Editorials

Iatrogenic vCJD from surgical instruments

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7302.1558 (Published 30 June 2001) Cite this as: BMJ 2001;322:1558

The risk is unknown, but improved decontamination will help reduce the risk

  1. Adam Frosh, consultant ENT surgeon (a.frosh@btinernet.com),
  2. Rachel Joyce, senior registrar, public health medicine,
  3. Alan Johnson, consultant ENT surgeon and honorary secretary
  1. Lister Hospital, Stevenage, Herts SG1 4AB
  2. South Thames Public Health Rotation, St George's Hospital, London SW17 0RE
  3. British Association of Otorhinolaryngologists-Head and Neck Surgeons (BAOHNS), Royal College of Surgeons of England, London WC2A 3PE

    Because of fears about iatrogenic transmission of new variant Creutzfeldt-Jakob disease (vCJD), the Department of Health recently announced fundamental changes in surgical practice, and in particular the practice of ear, nose, and throat surgery. Decontamination facilities in hospitals are to be upgraded, and by the end of 2001 all adenotonsillectomy procedures will be performed using disposable instruments.1 Why are these measures necessary?

    At present both the prevalence of subclinical vCJD and its degree of infectivity via surgical instruments are unknown. Also, no cases of iatrogenic vCJD in humans have so far been identified. Nevertheless, based on the evidence we do have, we can make judgments about the features that are likely to affect the size of the risk from surgical instruments.

    So far the disease marker (and likely transmissible agent) for vCJD (PrPSc) has been identified by sensitive western blot techniques in the neural and lymphoreticular tissues of brain, tonsil, and spleen.2 A positive appendix (which consists largely of lymphoreticular tissue) has not yet been reported using this technique, …

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