Effects on instruments of the World Health Organization–recommended protocols for decontamination after possible exposure to transmissible spongiform encephalopathy–contaminated tissue

Abstract

It has been recommended by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) that rigorous decontamination protocols be used on surgical instruments that have been exposed to tissue possibly contaminated with CreutzfeldtJakob disease (CJD). This study was designed to examine the effects of these protocols on various types of surgical instruments. The most important conclusions are: (1) autoclaving in 1N NaOH will cause darkening of some instruments; (2) soaking in 1N NaOH at room temperature damages carbon steel but not stainless steel or titanium; (3) soaking in chlorine bleach will badly corrode gold-plated instruments and will damage some, but not all, stainlesssteel instruments, especially welded and soldered joints. Damage became apparent after the first exposure and therefore long tests are not necessary to establish which instruments will be damaged.

Efficacy of humidity retention bags for the reduced adsorption and improved cleaning of tissue proteins including prion-associated amyloid to surgical stainless steel surfaces

“…Strong alkali solutions such as sodium hydroxide or sodium hypochlorite can eliminate PrP Sc infectivity. However, as they also damage the surgical surfaces and washer/disinfectors they are not a suitable solution (McDonnell & Burke 2003;Brown et al 2005;Lipscomb et al 2006a;Stephenson 2007). The transmission of infectious prions from contaminated surgical SS surfaces was identified in humans and primates, and has been confirmed in both animal and cell-based bioassays, demonstrating the risk of Iatrogenic Creutzfeldt-Jakob disease (iCJD) from poorly decontaminated surgical surfaces (Flechsig et al 2001;Yan et al 2004;Edgeworth et al 2009).…”

Tissue Safety in View of CJD and Variant CJD

“…No data exist on the possibility to acquire vCJD. In a number of countries countermeasures have been introduced to reduce the risk of nosocomial transmission of human TSE Brown et al 2005). In addition, experimental efforts were made to improve the decontamination and sterilisation methods of surgical instruments (Darbord 1999;Fichet et al 2004;Lemmer et al 2004).…”

Disinfection and Sterilization of Prion-Contaminated Medical Instruments

“…ber (Brown and Merritt 14 and Brown et al 15 ). Until more robust data about reliable inactivation of TSE infectivity become available, it remains prudent to use the more stringent decontamination methods shown in Table 1 to inactivate prions on contaminated surgical instruments.…”