Case report
Preventing the risk of prion transmission via neurosurgical instruments: a case report
Sanja Zember
; Opća bolnica Varaždin, Varaždin, Hrvatska
Nenad Kudelić
; Opća bolnica Varaždin, Varaždin, Hrvatska
Dubravka Dobec-Gorenak
; Opća bolnica Varaždin, Varaždin, Hrvatska
Dubravko Tršinski
; Opća bolnica Varaždin, Varaždin, Hrvatska
Anita Atelj
; Opća bolnica Varaždin, Varaždin, Hrvatska
Abstract
In the last 10 years there have been 15 cases of Creutzfeldt-Jakob disease (CJD) reported to the Croatian Institute of Public Health/Department of Epidemiology. In June 2012, a 58-year-old patient that had been relocated from the Department of Neurology of the University Hospital Centre Zagreb to General Hospital Varaždin, died from a suspected sporadic form of Creutzfeldt-Jakob disease. After autopsy was performed in our hospital, CJD was confirmed by histopathological analysis of the brain in the Clinical Institute of Neurology/Medical University of Vienna. The Hospital Infection Control Committee drafted guidelines for infection control measures regarding work areas, equipment and instruments that were potentially contaminated with prions. Since the patient had undergone a neurosurgical operation in our institution 2.5 months prior to CJD diagnosis, and the neurosurgical instruments used during this procedure were not processed according to the prion decontamination principles, a question was raised regarding a potential prion transmission via contaminated instruments to the 29 patients who subsequently underwent neurosurgical operation. By analyzing the neurosurgical procedure that the patient underwent, we established that neurosurgical instruments were in contact with the patient's skin, subcutaneous tissue, fascia muscle, bones and intervertebral cartilage and not with the dura mater and that there was no cerebrospinal fluid drainage during surgery either. Therefore, we concluded that during neurosurgery the instruments did not come into contact with tissues of higher or medium risk for transmission of prions and that routine procedure for cleaning and sterilization of neurosurgical instruments was sufficient for preventing prion transmission, which is in accordance with the British and Canadian CJD infection control guidelines. Subsequent follow-up recorded not a single case of secondary CJD among the 29 patients who underwent surgery after the infected patient in our hospital.
Keywords
Creutzfeldt-Jakob disease; prion transmission; neurosurgical instruments
Hrčak ID:
133436
URI
Publication date:
30.9.2013.
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