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PALMS OF PASADENA HOSPITAL
Standard Operating Policy Effective Date:
Department No.S.O.P. No: SUR
SUBJECT: CREUTZFELDT-JAKOB DISEASE PRECAUTIONS IN
PURPOSE: To define the procedure for
disinfection/sterilization of surgical instrumentation
and to provide guidelines for special precautions
necessary for disinfection of equipment used on
patients with a potential diagnosis of Creutzfeldt-
Creutzfeldt-Jakob Disease (CJD) is a rare,
transmissible, progressive, degenerative neurological
disorder which is invariably fatal. It emerged from
relative obscurity in 1996 with the report of a new
variant of the disease and speculation about its
relationship to Mad Cow Disease. The need for special
precautions is due to an extremely resistant prion
which resists normal inactivation methods, such as
steam sterilization or Ethylene Oxide (ETO)
Despite fears to the contrary, Creutzfeldt-Jocob
Disease is not contagious through casual contact with a
CJD patient. However, it can be transmitted by exposure
to brain or nervous system tissue, usually through
certain medical/surgical procedures. The prion, which
is the infectious agent, is almost never found
in blood or urine and blood transfusions do not appear
to be a major risk factor for the acquisition of CJD.
POLICY: Whenever a neurosurgical procedure involving
brain tissue is scheduled for a person sustected of
having Creutzfeldt-Jacob disease, the following
precautions and procedure will be initiated for
protecting patients and personnel:
1. All aspects of Standard Precautions apply, but no
other special precautions are needed for contact with
urine, stool, sweat, tears or for transporting
2. Traffic in the operating room will be restricted
to those individuals required for the procedure.
SOURCE: Standards & Recommended Practices, AORN 2000,
APIC, National Institute of
Neurological Disorders 11/00, American Journal of
Infection Control 2/98, “Prion Disease of the
CNS” Major Clinical Syndromes
DATE OF REVIEW: NEW
AREAS AFFECTED: SURGICAL SERVICES
APPROVED BY: TITLE: Director of
CJD PRECAUTIONS IN SURGERY:
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3. Use of personal protective equipment will be strictly
A. Double-gloving by sterile personnel recommended.
B. Use of protective eyewear is essential due to potential
splashing or spraying of CSF or brain tissue.
C. Use of impervious gowns by sterile personnel will be
D. Masks will be worn as usual during surgical procedure.
4. Handling of laboratory specimens:
A. Tissue considered to have high risk of CJD prion are brain,
duramater, and corneal tissues.
B. Notify Laboratory/Histology before transporting specimens
C. Specimen is be placed a specimen container with “Suspected
CJD” clearly written on label.
D. Specimen container is then placed into a zip-lock plastic
bag and transported to the histology lab by personnel
5. Decontamination/disinfection of Operating Room:
A. Before routine cleaning of the OR Room, disinfect surfaces
contaminated with infectious material (OR table, neuro
headrest) by wiping with a 1-2N concentrated solution of
Sodium Hydroxide (Stored in flammable cabinet), allowing
the solution to remain in contact with the contaminated
surfaces for at least one hour. Then rinse well with
NOTE**SODIUM HYDROXIDE IS VERY CAUSTIC. HANDLE CAREFULLY.
RESPIRATOR MUST BE WORN BECAUSE OF RESPIRATORY
HAZARDS (Obtain from Environmental Services)
Review MSDS before handling. Excess solution
may be disposed of by flushing down hopper.
B. Procede with routine cleaning, wearing Personal Protective
Equipment (gown, gloves, mask, eyewear
protection).Environmental surfaces (Floors, walls, counter
tops, or other surfaces) would not be expected to be
associated with transmission of CJD to health care
workers or patients and can be cleaned in the conventional
C. Liquids should be sucked into suction liners, “ISOLIZED”,
and then discarded in the biomedical waste that will be
sent for incineration.
6. Decontamination/sterilization of Non-disposable
instruments:Two major factors significantly affect the
sterilization strategy for CJD-contaminated instruments.
One is the type of tissue to which the instrument has been
exposed, and the other is the ability to clean the device.
A. Disposable intems/instruments should be used whenever
B. If the instrument is exposed to high-risk tissue that
contains a high prion burden (brain tissue or CSF), and
CANNOT BE CLEANED effectively, it will be discarded
(frazier suction tips, Rhoton suction tips, and
CJD PRECAUTIONS IN SURGERY Page
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C. Instruments that are exposed to high-risk tissue, but that
CAN BE CLEANED effectively:
1). Will be sent to the Decontamination Room in a hard,
closed container (Use Soak Pan that is kept up
2). Clearly communicate to SPD personnel that the
instruments have to be treated using the Creutzfeldt-
3). These exposed instruments must then be soaked in a
1-2N concentrated solution of Sodium Hydroxide
for one(1) hour before terminal sterilization.
4). Sterilization must be done at 132 degrees C (269
degrees F) for one(1) hour in a Gravity Displacement
***NOTE: Gravity Ddisplacement sterilizers are the flash
sterilizers--except the one between Rms 6 & 7, which is
a pre-vacuum sterilizer. These are set for 270 degrees F
The SPD sterilizers are also pre-vacuum. We cannot use
our pre-vacuum sterilizers because they cannot achieve
the recommended temperature pre-vacuum sterilization of
D. Instruments that are NOT in contact with high-risk tissue
and can be cleaned effectively, can be cleaned by
processing and the usual sterilization/disinfection
protocols can be used.
E. Current guidelines for cleaning and disinfection of
flexible endoscopes after use on a patient with CJD
need not be changed.