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From: TSS ()
Subject: CJD fears over use of second-hand implants for bones
Date: November 12, 2006 at 3:23 pm PST

CJD fears over use of second-hand implants for bones


THOUSANDS of patients who have suffered a broken bone are having their limbs repaired with second-hand screws and plates that may carry dangerous infections such as CJD, Scotland on Sunday can reveal.

Some recycled implants are thought to be 20 years old, even though the equipment is supposed to be used only once.

Chief medical officer Dr Harry Burns has officially warned doctors old implants could carry CJD and may trigger "inflammatory reactions".

He has demanded the scandal be brought to an end, with only new fittings to be used.

The revelation was made in a letter sent by Dr Burns to other health officials, in which he wrote: "Most orthopaedic units in NHS Scotland use screws, small plates and other small orthopaedic implants which have been repeatedly reprocessed."

He goes on: "Concerns have been raised that these implants cannot be properly cleaned and we have photomicroscopic evidence that they retain or acquire organic and/or chemical residues during reprocessing."

Last night, infection control experts slammed the practice, which they claimed was largely due to cash-strapped hospitals preferring to sterilise implants before using them again.

Along with orthopaedics - which covers such operations as hip replacements - the practice of re-using implants has been seen in spinal surgery and maxillofacial surgery, the treatment of the face and jaw.

Health chiefs have yet to find clear evidence a second-hand implant has caused damage to a patient. But they concede such material is probably a factor when complications arise.

Dr Burns told chief executives to inform heads of orthopaedic units, infection control and theatre managers and central decontamination units within 14 days of his letter sent last week. They are being urged to ensure implants are used only once. Some recycled stock has been offered to the Third World.

One centre is thought to have made the switch completely and at least two other centres have moved to new stock for more than 50% of procedures.

Dr Alistair Leanord, an infection control expert at Monklands hospital in Airdrie, condemned what he said was "bad practice", adding: "This cuts across the good work [in reducing risks to patients] that has been going on for the last decade. These bits of kit are not designed to be cleaned."

Dr Leanord said the risk of anyone contracting CJD was minimal and the risk in general surgery was very low. However, he added: "It is a low risk, but it is still a risk."

But a leading Scottish expert said the proposals would make little difference to patients.

Charles Court-Brown, Professor of Orthopaedics at Edinburgh University, said: "We don't re-use screws or anything like that; we use them only once and we sterilise them. The difference being brought in is that the company producing the implants will sterilise them before they send them to us. No one re-uses things implanted in the body."

However, Shona Robison, SNP health spokeswoman, said: "The public are concerned about infection and we want to make sure we can minimise their concerns."

Nanette Milne, for the Scottish Conservatives, said: "If it is now recognised that multi-use is not safe for patients, it is right they are discontinued."

The Executive said there was no evidence of patients being harmed, but it was tightening guidance as a precaution.

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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