How to Process an Instrument Infected by CJD

Creutzfeldt-Jakob disease (CJD) is caused by a proteinacous infectious agent or prion, report Professor William Rutala and Dr. David Weber of the University of North Carolina. A CJD variant is bovine spongiform encephalopathy or mad cow disease. In a minority of cases, CJD has been transmitted through contaminated medical equipment. CJD prions are extremely resistant to conventional disinfection and sterilization methods.



The Society for Healthcare Epidemiology (SHEA) guidelines concerning CJD-infected instruments are still evolving. Current protocol consists of using disposable surgical instruments, discarding CJD-infected equipment, incinerating equipment and sterilizing instruments with steam or sodium hydroxide, report Rutala and Weber.

Things You'll Need

• Mechanical washer
• Prioncidal detergent
• Prevacuum or gravity displacement sterilizer
• Sodium hydroxide

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Instructions

• 1

  Instruments should be kept wet until they are decontaminated.

  Keep medical equipment wet until it is decontaminated because dried tissue is more resistant to sterilization. Immerse instruments in water or prioncidal detergent. If immersion is not possible, cover the instrument with gel, foam or a wet cloth.

• 2

  Equipment should be run through a mechanical washer.

  Clean CJD-infected instruments in a mechanical washer as soon as possible after use. Use a detergent proven to inactivate prions.

• 3

  Steam can inactivate prions.

  Sterilize the medical equipment through steam sterilization or sodium hydroxide solution. CJD-infected instruments can be steam sterilized in a prevacuum sterilizer for 18 minutes at 134 degrees Celsius or in a gravity displacement sterilizer for one hour at 132 degrees Celsius.

  The sodium hydroxide (NaOH) solution used to disinfect medical equipment consists of 40 grams of NaOH per liter of water. Immerse the instruments in this solution for one hour, remove and rinse them, and then place the equipment into a gravity displacement sterilizer at 121 degrees Celsius or into a porous or prevacuum sterilizer at 134 degrees Celsius for one hour.

  The fourth option for disinfecting the instruments is to soak them in NaOH solution for one hour, place them in a gravity displacement sterilizer at 121 degrees Celsius for 30 minutes, and then clean and subject them to routine sterilization.

• 4

  Disposable instruments are preferable.

  Discard any medical devices that cannot be adequately cleaned or fully exposed to steam sterilization. Discard single-use devices. Do not use flash sterilization to re-use CJD-infected instruments. Discard medical equipment that will only tolerate low-temperature sterilization. Recall any brain biopsy instruments used in the past that have not been sterilized according to the SHEA protocol.

• 5

  A tracking system can help in recalls of contaminated equipment.

  Clean work surfaces and spot-decontaminate with a hypochlorite solution diluted in a 1:5 or 1:10 ratio or the NaOH solution, allowing the disinfectant to remain on the surface for 15 minutes. The EPA has issued some states quarantine exemptions that permit the use of phenolic cleanser for nonporous surfaces in laboratories.