The Frequently Asked Questions below are specifically aimed to provide more information for healthcare workers. Please note, in the following section the "Transmissible Spongiform Encephalopathy agents: safe working and the prevention of infection" guidelines will be referred to as the ACDP TSE Guidance.

General questions
Identification of patients with or at risk of CJD
Advice on CJD infection control in specialist areas
Advice on decontamination
Further information and links

General questions

Where can I find the most recent advice?

The revised ACDP TSE guidance was published in June 2003 to replace the edition issued in 1998. The 2003 guidance continues to be updated by the ACDP TSE Working Group as further scientific information becomes available or future policy decisions need to be reflected. The publication date of each section is given at the foot of every page and any amended sections are clearly marked with the date of revision.

Identification of patients with or at risk of CJD

My patient has told me that he/she has received growth hormone - how do I know if this was pituitary-derived or synthetic growth hormone? Should my patient be considered at risk of CJD for public health purposes?

Recipients of pituitary-derived growth hormone should be regarded as at risk of iatrogenic CJD for public health purposes, as detailed in Table 4a of Part 4 of the guidelines. In the UK, human pituitary-derived growth hormone was banned in 1985 but the use of human-derived products may have continued in other countries. As it is highly unlikely that pituitary-derived growth hormone would have contained the vCJD infectious agent, recipients should be considered as at risk of iatrogenic CJD but not vCJD.

My patient received a dura mater graft - should he/ she be considered at risk of all forms of CJD including vCJD for public health purposes?

Recipients of dura mater should be considered as at risk of iatrogenic CJD but not vCJD. Dura mater grafts were discontinued in August 1992 and the first case of vCJD was identified in 1996 in the UK and reported later in other countries. It is therefore very unlikely that the dura mater graft would have contained the vCJD infectious agent. Moreover, the majority of dura mater used in the UK was sourced from cadavers from outside the UK.

My patient has been told they shouldn't donate blood because they have been transfused in the past - does this mean he/she should be considered at risk of CJD for public health purposes due to receipt of blood components or plasma derivatives?

Not necessarily - only certain patients who have received transfusion or plasma-products are to be considered as 'at-risk' for public health purposes. These patients have been contacted and informed they are 'at-risk'. Please see the footnote to Table 4a in Part 4. The Blood Services ask all previously transfused (in UK) people not to donate blood - but only a few of these people are considered 'at-risk' for public health purposes.

How can I ensure all my patients are effectively assessed before surgery to identify patients with or at risk of CJD?

Guidance on assessments to be carried before surgery or endoscopy to identify patients with or at risk of CJD has recently been added to the TSE Guidance as Annex J. This cross-refers to the CJD risk categorisation of patients is given in paragraphs 4.16 -4.17 and Table 4a of Part 4 of the TSE Guidance. Effective pre-surgery assessment should be carried out before any surgical or endoscopic procedure that may involve contact with tissues with high or medium level infectivity.

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Advice on CJD infection control in specialist areas

Where can I find advice on endoscopes and CJD infection control?

Advice on endoscopes and CJD infection control is given in Annex F of the ACDP TSE Guidance. This guidance was significantly revised in November 2005 to clarify the vCJD transmission risks associated with different types of endoscopic procedures and to identify which endoscopic procedures should be considered invasive. A consensus statement between the British Society of Gastroenterology (BSG) Decontamination Working Group and the TSE expert Working Group was also published in November 2005 to explain the rationale behind Annex F.

Where can I find advice on dialysis and CJD infection control?

Guidance on dialysis and CJD will be available shortly (to be published as Annex G of the TSE Guidance). Please check back to the TSE Guidelines webpage to see if the guidance has been published or alternatively contact the secretariat, asking for an email alert when this annex is published.

Where can I find advice on ophthalmology and CJD infection control?

SEAC issued advice on lenses and ophthalmic devices touching the surface of the eye and CJD infection control in 2001:
www.seac.gov.uk/summaries/summ_0601.htm.

Guidance was also issued by the College of Optometrists/Association of British Dispensing Opticians in 2001. A sub-group of the ACDP TSE Working Group is to be convened shortly to consider ophthalmology and CJD in detail and to take into account any new evidence. Further ACDP guidance is expected to be published in 2007.

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Advice on decontamination

Are there any alternatives to the decontamination agents listed in Annex C now available e.g. to use for decontamination of surfaces in contact with high or medium risk material from definite, probable or high risk cases?

At present no. However, the advice given regarding decontamination in Annex C, alongside the rest of the TSE guidance, is monitored as new information and findings become available. In addition, the TSE Working Group works closely with another committee, ESAC-Pr (Engineering and Science Advisory Committee into the Decontamination of surgical instruments including prion removal), which will evaluate new technologies effective at inactivating prions. It is important that until the efficacy of products and technologies claiming to remove/inactivate prion protein from contaminated medical devices in laboratory and clinical practice, is established fully against human prions, clinicians and laboratory managers should ensure that the current ACDP TSE guidelines are followed.

How should novel decontamination technologies be evaluated?

SEAC have recently considered this issue and published a SEAC position statement on methods to evaluate decontamination technologies for surgical instruments. This is available from:
www.seac.gov.uk/statements/statement310806.htm

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Further information and links

See the further information and links page.

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copyright: © | published: 16 November, 2006