Isolation of Patients With CJD or vCJD
Standard Precautions are recommended when caring for patients with Creutzfeldt-Jakob disease (CJD), new-variant CJD (vCJD), or other unexplained rapidly progressive dementias (see Guidelines: Centers for Disease Control and Prevention/Healthcare Infection Control Practices Advisory Committee [CDC/HICPAC] Guidelines for Isolation Precautions in Hospitals). In addition, the CDC/HICPAC guidelines recommend that special precautions are necessary for handling and decontamination of blood, body fluids, and tissues from patients with confirmed or suspected disease according to recommendations from the College of American Pathologists (CAP). Those recommendations are included in the following section, Handling Tissue From Patients With Possible CJD. Private rooms for patients with CJD or vCJD are not necessary because the CJD agent is generally not transmitted from person to person.
Patients with known or suspected CJD should not donate blood, organs, or human tissue for preparation of biologic products to be used in humans (eg, dura mater, pituitary hormones, and human interferon).
Sterilization and Cleaning of Equipment
The data outlining appropriate measures for decontamination of equipment following potential exposure to the CJD agent are somewhat limited, and best practices have yet to be agreed on. However, current recommendations from several agencies/organizations are presented below.
According to the Association for Professionals in Infection Control and Epidemiology (APIC) Guideline for Selection and Use of Disinfectants (see Guidelines), items potentially contaminated with the CJD agent require unique decontamination procedures. The APIC recommendations include the following:
- Contaminated material should undergo steam sterilization for at least 1 hour at 132°C.
- When autoclaving of critical and semicritical items is not possible, immersion in 1N NaOH for 1 hour at room temperature is an alternative procedure.
- Noncritical patient care items or surfaces (eg, autopsy tables, floors) may be disinfected with either bleach (undiluted or up to 1:10 dilution) or 1N NaOH at room temperature for 15 minutes or less.
- Single-use items and instruments that are impossible to clean should be discarded.
Similar recommendations are available from the Centers for Disease Control and Prevention's Hospital Infections Program (CDC/HIP) (see Guidelines):
- Steam autoclave for 1 hour at 132°C.
- Immerse in 1N NaOH for 1 hour at room temperature.
- Immerse in 0.5% NaOH for 2 hours at room temperature.
The HIP website indicates that the recommendations are under revision at this time. The revised recommendations will be included here when they are available.
The World Health Organization (WHO) Report of a WHO Consultation on Medicinal and Other Products in Relation to Human and Animal Transmissible Spongiform Encephalopathies states the following with regard to preventing transmission of the CJD agent from contaminated instruments (see Guidelines):
- It is strongly recommended that instruments used for neurosurgical and invasive ophthalmologic procedures on patients with CJD be discarded.
- If instruments are to be reused, they should be immersed in 1N NaOH for 1 hour, cleaned, and then autoclaved at 134°C for 1 hour.
Pete Bobb
|