Call for action on surgical instruments over CJD

TOUGHER guidelines on the re-use of surgical instruments need to be introduced to prevent the potential spread of the human form of mad cow disease, researchers said yesterday.

Better logging of the number of times instruments are used, and on whom, could save hundreds of lives, they claim.

Researchers from the National Creutzfeldt-Jakob Disease Surveillance Unit at the Western General Hospital in Edinburgh and the London School of Hygiene and Tropical Medicine say that, in a worst-case scenario, hundreds could die in the next 20 years as a result of contracting vCJD during surgery.

They have called for an audit of how often instruments are used and for equipment to be tracked to reduce uncertainties and allay people's fears. This would mean that, if a patient was later diagnosed with vCJD, the instruments that were used on them could be taken out of use.

Some hospitals have already taken action to improve tracking and make sure that the decontamination of instruments is at the highest possible standard.

More than 160 people have been diagnosed with vCJD in the UK, with most cases believed to have been from eating BSE- infected beef. But there are fears the disease may never disappear, despite being taken out of the food chain, due to other routes of transmission, such as surgery.

Dr Tini Garske, from the London School of Hygiene and Tropical Medicine, said: "At present, we can't exclude the possibility that there is going to be ongoing transmission. We need more data to look at that risk."

She said that if surgical instruments were used once on someone harbouring vCJD then thrown away, there was no risk of onward transmission.

"If they are used twice, there is a chance that the infection will spread. The more they are used, the more chance there is of the infection spreading," she said.

The risk of infection also increased depending on how infectious the contaminated instruments were, and how effective the cleaning was.

No case of vCJD has so far been linked to surgical instruments. But Dr Garske said theoretical models found it was possible that hundreds of deaths could occur between 2006 and 2021 as a result of infection with vCJD via surgery. It was also possible that there would be no cases, due to uncertainties about the risks of transmission on reused instruments and the lack of data on how often they are reused.

Of 161 people diagnosed with vCJD by the end of 2005, 130 had had surgery in the years preceding the start of symptoms. But there was no evidence to suggest this was higher than the rest of the population, the report said.

A spokeswoman for the Executive said: "All UK health departments agree that this is potentially a matter for concern and research is being conducted to determine the best ways of reducing any risk of transmission via surgical instruments."

Graham Steel, of the CJD Alliance, said many unknowns remained over the issue of surgical transmission of vCJD.

"As a precaution, however, £200 million has been allocated by the UK government with regards to much better sterilisation and tagging/tracking of reusable surgical equipment," he said.