Cjd

[colorado'n]

We do a lot of spine cases. With the potential for cjd from "any" spine/brain case, does anyone take the cjd precautions as recommended by AORN and CDC for every case of this type.

[sonny1388]

I am trying to put in place a system where a questionaire is given during pre-op to screen for patients with the potential to carry, and run precautions on those patients. If I remember correctly, high risk for cjd is in CSF and in the cornea of the eye. Any case where there is an invasion of either should be handled as high risk and be treated as such. Most spinal cases (e.g. PLIF, laminectomy) do not come in contact with the CSF and are considered Medium risk where a screening process could be appropriate. I will have to dig out some notes from Nancy Chobin to confirm, but I am pretty sure that was what she does in NJ.

[colorado'n]

Thanks for your comments. I understand that most spine cases do not come in contact with the CSF, however, what do you do in the event of a dural tear discovered after the fact? What is your process for "medium risk" ?
I will try and contact Nancy Chobin.

[nchobin]

We do a lot of spine cases. With the potential for cjd from "any" spine/brain case, does anyone take the cjd precautions as recommended by AORN and CDC for every case of this type.
Yes, the Saint Barnabas HC System processes all loaner spine insts on a prion cycle.

Nancy Chobin

[colorado'n]

What are the parameters of the prion cycle? What do you do with your own instruments used during the case?

[nchobin]

I am trying to put in place a system where a questionaire is given during pre-op to screen for patients with the potential to carry, and run precautions on those patients. If I remember correctly, high risk for cjd is in CSF and in the cornea of the eye. Any case where there is an invasion of either should be handled as high risk and be treated as such. Most spinal cases (e.g. PLIF, laminectomy) do not come in contact with the CSF and are considered Medium risk where a screening process could be appropriate. I will have to dig out some notes from Nancy Chobin to confirm, but I am pretty sure that was what she does in NJ.

email me at: nchobin@att.net and I will send our screening form and policy

Nancy Chobin

[nchobin]

What are the parameters of the prion cycle? What do you do with your own instruments used during the case?


email me at: nchobin@att.net and I will send our screening form and policy

Nancy Chobin

[jrc]

If I remember correctly, high risk for cjd is in CSF and in the cornea of the eye. Any case where there is an invasion of either should be handled as high risk and be treated as such.
I'll have to pull out my notes, but I do not believe corneas and CSF are high risk tissues. I thought high risk was central neural tissues, i.e. brain, spinal cord, retina. The cornea is epithelial tissue, so I am pretty sure it would be low risk.

[carol1967]

The cornea is high risk tissue for CJD

[chipmoore]

In your procedures, you need to address the potential for CJD as well as vCJD. There are different risk factors to consider.

Chip Moore
Getinge
Rochester, NY

[sonny1388]

From the American Society for Microbiology:

Tissue Risk category:
Tissues
Donor Screening:

1. High Risk
Brain(dura), eye(cornea), spinal tissue
Complete donor screening including brain biopsy prior to transplant

2. Mod-Low Risk
Kidney*, liver*, spleen*,
Require exclusion of confirmed and suspected CJD/vCJD donor

3. Low-No Risk
Heart*, lungs*, tendons
Require exclusion of confirmed and suspected CJD/vCJD

http://www.asm.org/policy/index.asp?bid=4387

[nchobin]

Chip

Our screening form does that by using the American Red Cross screening criteria. This would include vCJD.

[sonny1388]

JRC- Thank you for the correction. CSF is a medium risk, as well as the cornea. This is on a High-Medium-Low scale as compared to a High-Low-No risk scale. Dura (including spinal cord tissue) and the retina are High risk.