A CJD (Creutzfeldt-Jacob Disease) Screening Tool for OR Staff

ISSUE: CJD and related infectious disorders, which cause progressive neurological disease can have extended incubation periods. Prions are very resistant to routine decontamination and sterilization procedures used in healthcare facilities. All patients known or suspected of having CJD and all patients who are at risk must be screened prior to certain surgeries. PROJECT: A subcommitteee was formed that included Medicine,Infection Control, OR Management, Sterilization/Processing Department and Risk Management. Patients needed to be screened for certain high risk procedures prior to all eye, spinal cord(including laminectomy) and brain cases. Attending physicians were initially asked to screen patients before surgery. A peri-op screening form was developed by the task force. Physicians involved in these types of surgeries and the OR staff were educated to the screening form. image RESULTS: Patients responding to “yes” to any question on the CJD form activated the “CJD precautions” policy. The Sterilization/Processing Department (SPD) was notified. A special “prion processing” label is affixed to all instruments used on high risk tissue. No flash sterilization is permitted. Disposal items/instruments are used as a priority for cases.Covers for power equipment are utilized. If device can be cleaned and decontaminated, sterilize in a pre-vac at 270° F for 18 minutes or gravity displacement at 250° F for 60 minutes. If device cannot be cleaned, soak in 1:10 bleach solution for 30 minutes and discard in rigid container. LESSONS LEARNED: Problems encountered included: physicians were not screening their patients prior to surgery; OR staff requested more information on the other rare infectious disorders besides CJD. OR staff were then educated to interview patients in the pre-admission setting or while in the OR Holding area. The screening tool was redesigned to define obscure medical conditions such as Gertsmann-Straussler-Scheinker Disease and Fatal Famialial Insomnia. Using the screening form, five cases in 2005 activated the “CJD precautions” policy. Communication between the physician,the OR, SPD and Infection Control is critical in the screening process of these cases while not compromising patient care and outcomes.