Prion disease and recommended procedures for flexible endoscope reprocessing – review of policies worldwide and proposal for a simplified approach

Publication date: Available online 10 August 2019Source: Journal of Hospital InfectionAuthor(s): Günter Kampf, Michael Jung, Miranda Suchomel, Philippe Saliou, Helen Griffiths, Margreet C. VosSummarySeveral guidelines recommend specific treatments for endoscopes, procedures of quarantine for endoscopes or additional treatments for the endoscope washer disinfector (EWD) in suspected or confirmed cases of CJD or vCJD but vary in many details. We therefore reviewed guidelines on reprocessing flexible endoscopes after use in patients with suspected or confirmed prion disease. In addition, a literature search was done on Medline on prion, CJD, vCJD, chemical inactivation, transmission healthcare, epidemiology healthcare, concentration tissue human and endoscope. So far no case of CJD or vCJD transmitted by flexible endoscope has been reported. In animals it was shown that oral uptake of 0.1 – 5 g of BSE-infected brain homogenate is necessary for transmission. The maximum prion concentration in other tissues (e.g. terminal ileum) is at least 1000-fold lower. Automated cleaning of endoscopes alone results in very low residual protein ≤ 5.6 mg per on duodenoscopes. Recommendations vary between countries, sometimes with additional cleaning, use of alkaline cleaners, no use of cleaners with fixative properties, use of disinfectants without fixative properties or single use disinfectants. Sodium hydroxide (1 M) and sodium hypochlorite (10,000 and 25,000 mg/l) are very effective to ...
Source: Journal of Hospital Infection - Category: Infectious Diseases Source Type: research