Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments

Smith, A. , Winter, S., Lappin, D., Sherriff, A. , McIvor, I., Philp, P., Suttner, N., Holmes, S. and Stewart, A. (2018) Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments. Journal of Hospital Infection, 100(3), e70-e76. (doi: 10.1016/j.jhin.2018.03.001) (PMID:29530742)

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Background: In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5 μg protein per instrument side. Aim: To quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning. Methods: Two instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets. Findings: ProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5 μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive. Conclusion: Although we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Sherriff, Professor Andrea and Winter, Ms Sandra and Smith, Professor Andrew and Lappin, Dr David
Authors: Smith, A., Winter, S., Lappin, D., Sherriff, A., McIvor, I., Philp, P., Suttner, N., Holmes, S., and Stewart, A.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
Journal Name:Journal of Hospital Infection
ISSN (Online):1532-2939
Published Online:09 March 2018
Copyright Holders:Copyright © 2018 The Healthcare Infection Society
First Published:First published in Journal of Hospital Infection 100(3):e70-e76
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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