Procedures should be in place and
clinicians instructed to segregate instruments contaminated by High
Risk, Low Risk and No Risk body tissue from CJD patients.
• High Risk Tissue contamination would be those instruments which
have come in contact with spinal cord, brain matter, and or eye
tissue.
• Low Risk Tissue contamination includes devices which have been in
contact with cerebrospinal fluids, kidney, spleen, liver, lungs, or
lymph nodes.
• No Risk tissue includes intestinal tissue, blood, serum,
leukocytes, adrenal gland, thyroid gland, peripheral nerve tissue, and
bone marrow.
As in all cases, soiled and contaminated instruments should be kept
moist to prevent the coagulation and drying of organic matter, blood,
proteins and other body fluids. It is also very important that soiled
instruments be cleaned as soon as possible. OSHA protocols relative to
the safe handling and transportation of bio hazardous materials must
be enforced including the application and appropriate use of PPE.
In known CJD cases medical devices which have come in contact with
or are contaminated by high risk tissues must be carefully handled
from the point of use through the contamination process. Non complex
basic instruments which can be cleaned effectively to remove tissue
should then be sterilized at 134°C for a minimum of 18 minutes in a
pre vac sterilizer or in a gravity displacement sterilizer at 121°C -
132°C for one hour.
Complex medical devices, e.g. those with movable or multiple parts
which can not be disassembled, cleaned effectively or pose a challenge
to the cleaning process should be discarded. Alternatively such
devices can be placed in a container of water or phenolic solution to
prevent the adherence of organic soil and decontaminated by a pre
vacuum steam sterilization process at 134°C for a minimum of 18
minutes or at 121°C - 132°C in a gravity displacement sterilizer
(solution should be removed prior to sterilization) or the device may
be soaked in a solution of NaON (lye) for one hour. The device may
then be cleaned, wrapped and terminally sterilized in the conventional
manner. It is important to note that NaON solutions should not be
placed in a sterilizer as this would pose a risk to employee safety,
and would be extremely damaging to instruments and the sterilizer.
Power equipment such as saws and drills should not be used in
procedures where they are likely to be contaminated by high risk
tissue. These devices by design are difficult to clean and too
expensive to discard.
The safest method for ensuring that there is no risk of residual
CJD infectivity on contaminated instruments and other materials is to
destroy them by incineration. Disposable instrument sets appropriate
for use on CJD procedures are commercially available and should be
used accordingly.
Medical devices and surgical instruments contaminated through
contact with low risk or no risk tissue can be reprocessed, cleaned,
decontaminated, disinfected and sterilized using conventional
protocols. As is the case in all matters of reprocessing and
sterilization the device manufacturer’s instructions for care,
handling and reprocessing should be followed. A tracking system -
either a computerized or manual system - should be in place which
could identify medical devices used in high risk cases and the patient
such devices were utilized on. Tracking information should also
include the date and type of procedure performed and the surgeon’s
name.
