Cost-Effective Way To Handle Possible Creutzfeld-Jakob Disease (CJD)–Contaminated Surgical Instruments

ISSUE: Instruments used on surgical cases of possible CJD patients are quarantined. In the past, all instruments opened for a brain biopsy were quarantined until the pathology was known. Instruments from negative cases were then put back into circulation. On removal from quarantine, it was noted that several instruments needed to be destroyed due to damage. This decreased instrument availability and increased replacement costs. PROJECT: To decrease cost, provide an adequate supply of instruments, and reduce replacement without increasing risk for CJD, a new procedure was instituted. Surgery meets with the surgeon ahead of time to determine instruments vital for the case and those potentially needed. The surgical team then creates two sterile setups. Setup I is for instruments required to perform the procedure. Setup II is opened and available instruments that will remain uncontaminated with blood or body fluids throughout the case. Each setup has a separate scrub nurse. Upon request of an instrument from Setup II, the scrub nurse covering Setup II delivers the item to Setup I in a sterile manner, preventing cross contamination. Instruments from Setup I are maintained on that setup until case completion and never returned to Setup II. Only the instruments used on Setup I are quarantined. Instruments remaining on Setup II are sent for routine processing. RESULTS: The process of setting up two separate sterile fields decreases the number of instruments actually used, decreasing the number of instruments to be quarantined. Availability of instruments increases, and fewer instruments are lost in the quarantine process reducing replacement costs while providing maximum patient safety from transmission. LESSONS LEARNED: Developing unconventional procedures and creative use of additional manpower can effectively decrease cost and maintain optimal patient safety.