VARIANT CREUTZFELDT-JAKOB DISEASE (vCJD) AND ...

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PAT/IC 4 v.3 all their detachable components, to be traced to the patients on whom they have been used. Endoscopes used for certain procedures in the CNS and nasal cavity in individuals with CJD/vCJD, or in whom the diagnosis is unclear, should be removed from use or quarantined pending diagnosis. Endoscopes , other than those used in the CNS and nasal cavity, which have been used for invasive procedures in individuals with or at risk of vCJD should be removed from use or quarantined to be re-used exclusively on the same individual if required. The principles for quarantining surgical instruments should be followed, except the endoscope should be fully cleaned and decontaminated, alone using an automated endoscope reprocessor (AER), immediately after use. For For further advice and a list of common flexible endoscopic procedures classified as invasive or non-invasive, see “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” – Annex F. Endoscopy for inspection, in the absence of an invasive procedure, is deemed to be of low risk, providing decontamination of the endoscope is to approved standards. Aldehyde disinfectants with fixative qualities (such as glutaraldehyde and OPA) tend to stabilise rather than inactivate prions and should not be employed on flexible endoscopes used for any procedure on patients with, or at risk of CJD/vCJD. Following decontamination of the endoscope the automated endoscope reprocessor (AER) should be run through an empty cycle. Any solid waste remaining in the AER should be removed together with the outlet strainer and disposed of by incineration. Liquid waste should be disposed of safely by normal direct discharge from the AER. The usual selfdisinfect cycle should be run as per recommended routine. Endoscopic accessories and cleaning aids such as brushes should be disposed of by incineration. viii) Transrectal prostatic biopsy in men at risk of variant CJD Patients at risk of vCJD requiring transrectal biopsy should have the procedure performed by means of single use equipment that runs alongside (rather than through) the ultrasound probe. If the procedure is undertaken with equipment that has internal biopsy channels, the reusable components should be quarantined after decontamination. It must be accepted that this equipment would be unlikely to return to general use, except for dedicated re-use in the same patient. For further advice see “Alert to Urological Surgeons: Transrectal Prostatic Biopsy in Men at Risk of variant CJD” Page 18 of 22
PAT/IC 4 v.3 Table 5. Summary of precautions advised for use of endoscopes Adapted from “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” – Annex F. Department of Health Jan 2010 Tissue infectivity High • Brain • Spinal cord Medium • Olfactory epithelium 2 • Lymphoid tissue 3 (vCJD only) Status of patient Symptomatic Definite/ Possible/ probable diagnosis unclear Single use or Quarantine 1 pending diagnosis Single use or Destroy after use Single use or Destroy after use Low/none detectable • All other tissues 4 No special precautions Single use or Quarantine 1 pending diagnosis No special precautions Asymptomatic At risk iatrogenic/familial Single use or Destroy after use or Quarantine for re-use exclusively on same patient Single use or Destroy after use or Quarantine for re-use exclusively on same patient No special precautions 1 The endoscope should be fully cleaned and decontaminated (alone using an AER) immediately after use and quarantined as for surgical instruments (see above). Following decontamination, the quarantined endoscope may be re-used exclusively on the same individual patient if required. If further clarification of the diagnosis is not possible, the endoscope should be removed from use. 2 The advice of the consultant carrying out endoscopic procedure in the nasal cavity should be sought to determine whether a risk of contamination with olfactory epithelium can be excluded with confidence. If such contamination cannot be excluded, take precautions appropriate for medium infectivity tissue. 3 Lymphoid tissue refers to spleen, thymus, tonsils, adenoids, lymph nodes, appendix and gastrointestinal tract sub-mucosa. 4 For patients with, or at risk of, vCJD: For all other types of endoscopy, providing decontamination of the endoscope is to approved standards, the use of the instrument for inspection in the absence of invasive procedures is deemed to be a low risk procedure. If a biopsy or other invasive procedure is carried out, the possibility of contamination of the instrument channel with lymphoid tissue means the endoscope should be quarantined pending assessment of likely contact with potentially infected tissue. See “Transmissible spongiform encephalopathy agents : Safe working and the prevention of infection” – Annex F. Department of Health and “Endoscopy and individuals at risk of vCJD for public health purposes” A consensus statement from the British Society of Gastroenterology Decontamination Working Group and the ACDP TSE Working Group Endoscopy and vCJD Subgroup for further advice and details of invasive procedures. Page 19 of 22
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