Hospital replaces all surgical instruments after contamination

Source: icanPREVENT.com

By Robert Roos,
icanNEWS staff

icanNEWS –- Hotel-Dieu Grace Hospital in Windsor, Ont., is replacing its entire inventory of about 20,000 surgical instruments because of the possibility of contamination with the agent that causes Creutzfeldt-Jakob disease (CJD), according to Shannon Tompkins, the hospital's director of development and public affairs.

The concern about contamination arose when a woman who underwent neurosurgery at the hospital March 11 was later found to have a possible diagnosis of CJD. When this became known on May 8, the hospital closed its operating rooms and began contacting patients who had undergone surgery with possibly contaminated instruments.

"This hospital made an ethical decision," said Tompkins in describing the hospital's effort to replace its surgical instruments. "If we couldn't say with 100% certainty that nobody's at risk, we decided it's best to err on the side of extreme caution."

Prions, the protein particles thought to cause CJD, are resistant to conventional sterilization and disinfection procedures. Instruments used to operate on the woman with possible CJD March 11 were sterilized by conventional methods, creating the theoretical possibility of contamination and subsequent exposure for other patients on whom the instruments were used later.

Tompkins said the concern about exposure focuses mainly on about 10 patients who underwent neurosurgery or orthopedic surgery on March 11 and 12. "All the neuro patients were contacted by the surgeons personally and a follow-up meeting was scheduled between them," she said.

There is also a very slight risk that other surgical instruments not used in the original surgery could have been cross-contaminated if they were cleaned and sterilized along with instruments used on the original patient, hospital officials have said. Regarding patients who had surgery after Mar 11 or 12, Tompkins said, "We believe that they're at very remote possible risk." She said the hospital established a hot line for those patients, and if they called and wanted to talk with their physicians, the messages were passed to the physicians for follow-up.

Equipment incinerated
Tompkins said the neurosurgical instruments that may have been contaminated have been incinerated, and instruments that could have been cross-contaminated during processing have been "quarantined" until the CJD diagnosis is confirmed or disproved.

Initially, hospital officials had said the surgical instruments would undergo special cleaning and sterilization procedures, but this turned out to be impractical, according to Tompkins. "We were guided through this process by Health Canada, and it just wasn't practical in terms of their guidelines for such a large volume of equipment," she said. The sodium hydroxide used for sterilization caused pitting in some of the instruments, raising questions about their future reliability, and the processes also raised health concerns for the hospital staff, she explained. "So, early in the process we switched gears and started purchasing."

The hospital is replacing 400 sets of instruments, each containing about 50 pieces, for a total of roughly 20,000 pieces, Tompkins said. The total cost is unknown at this point. Officials felt it was urgent to proceed with replacement despite the high cost, she explained. "We're a trauma center, and when we close down, it has a real impact on this community."

The hospital has two facilities with a total of seven operating rooms (ORs), according to Tompkins. Two ORs were reopened last week, and five were expected to be open by the end of this week, she said. "But we're not functioning as a trauma center, because we have to be able to respond to a multisystem trauma," and not all of the necessary equipment has been replaced yet, she added. Officials don't know yet when all the ORs will be fully operational.

An uncertain diagnosis
The woman now suspected of having CJD underwent a ventriculoperitioneal shunt operation for normal-pressure hydrocephalus on Mar 11. She was discharged afterward, but later was readmitted because of neurologic symptoms. A subsequent 14-3-3 protein test of her cerebrospinal fluid was positive, indicating the possibility of CJD, as previously reported. The patient was later released from the hospital again. In most cases, a diagnosis of CJD can be confirmed only by postmortem analysis of brain tissue.

The typical reaction of patients notified of their risk of exposure to CJD has been to ask if or when they will find out whether the woman suspected of having CJD actually has it, according to Tompkins. "At this point we can't give them any promises," she said. "This person could travel somewhere and pass on and we wouldn't even know. And there are issues of confidentiality. . . . We're looking into it, but we don't have an answer right now."

In addition, hospital personnel are discussing how to revise their sterilization protocols for neurosurgical equipment in order to avoid future CJD contamination scares, Tompkins said. "We're working on a process with Health Canada," she said. "Neurosurgery isn't up and running at this point. Until they have some protocol in place for taking care of the equipment, I don't think they'll be up and running."

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