Precautions in handling tissues, fluids, and other contaminated materials from patients with documented or suspected Creutzfeldt-Jakob disease

R. N. Rosenberg, C. L. White, P. Brown

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

Once symptoms of CJD develop, the disorder is uniformly fatal. Procedures for decontamination of CJD-infected materials and tissues must be defined and implemented. Resistance of the infectious pathogen of CJD to inactivating procedures is well recognized, but a consensus on exactly what constitutes optimal conditions for its inactivation has yet to be reached. Obvious simple precautions include: specimens submitted to clinical chemistry, surgical pathology, or neuropathology laboratories should be clearly marked as coming from a patient with definite or suspected CJD. Disposable gloves should be worn and any skin contact with possible infectious materials should be followed by washing with 1N sodium hydroxide for several minutes; the wash water should be sterilized as described below. The pathologist, neuropathologist, and autopsy diener should wear a gown and gloves when handling potentially infectious tissue. The work areas should be restricted to necessary personnel. A manual saw is preferred for opening the skull, and every effort should be made for the saw not to cut into brain or spinal cord tissue; if an electric saw is used, a towel should be placed over the saw blade to reduce the incidence and risk of aerosolization. The autopsy table drain should be plugged and the water collected and decontaminated. The body should be washed with 1N sodium hydroxide, the wash water sterilized, and appropriate precautions communicated to the mortician. Organs and trimmed tissues used to prepare tissue blocks should be meticulously collected and completely incinerated. The preferred methods of disinfection of CJD-contaminated materials are steam autoclaving at 132°C for one hour; or immersion in 1N sodium hydroxide at room temperature for one hour. Shorter treatment periods have occasionally not fully inactivated the pathogen, and lower dilutions of sodium hydroxide, or even the use of undiluted bleach, are not reproducibly effective. Even more vigorous treatment has been required to sterilize the much higher pathogen titers present in scrapiecontaminated materials. These procedures must be followed on the ward for venipuncture needles, forceps, scissors, and lumbar puncture needles; also for autopsy instruments, autopsy table water, specimen containers and their solutions, centrifuge tubes, the gown, mask, and gloves worn by pathology and hospital staff personnel handling CJD tissues, and unless formalin-fixed tissue blocks are autoclaved before processing, microtome blades, small microtomes, and other pathology instruments.

Original languageEnglish (US)
Pages (from-to)75-77
Number of pages3
JournalAnnals of Neurology
Volume19
Issue number1
StatePublished - 1986

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Creutzfeldt-Jakob Syndrome
Sodium Hydroxide
Autopsy
Water
Needles
Pathology
Hospital Personnel
Surgical Pathology
Clinical Chemistry
Spinal Puncture
Phlebotomy
Decontamination
Disinfection
Steam
Immersion
Masks
Surgical Instruments
Skull
Formaldehyde
Spinal Cord

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

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title = "Precautions in handling tissues, fluids, and other contaminated materials from patients with documented or suspected Creutzfeldt-Jakob disease",
abstract = "Once symptoms of CJD develop, the disorder is uniformly fatal. Procedures for decontamination of CJD-infected materials and tissues must be defined and implemented. Resistance of the infectious pathogen of CJD to inactivating procedures is well recognized, but a consensus on exactly what constitutes optimal conditions for its inactivation has yet to be reached. Obvious simple precautions include: specimens submitted to clinical chemistry, surgical pathology, or neuropathology laboratories should be clearly marked as coming from a patient with definite or suspected CJD. Disposable gloves should be worn and any skin contact with possible infectious materials should be followed by washing with 1N sodium hydroxide for several minutes; the wash water should be sterilized as described below. The pathologist, neuropathologist, and autopsy diener should wear a gown and gloves when handling potentially infectious tissue. The work areas should be restricted to necessary personnel. A manual saw is preferred for opening the skull, and every effort should be made for the saw not to cut into brain or spinal cord tissue; if an electric saw is used, a towel should be placed over the saw blade to reduce the incidence and risk of aerosolization. The autopsy table drain should be plugged and the water collected and decontaminated. The body should be washed with 1N sodium hydroxide, the wash water sterilized, and appropriate precautions communicated to the mortician. Organs and trimmed tissues used to prepare tissue blocks should be meticulously collected and completely incinerated. The preferred methods of disinfection of CJD-contaminated materials are steam autoclaving at 132°C for one hour; or immersion in 1N sodium hydroxide at room temperature for one hour. Shorter treatment periods have occasionally not fully inactivated the pathogen, and lower dilutions of sodium hydroxide, or even the use of undiluted bleach, are not reproducibly effective. Even more vigorous treatment has been required to sterilize the much higher pathogen titers present in scrapiecontaminated materials. These procedures must be followed on the ward for venipuncture needles, forceps, scissors, and lumbar puncture needles; also for autopsy instruments, autopsy table water, specimen containers and their solutions, centrifuge tubes, the gown, mask, and gloves worn by pathology and hospital staff personnel handling CJD tissues, and unless formalin-fixed tissue blocks are autoclaved before processing, microtome blades, small microtomes, and other pathology instruments.",
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N2 - Once symptoms of CJD develop, the disorder is uniformly fatal. Procedures for decontamination of CJD-infected materials and tissues must be defined and implemented. Resistance of the infectious pathogen of CJD to inactivating procedures is well recognized, but a consensus on exactly what constitutes optimal conditions for its inactivation has yet to be reached. Obvious simple precautions include: specimens submitted to clinical chemistry, surgical pathology, or neuropathology laboratories should be clearly marked as coming from a patient with definite or suspected CJD. Disposable gloves should be worn and any skin contact with possible infectious materials should be followed by washing with 1N sodium hydroxide for several minutes; the wash water should be sterilized as described below. The pathologist, neuropathologist, and autopsy diener should wear a gown and gloves when handling potentially infectious tissue. The work areas should be restricted to necessary personnel. A manual saw is preferred for opening the skull, and every effort should be made for the saw not to cut into brain or spinal cord tissue; if an electric saw is used, a towel should be placed over the saw blade to reduce the incidence and risk of aerosolization. The autopsy table drain should be plugged and the water collected and decontaminated. The body should be washed with 1N sodium hydroxide, the wash water sterilized, and appropriate precautions communicated to the mortician. Organs and trimmed tissues used to prepare tissue blocks should be meticulously collected and completely incinerated. The preferred methods of disinfection of CJD-contaminated materials are steam autoclaving at 132°C for one hour; or immersion in 1N sodium hydroxide at room temperature for one hour. Shorter treatment periods have occasionally not fully inactivated the pathogen, and lower dilutions of sodium hydroxide, or even the use of undiluted bleach, are not reproducibly effective. Even more vigorous treatment has been required to sterilize the much higher pathogen titers present in scrapiecontaminated materials. These procedures must be followed on the ward for venipuncture needles, forceps, scissors, and lumbar puncture needles; also for autopsy instruments, autopsy table water, specimen containers and their solutions, centrifuge tubes, the gown, mask, and gloves worn by pathology and hospital staff personnel handling CJD tissues, and unless formalin-fixed tissue blocks are autoclaved before processing, microtome blades, small microtomes, and other pathology instruments.

AB - Once symptoms of CJD develop, the disorder is uniformly fatal. Procedures for decontamination of CJD-infected materials and tissues must be defined and implemented. Resistance of the infectious pathogen of CJD to inactivating procedures is well recognized, but a consensus on exactly what constitutes optimal conditions for its inactivation has yet to be reached. Obvious simple precautions include: specimens submitted to clinical chemistry, surgical pathology, or neuropathology laboratories should be clearly marked as coming from a patient with definite or suspected CJD. Disposable gloves should be worn and any skin contact with possible infectious materials should be followed by washing with 1N sodium hydroxide for several minutes; the wash water should be sterilized as described below. The pathologist, neuropathologist, and autopsy diener should wear a gown and gloves when handling potentially infectious tissue. The work areas should be restricted to necessary personnel. A manual saw is preferred for opening the skull, and every effort should be made for the saw not to cut into brain or spinal cord tissue; if an electric saw is used, a towel should be placed over the saw blade to reduce the incidence and risk of aerosolization. The autopsy table drain should be plugged and the water collected and decontaminated. The body should be washed with 1N sodium hydroxide, the wash water sterilized, and appropriate precautions communicated to the mortician. Organs and trimmed tissues used to prepare tissue blocks should be meticulously collected and completely incinerated. The preferred methods of disinfection of CJD-contaminated materials are steam autoclaving at 132°C for one hour; or immersion in 1N sodium hydroxide at room temperature for one hour. Shorter treatment periods have occasionally not fully inactivated the pathogen, and lower dilutions of sodium hydroxide, or even the use of undiluted bleach, are not reproducibly effective. Even more vigorous treatment has been required to sterilize the much higher pathogen titers present in scrapiecontaminated materials. These procedures must be followed on the ward for venipuncture needles, forceps, scissors, and lumbar puncture needles; also for autopsy instruments, autopsy table water, specimen containers and their solutions, centrifuge tubes, the gown, mask, and gloves worn by pathology and hospital staff personnel handling CJD tissues, and unless formalin-fixed tissue blocks are autoclaved before processing, microtome blades, small microtomes, and other pathology instruments.

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