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Saturday, September 28th 2013

The Risk of Exposure In Healthcare

Prions, the misformed proteins behind the various spongiform encephalopathies (including Mad Cow disease), are difficult things to sterilize for. They’re not “living” and so the typical techniques used to sterilize surgical instruments before they’re use in the next surgery are ineffective. These prions are infective. You can transmit these fatal, horrific encephalopathies from one patient to another via organ transplants or contaminated surgical equipment. Contaminated equipment may have exposed a number of people undergoing spinal procedures in Massachusetts recently, it was revealed earlier this month.

Five patients underwent spinal surgery at Cape Cod Hospital with the same potentially contaminated instruments used on a New Hampshire patient who likely died from CJD, a rare and fatal brain disease. Dr. Alfred Delmaria with the MA Dept of Public Health says, “The instruments are so specialized, they were carefully tracked, know exactly where they went.”

I remember once doing a stereotactic brain biopsy where, amongst the differential was Creutzfeldt-Jakob disease. It turned out not to be that but before the surgery everyone sat down in a conference room and talked about the steps we were going to take to only use equipment that could safely undergo the sterilization techniques needed to rid prions without destroying the equipment and the quarantine techniques that were going to be used to make sure all the used equipment got to the right place for proper sterilization.

This case in Massachusetts isn’t the first time there has been a scare over prion contaminated surgical equipment as a transmission vector. It won’t be the last despite commercial products coming on line to try to reduce such risk.