Instrument contamination after CJD diagnosis

Axe Rake

The HSE has said it is checking medical records to see how many patients were operated on using instruments which had been used on a patient who has been diagnosed at Beaumont Hospital with Creutzfeldt-Jakob disease.
The fatal degenerative brain disease can be passed on through contaminated surgical instruments. There is a risk to both doctors and other patients.
If instruments are used on a patient with CJD, international guidelines say they must be put through a special highly rigorous sterilisation procedure or destroyed.
Normal sterilisation techniques are not sufficient.
It is understood the operation on the patient with CJD happened around two weeks before their recent diagnosis.
The instruments were not isolated until the diagnosis and were used on other patients before then.
It is not known how many patients are involved, but it is believed to be between ten and 20.
Those patients will be contacted and will have to be monitored indefinitely.

http://www.rte.ie/news/2013/0718/463298-cjd-beaumont-hospital/

Disgusting.

I'd sue the hospital immediately, no doubt about it.

IM0

for inability to know everything about someone including diseases the person themselves dont know they have before the opperation?

Axe Rake

Axe Rake wrote: »

I'd sue the hospital immediately, no doubt about it.

For what?

MurdyWurdy

Axe Rake wrote: »

http://www.rte.ie/news/2013/0718/463298-cjd-beaumont-hospital/

Disgusting.

I'd sue the hospital immediately, no doubt about it.

Why? They didn't know the patient had CJD - it says he/she was diagnosed two weeks later. I'd imagine it's not practical to do the special sterilisation necessary on all equipment in case a patient has CJD which is quite rare.

IM0

Deleted User wrote: »

For what?

the laugh?

returnNull

It is understood the operation on the patient with CJD happened around two weeks before their recent diagnosis.

thats the important part...so explain what you'd sue them over?

IM0

IM0 wrote: »

the laugh?

Mad cow

Nemeses

Deleted User wrote: »

Mad cow

Mad cow disease?

Ah, that's not back again is it?:eek:

endacl

Fastest outrage backfire ever??

Facebook is over there OP... >>>>>

IM0

Deleted User wrote: »

Mad cow

how now brown

The Backwards Man

Nemeses wrote: »

Mad cow disease?

Ah, that's not back again is it?:eek:

It never went away.


CJD I mean. It's a different animal to BSE.

Nemeses

The Backwards Man wrote: »

It never went away.

Then there lies the problem.

CramCycle

BSE is still around, I mean the numbers (in Ireland) are tiny but it is still there. I imagine there is alot of it in the US but you are not allowed test for it over there. That said CJD and BSE are not related, it is believed BSE could cause vCJD.

Have they any idea where or how the patient developed CJD? ie was it genetic or transmission?

RachaelVO

That's a bit of scary s**t alright, but why is it the hospitals fault? They can't see into people blood to see if they have something or not. I know by european standards Irish hospitals are a bit rubbish, but jaysus you can't blame them for that one!

AndonHandon

And so it begins
http://s3.amazonaws.com/sfb111/story_xlimage_2010_10_R2428_Zombies_Roam_the_City_During_Morning_Rush_102610.jpg

TheChizler

CramCycle wrote: »

I imagine there is alot of it in the US but you are not allowed test for it over there.

Eh what? They've detected at least 4 cases, how can they do that without testing?

http://www.cdc.gov/ncidod/dvrd/bse/

seven_eleven

IM0 wrote: »

for inability to know everything about someone including diseases the person themselves dont know they have before the opperation?

I've tried but I still cant make sense of this sentence.

My name is URL

IM0 wrote: »

for inability to know everything about someone including diseases the person themselves dont know they have before the opperation?

Aren't they effectively saying that instruments were not properly sterilised before reuse?

It doesn't really matter whether or not the hospital knew the patient had CJD, as far as anyone potentially effected is concerned; unsafe instruments were used on them.

These things can happen, but saying that nobody is to blame is fallacious. Maybe no one individual is responsible, but the fact that it's possible to insure it doesn't happen; yet still has happened means that something went wrong. Nothing is ever preventable when you believe that things are unpreventable.

SpaceTime

Prions oddly enough are like some kind of super-difficult to inactivate thing.
Even steam steralisation at 135ºC doesn't seem to kill them all!
Nor does using standard disinfectants.

Gas type disinfectors that are extremely effective against bacteria and viruses aren't effective at all against prions.

Weirdly enough, formaldehyde containing products even make them stronger and result in them surviving steam / dry heat sterilisation.

Even bleaching them doesn't necessarily work!

Then you've also got issues that some surgical instruments wouldn't be able to withstand the kinds of cleaning processes that might be required. Especially complicated instruments like endoscopes.

They may actually need to use gamma rays or electron beams to kill them off / make them inactive.

Completely disposable instruments are probably the best approach and they would need to be incinerated after use.

To be fair to the hospitals, it's a close enough to having to deal with thing from Alien!

gctest50

And now _____ they've learned to fly

http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1001257

skyfall2012

SpaceTime wrote: »

Prions oddly enough are like some kind of super-difficult to inactivate thing.
Even steam steralisation at 135ºC doesn't seem to kill them all!
Nor does using standard disinfectants.

Gas type disinfectors that are extremely effective against bacteria and viruses aren't effective at all against prions.

Weirdly enough, formaldehyde containing products even make them stronger and result in them surviving steam / dry heat sterilisation.

Even bleaching them doesn't necessarily work!

Then you've also got issues that some surgical instruments wouldn't be able to withstand the kinds of cleaning processes that might be required. Especially complicated instruments like endoscopes.

They may actually need to use gamma rays or electron beams to kill them off / make them inactive.

Completely disposable instruments are probably the best approach and they would need to be incinerated after use.

To be fair to the hospitals, it's a close enough to having to deal with thing from Alien!

In that case, CJD has never gone away perhaps there should have been some measures in place for this sort of thing e.g. disposable instruments, if not already invented they need to be. Could be a death sentence for 20 people in for routine operations.

gurramok

CramCycle wrote: »

BSE is still around, I mean the numbers (in Ireland) are tiny but it is still there. I imagine there is alot of it in the US but you are not allowed test for it over there. That said CJD and BSE are not related, it is believed BSE could cause vCJD.

Have they any idea where or how the patient developed CJD? ie was it genetic or transmission?

I and many others would like to know too. Back in the 90's, there was the CJD scare predicting many thousands of cases in the UK as a result of BSE but as far as i know, that has not happened.

Basically if you ate beef in the 80s\90's you were screwed, but now 20 odd years later there has been no outbreak yet.(yes i know they did say CJD has an incubation period of 20 yrs!)

goose2005

Deleted User wrote: »

For what?

money. or free drugs

CramCycle

TheChizler wrote: »

Eh what? They've detected at least 4 cases, how can they do that without testing?

http://www.cdc.gov/ncidod/dvrd/bse/

I have no idea, there was sporadic testing instituted by the DOA in America many years ago, they got so many positive hits that the export market to Japan disintegrated overnight costing their exchequer about 3billion if memory serves (could be way off, this is from memory of my induction day in work). To combat this, they fired the woman who started the testing and banned (or maybe just stopped the random sampling) of herds.

Still quite a few Scrapie positives but not enough to be overly concerned in Ireland.

My name is URL wrote: »

Aren't they effectively saying that instruments were not properly sterilised before reuse?

You can't properly sterlise them if contaminated. BSE and Scr material in ireland is autoclaved in a lab before being double autoclaved at a disposal site before incineration, while the Scr is destroyed with the autoclaving the activity of the BSE never fully disappears AFAIK.

gurramok wrote: »

I and many others would like to know too. Back in the 90's, there was the CJD scare predicting many thousands of cases in the UK as a result of BSE but as far as i know, that has not happened.

Basically if you ate beef in the 80s\90's you were screwed, but now 20 odd years later there has been no outbreak yet.(yes i know they did say CJD has an incubation period of 20 yrs!)

I worked in a BSE lab for years, we were always told the incubation was about 14years in theory but in truth it was effectively unknown. On the upside my health insurance and insurance on a mortgage is more than the average person, really reassuring when you find that one out Can't give blood either

NuckingFacker

Those patients are burgered, they'll have a serious beef with the Hse over this.

SpaceTime

skyfall2012 wrote: »

In that case, CJD has never gone away perhaps there should have been some measures in place for this sort of thing e.g. disposable instruments, if not already invented they need to be. Could be a death sentence for 20 people in for routine operations.

Of course it's never gone away. We have been aware of CJD since the 1920s. It's just that it's exceedingly rare and can be caused by other factors too.

wil

My name is URL wrote: »

Aren't they effectively saying that instruments were not properly sterilised before reuse?

It doesn't really matter whether or not the hospital knew the patient had CJD, as far as anyone potentially effected is concerned; unsafe instruments were used on them.

These things can happen, but saying that nobody is to blame is fallacious. Maybe no one individual is responsible, but the fact that it's possible to insure it doesn't happen; yet still has happened means that something went wrong. Nothing is ever preventable when you believe that things are unpreventable.

I'd be happy if they stopped infecting people with MRSA, C diff etc by improving hygiene standards.
That'd be a good start.

April O Neill

Axe Rake wrote: »

http://www.rte.ie/news/2013/0718/463298-cjd-beaumont-hospital/

Disgusting.

I'd sue the hospital immediately, no doubt about it.

That's really unfortunate and scary.

I really hope a way to sterilise instruments of prion matter is discovered soon, and becomes a matter of course for surgical instruments.

I don't think the hospital was negligent here. The only way to avoid this is to use new instuments after every single procedure. Do you think the HSE can afford that?

April O Neill

MurdyWurdy wrote: »

I'd imagine it's not practical to do the special sterilisation necessary on all equipment in case a patient has CJD which is quite rare.

I'm not sure that special sterilisation proceudre even exists yet! If it does, it should be used on all surgical instrumentation.

April O Neill

CramCycle wrote: »

I imagine there is alot of it in the US but you are not allowed test for it over there.

For real?

CramCycle wrote: »

Have they any idea where or how the patient developed CJD? ie was it genetic or transmission?

It's transmitted.

April O Neill

My name is URL wrote: »

Aren't they effectively saying that instruments were not properly sterilised before reuse?

It doesn't really matter whether or not the hospital knew the patient had CJD, as far as anyone potentially effected is concerned; unsafe instruments were used on them.

AFAIK, there is not yet a way to sterilise prions (the causative agent of these diseases) off surgical equipment. I know for a fact that as recently as 2010, research was being carried out in this field. So if the technology HAS come on stream, it's fairly recently.

humbert

Four people in the world and that is before any sterilisation. So nobody has ever suffered as a result of this practice.

Just a very sad situation and having just read about the disease and these prions, I don't think anyone is to blame.

Addle

If the patient was diagnosed just 2 weeks after surgery, would that not mean there was suspicions they had the disease before diagnosis?

Addle

Addle wrote: »

If the patient was diagnosed just 2 weeks after surgery, would that not mean there was suspicions they had the disease before diagnosis?

Not necessarily, no.

skyfall2012

gurramok wrote: »

I and many others would like to know too. Back in the 90's, there was the CJD scare predicting many thousands of cases in the UK as a result of BSE but as far as i know, that has not happened.

Basically if you ate beef in the 80s\90's you were screwed, but now 20 odd years later there has been no outbreak yet.(yes i know they did say CJD has an incubation period of 20 yrs!)

I lived and worked in London in the early 90s and eat a LOT of steak. There has yet been no signs of CJD, only that from time to time my husband would refer to me as a mad cow, but he is no doctor.

Coles

gurramok wrote: »

I and many others would like to know too. Back in the 90's, there was the CJD scare predicting many thousands of cases in the UK as a result of BSE but as far as i know, that has not happened.

Basically if you ate beef in the 80s\90's you were screwed, but now 20 odd years later there has been no outbreak yet.(yes i know they did say CJD has an incubation period of 20 yrs!)

The level of deaths from CJD in the UK is very low, but it is slowly increasing.

SpaceTime

Considering that we couldn't even guarantee that we were eating beef and not horse in certain processed foods from a whole range of EU countries, I'm sure we were probably exposed to BSE at some stage via low quality processed food before the disease was identified in the 1990s in cows.

I just hope that the worst case scenario never materialises! So far, it looks unlikely.

Remember too that medics are looking out for CJD these days too. The increasing numbers on that chart are so small that they could be explained by better diagnosis.

A lot of people in the past may have been categorised as having early onset dementia or other degenerative brain diseases.

Even scanning technologies have become much higher resolution, cheaper and more widely used in that period of time. So diagnosis is easier.

I'd still say it's a pretty unlikely cause of death and also it can occur for other reasons than contamination via food.

Essentially, it's where a prion goes rogue and starts to cause havoc. It's in some ways a bit more like a form of cancer than an infection. It can be triggered by your own prions containing an error.

boombang

Seems really ham-fisted of the HSE to release this story to the press before they contacted all the patients. I don't know why they did that.

RTE's Morning Ireland piece on this item this morning was rather alarmist I thought. There'll be hundreds of people unnecessarily scared that they have a killer brain disease.

Terrible management of an scary health issue by the HSE, which is then blown out proportion by the media.

skyfall2012

SpaceTime wrote: »

Considering that we couldn't even guarantee that we were eating beef and not horse in certain processed foods from a whole range of EU countries, I'm sure we were probably exposed to BSE at some stage via low quality processed food before the disease was identified in the 1990s in cows.

I just hope that the worst case scenario never materialises! So far, it looks unlikely.

Remember too that medics are looking out for CJD these days too. The increasing numbers on that chart are so small that they could be explained by better diagnosis.

A lot of people in the past may have been categorised as having early onset dementia or other degenerative brain diseases.

Even scanning technologies have become much higher resolution, cheaper and more widely used in that period of time. So diagnosis is easier.

I'd still say it's a pretty unlikely cause of death and also it can occur for other reasons than contamination via food.

Essentially, it's where a prion goes rogue and starts to cause havoc. It's in some ways a bit more like a form of cancer than an infection. It can be triggered by your own prions containing an error.

You guys can let me know, if you notice any dementia setting in:)

stevenmu

boombang wrote: »

Seems really ham-fisted of the HSE to release this story to the press before they contacted all the patients. I don't know why they did that.

RTE's Morning Ireland piece on this item this morning was rather alarmist I thought. There'll be hundreds of people unnecessarily scared that they have a killer brain disease.

Terrible management of an scary health issue by the HSE, which is then blown out proportion by the media.

Just a guess, but someone in the media probably found out about it, and the HSE decided to go public early to have some control over the story rather than just rampant speculation.

SpaceTime

stevenmu wrote: »

Just a guess, but someone in the media probably found out about it, and the HSE decided to go public early to have some control over the story rather than just rampant speculation.

I think there's a lot more transparency now because of HIQA, which is no bad thing!
In the past it would have just been an internal report of some sort.

Amirani

skyfall2012 wrote: »

In that case, CJD has never gone away perhaps there should have been some measures in place for this sort of thing e.g. disposable instruments, if not already invented they need to be. Could be a death sentence for 20 people in for routine operations.

Disposable instruments aren't practical in every case. Some medical instruments are too intricate and expensive to be disposable.

This is a really tragic situation. I can't really see how it could've been avoided. Nobody is really at fault.

GLaDOS

Seems a like a really unfortunate turn of events, not much the hospital could have done about it. Maybe disposable surgical equipment should be the norm? Probably not economically/technically viable though.

CJD is an awful disease Prions in general are quite scary.

SpaceTime

It's not really possible to have all disposable / single use equipment. A lot of that gear is very specialised and very, very expensive!

They sterilise everything to very high standards, but prions are just off the scale in terms of what's required to deactivate them.

The big issue is that you would destroy the equipment doing some of the steralisation procedures that are known to work to remove them as they involve a combination of very high heat for prolonged periods and quite caustic chemicals.

Radiation is probably the most likely approach that will end up being used i.e. blasting equipment with gamma rays and intense UV or something like that for long enough to destroy *all* proteins.

The idea being you sterilise the equipment but because it's just gamma rays, you don't end up leaving it radioactive either.

So far, chemical and heat approaches aren't ideal and they risk doing serious damage to the equipment.

You have to remember that some of this gear is microsurgical equipment, such as complicated operating microscopes, endoscopes etc etc.

For areas like neurosurgery and otology you're talking about extremely sophisticated, sensitive and very expensive equipment. It's a lot more than just scalpels and clamps!

Also, only two centres in Ireland are geared and staffed up to do this kind of stuff - Beaumount and CUH. So, it's mostly not the kind of equipment you can just throw in the bin when you're finished.

anncoates

Axe Rake wrote: »

I'd sue the hospital immediately, no doubt about it.

You're definitely showing signs of an infected brain, so your case is good.