TRANSMISSIBLE SPONGIFORM ENCEPHALOPATHY EXPOSURE SPREADING VIA HOSPITALS AND SURGICAL PROCEDURES AROUND THE GLOBE
Mad cow disease warning to 38 patients in Wales
Section Health | Published on 29 Mar 2011
Public Health Wales has contacted 38 patients who may have been put at risk of contracting Creutzfeldt-Jakob Disease (CJD) during surgery.
CJD, an incurable brain disease, is commonly known as a human form of mad cow disease because bovine spongiform encephalopathy is the cause of variant Creutzfeldt-Jakob disease in humans.
Letters were sent to those at risk after it became apparent that a patient who underwent surgery in a hospital in the Abertawe Bro Morgannwg Health Board area in 2007 was at high risk of the disease.
All surgical instruments used on the patient were removed from use when the patient’s history became known, and all patients operated on with the same instruments in the interim have now been informed.
Public Health Wales says that the risk of transmission of CJD from one patient to another via surgical instruments is extremely low. There have only ever been six cases worldwide of any form of CJD being transmitted in this way.
Dr Jörg Hoffmann, Consultant in Communicable Disease Control for Public Health Wales, said: “In this incident, we do not have a single confirmed case of CJD. However, we do have one patient who was at high risk and 38 people at extremely low risk.
“We know that all the surgical instruments used on this group of patients were cleaned, disinfected and sterilised normally. However, it is possible that the proteins that cause CJD, known as prions, survived these routine sterilisation procedures so an extremely small risk of transmission remains.
“We have identified and written to all patients concerned to make them aware of the extremely low risk. They have been offered information and support and a helpline has been set up for anyone who has received a letter and has further questions.
“All patients at risk have been contacted and there is no risk to anybody else. People who have had any type of surgery in the Abertawe Bo Morgannwg Health Board area since 2007 but who have not been contacted by us have no reason at all to worry.”
CJD is a rare disease that affects the structures of the brain and causes incurable neurological symptoms. There is currently no treatment or cure for CJD.
Anyone who is aware they are at increased risk of CJD should not donate blood or organs and should always inform their surgeon or other health care professional before undergoing any health procedure.
More information on CJD is available from the Public Health Wales website at: http://www.wales.nhs.uk/sitesplus/888/page/43948
cjd and surgical instruments
Tulane Medical Center alerts patients after medical gear improperly sterilized
Published: Thursday, March 10, 2011, 9:30 PM
Tulane Medical Center has notified 360 patients that it failed to properly sanitize gastrointestinal scoping equipment used during seven weeks last fall, potentially exposing the group to various infectious diseases.
Dr. Robert Lynch, the hospital’s CEO, acknowledged the error in a Jan. 3 letter that invited affected patients to obtain free screening for hepatitis B, hepatitis C and HIV. The letter, however, characterized the chances of infection as “minimal to non-existent.”
Lynch cited a mistake in one of five steps in its sanitizing protocol and framed the tests as a way “to reassure patients whose procedures were impacted.”
State epidemiologist Dr. Raoult Ratard, who has conferred with Tulane officials about the case, said the chances of the equipment transmitting an infection “would be extremely, extremely small. I think Tulane just wants to be careful.”
That has not satisfied at least one patient, identified as “John Doe” in the lawsuit he filed Feb. 22 in Orleans Parish Civil District Court. The suit, which seeks class-action status, accuses the hospital of negligence and alleges a long list of harmful effects ranging from “mental anguish” to “loss of enjoyment of life.”
According to Lynch’s letter and a follow-up written statement released Thursday, a routine maintenance inspection confirmed that part of the disinfecting procedure for endoscopes and bronchoscopes did not occur at a sufficient temperature. The error persisted from Oct. 7 to Dec. 1 on equipment used for colonoscopies, sigmoidoscopies and upper-endoscopies of the stomach. “Once this was discovered, it was remediated immediately,” Lynch wrote, explaining that the hospital immediately contacted infection control experts, including the Ratard’s unit at the Louisiana Department of Health and Hospitals.
According to the Centers for Disease Control and Prevention, infection associated with the use of endoscopes occurs in about 1 in 1.8 million procedures, low odds but enough to make endoscopes the most likely medical device to yield outbreaks associated with health-care institutions.
Neither the letter nor Tulane’s statement detailed its sanitizing procedure.
According to Ratard, the scopes in question cannot be sanitized using steam because of the likelihood of heat damage. Instead, the key step of the cleaning process calls for application of a chemical disinfectant or sterilant for a specified period of time at an elevated temperature. Ratard said the settings on the sanitizer were elevated, but still too low, though he could not recall specifics. He attributed the mistake to human error.
Ratard characterized Tulane’s mistake as “fairly common” in American health care and said the hospital “has handled this by the book” by notifying patients and offering them several rounds of testing, along with follow-up counseling.
Harvey attorney Ron Austin, lead counsel on John Doe’s class-action petition, said the hospital’s admission of error does not mitigate the risk involved for the affected patients.
“This is extremely serious, and it’s unfortunate,” he said. “They are petrified. They are extremely angry. How do you have that conversation with your partner that you may have HIV, and what of the social fallout for anyone who discovers that?”
The suit also names John Doe’s wife, Jane Doe, as a plaintiff, because of her potential exposure through the couple’s sexual relations.
Austin said both Does have been tested for infectious diseases and both have been negative, though follow-up testing will be ordered because of the incubation periods of some viruses.
The case has been assigned to Judge Paulette Irons, who will decide whether to certify the matter as a class action.
Tulane Medical Center is jointly owned by the for-profit Health Care Corporation of America and Tulane University.
A decade ago, the hospital suffered a black eye and a subsequent legal tussle when it announced that eight surgery patients had been exposed to a rare, incurable brain disorder because they all underwent operations using some of the same instruments used on a patient with Creutzfeldt-Jakob disease.
Those incidents were not a clear-cut matter of errant sanitizing, however. With a similar pathology to mad-cow disease, Creutzfeldt-Jakob disease is spread through protein agents that, at least at the time, were resistant to standard sterilizing procedures. The condition was diagnosed with certainty in an initial Tulane surgery patient only after death.
The hospital settled a negligence claim by one of the subsequently exposed patients. The financial terms were never disclosed. None of the eight is known to have developed the disease.
Bill Barrow can be reached at firstname.lastname@example.org or 504.826.3452.
Related topics: tulane medical center, tulane university
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