Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments
In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that...
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Published in | The Journal of hospital infection Vol. 100; no. 3; pp. e70 - e76 |
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Main Authors | , , , , , , , , |
Format | Journal Article |
Language | English |
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England
Elsevier Ltd
01.11.2018
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Abstract | In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5 μg protein per instrument side.
To quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning.
Two instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets.
ProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5 μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive.
Although we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored. |
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AbstractList | In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5 μg protein per instrument side.
To quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning.
Two instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets.
ProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5 μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive.
Although we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored. BACKGROUNDIn all, there have been 178 variant Creutzfeldt-Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on archived appendix and tonsil tissue, implying that infection may be rare but carriage relatively frequent. Previous workers have identified that maintenance of surgical instruments in a humid atmosphere after use and prior to cleaning assists cleaning efficacy. Recently the Department of Health/Advisory Committee on Dangerous Pathogens UK have recommended a surgical instrument cleanliness threshold post cleaning of <5 μg protein per instrument side. AIMTo quantify cleanliness of neurosurgical instruments and to investigate cost-effective measures for improved cleaning. METHODSTwo instrument protein quantification methods were used: one based on the International Standard (15883 series) using sodium dodecyl sulphate elution and ortho-phthalaldehyde reaction, and a second in-situ protein fluorescence detection system (ProReveal) providing results per instrument side. In-vitro investigation of the efficacy of some commercial and in-house pre-clean wetting agents was undertaken using artificial test soil and stainless steel discs under standard conditions. In-vivo evaluation of best-performing in-vitro agents was undertaken on craniotomy sets. FINDINGSProReveal technology demonstrated that 163 out of 187 (87%) neurosurgical instruments had <5 μg residual protein per instrument side. The use of proprietary National Health Service plastic bags and sterile water-soaked wound pads were equivalent in efficacy to commercial pre-cleaning wetting products and significantly less expensive. CONCLUSIONAlthough we demonstrate low in-situ protein levels on neurosurgical instruments and the beneficial effects of keeping instruments moist, other cleaning critical-control points such as instrument loading patterns should also be monitored. |
Author | Lappin, D. Sherriff, A. Philp, P. Stewart, A. McIvor, I. Holmes, S. Smith, A. Winter, S. Suttner, N. |
Author_xml | – sequence: 1 givenname: A. surname: Smith fullname: Smith, A. email: andrew.smith@glasgow.ac.uk organization: College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK – sequence: 2 givenname: S. surname: Winter fullname: Winter, S. organization: College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK – sequence: 3 givenname: D. surname: Lappin fullname: Lappin, D. organization: College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK – sequence: 4 givenname: A. surname: Sherriff fullname: Sherriff, A. organization: College of Medical, Veterinary and Life Sciences, Glasgow Dental Hospital and School, University of Glasgow, Glasgow, UK – sequence: 5 givenname: I. surname: McIvor fullname: McIvor, I. organization: Cowlairs Sterile Service Department, NHS Greater Glasgow and Clyde, Glasgow, UK – sequence: 6 givenname: P. surname: Philp fullname: Philp, P. organization: Neurosurgery Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK – sequence: 7 givenname: N. surname: Suttner fullname: Suttner, N. organization: Neurosurgery Unit, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK – sequence: 8 givenname: S. surname: Holmes fullname: Holmes, S. organization: Health Facilities Scotland, NHS National Services, Glasgow, UK – sequence: 9 givenname: A. surname: Stewart fullname: Stewart, A. organization: Cowlairs Sterile Service Department, NHS Greater Glasgow and Clyde, Glasgow, UK |
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Cites_doi | 10.3201/eid1806.120116 10.1016/j.jhin.2011.03.021 10.1002/path.1580 10.1007/BF01310794 10.1016/j.jhin.2006.02.015 10.1016/j.jhin.2006.03.011 10.1136/bmj.f5675 10.1016/j.jhin.2005.01.021 10.1016/j.jhin.2006.09.025 |
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Keywords | Risk reduction Neurosurgical instruments Automated washer-disinfector Cleaning Pre-cleaning Creutzfeldt–Jakob disease |
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Snippet | In all, there have been 178 variant Creutzfeldt–Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on... In all, there have been 178 variant Creutzfeldt-Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate based on... BACKGROUNDIn all, there have been 178 variant Creutzfeldt-Jakob disease (vCJD) patients diagnosed in the UK, with an estimated maximum 1:2000 carriage rate... |
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SubjectTerms | Automated washer-disinfector Cleaning Creutzfeldt-Jakob Syndrome - epidemiology Creutzfeldt-Jakob Syndrome - prevention & control Creutzfeldt–Jakob disease Decontamination - economics Decontamination - methods Humans Iatrogenic Disease - epidemiology Iatrogenic Disease - prevention & control Infection Control - economics Infection Control - methods Neurosurgical instruments Pre-cleaning Proteins - analysis Risk reduction Surgical Instruments United Kingdom - epidemiology |
Title | Reducing the risk of iatrogenic Creutzfeldt–Jakob disease by improving the cleaning of neurosurgical instruments |
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