CJD Section from CDC Draft

CJD Section from CDC Draft

The Centers for Disease Control and Prevention’s new draft sterilization recommendations on Creutzfeldt-Jakob disease (CJD) include the following excerpt, which is numbered as it was in the draft version. Please consult the entire document for complete information at www.cdc.gov/ncidod/hip/dsguide.htm.

9. Processing CJD-Contaminated Patient-Care Equipment and Environmental Surfaces

a. The following recommendations should be used with high-risk tissues (defined as brain [including dura mater], spinal cord, and eyes) from high-risk patients (e.g., those with known or suspected CJD) and with critical/semicritical items. Category IB [Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.]

1. Those devices (e.g., surgical instruments) constructed so that cleaning procedures result in effective tissue removal can be cleaned and then sterilized by autoclaving either at 134 degrees C for > 18 minutes in a prevacuum sterilizer or at 121 degrees C to 132 degrees C for 1 hour in a gravity displacement sterilizer. Category IB

2. Those devices that are impossible or difficult to clean could be discarded. Alternatively, contaminated items could be placed in a container filled with a liquid (e.g., saline, water, or phenolic solution) to retard adherence of material to the medical device, followed by initial decontamination by autoclaving at 134 degrees C for 18 minutes in a prevacuum sterilizer (liquids must be removed before sterilization), or 121 degrees C to 132 degrees C for 1 hour in a gravity displacement sterilizer, or soaking in 1N NaOH for 1 hour. Finally, terminal cleaning, wrapping, and sterilization by conventional means would be used. Category IB

3. To minimize drying of tissues and body fluids on the object, keep instruments moist until cleaned and decontaminated. Category IB

4. Flash sterilization should not be used for reprocessing. Category IB

5. Items that permit only low-temperature sterilization (e.g., ETO, hydrogen peroxide gas plasma) should be discarded. Category IB

6. Contaminated items that have not been processed according to these recommendations (e.g., medical devices used for brain biopsy before diagnosis) should be recalled and appropriately reprocessed. Category II (Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale)

7. To minimize patient exposure to neurosurgical instruments later determined to have been used on a CJD patient, hospital personnel should consider using the sterilization guidelines above for neurosurgical instruments used on patients undergoing brain biopsy when a specific lesion has not been demonstrated (via computerized tomography or magnetic resonance imaging). Alternatively, neurosurgical instruments used in such patients could be disposable. Category IB

8. Environmental surfaces (noncritical) contaminated with high-risk tissues (e.g., laboratory surface in contact with brain tissue of a CJD-infected person) should be cleaned with a detergent and then spot decontaminated with a 1:10 dilution of sodium hypochlorite (i.e., bleach). In order to minimize environmental contamination, disposable cover sheets could be used on work surfaces. Category IB

9. Noncritical equipment contaminated with high-risk tissue should be cleaned and then disinfected with a 1:10 dilution of sodium hypochlorite or 1N NaOH, depending on material compatibility. All contaminated surfaces must be exposed to the disinfectant. Category IB

10. Equipment that requires special prion reprocessing should be tagged after use. Clinicians and reprocessing technicians should be thoroughly trained on how to properly tag the equipment and on the special prion reprocessing protocols. Category IB

b. The following recommendations should be used with low-risk tissues (defined as cerebrospinal fluid, kidney, liver, spleen, lung, and lymph nodes) from high-risk patients and critical/semicritical medical device. Category IB

1. These devices can be cleaned and disinfected or sterilized using conventional protocols of heat or chemical sterilants or high-level disinfection. Category IB

2. Environmental surfaces contaminated with low-risk tissues require only standard disinfection (use disinfectants recommended by the Occupational Safety and Health Administration (OSHA) for disinfecting blood-contaminated surfaces). Category IB.

c. The following recommendation should be used with no-risk tissue (defined as peripheral nerve, intestine, bone marrow, blood, leukocytes, serum, thyroid gland, adrenal gland, heart, skeletal muscle, adipose tissue, gingiva, prostate, testis, placenta, tears, nasal mucus, saliva, sputum, urine, feces, semen, vaginal secretions, milk) from high-risk patients and critical/semicritical medical devices. Category IB

1. These devices can be cleaned and disinfected or sterilized using conventional protocols of heat or chemical sterilization or high-level disinfection. Category IB

2. Endoscopes (except neurosurgical endoscopes) would be contaminated only with no-risk materials and hence standard cleaning and high-level disinfection protocols would be adequate for reprocessing. Category IB

3. Environmental surfaces contaminated with no-risk tissues or fluids require only standard disinfection (use disinfectants recommended by OSHA for decontaminating blood-contaminated surfaces, e.g.,1:10 to 1:100 dilution of 6% sodium hypochlorite). Category IB