed for all three cases. More than two years after their last use in humans, after three cleanings and repeated sterilisation in ethanol and formaldehyde vapour, the electrodes were implanted in the cortex of a chimpanzee. Eighteen months later the animal became ill with CJD. This finding serves to re-emphasise the potential danger posed by reuse of instruments contaminated with the agents of spongiform encephalopathies, even after scrupulous attempts to clean them.

PMID: 8006664 [PubMed - indexed for MEDLINE]


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