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From: TSS ()
Subject: Publication of new and revised documents concerning CJD
Date: December 23, 2005 at 10:11 am PST

CJD WATCH MESSAGE BOARD
TSS
Publication of new and revised documents concerning CJD
Fri Dec 23, 2005 12:26
68.238.110.77


Last updated: 15 December 2005
Next update due: 22 December 2005

News
Publication of new and revised documents concerning CJD


The Health Protection Agency and the Healthcare Commission published interim findings of national survey of the management, prevention, and surveillance of Clostridium difficile in NHS acute trusts

News Archive


Publication of new and revised documents concerning CJD


The fourth annual report of the CJD Incidents Panel, and a revision of the CJD Incidents Panel’s Framework document, have recently been published on the Health Protection Agency (HPA) website (1). An updated version of the National CJD Surveillance Unit’s guidance for local reporting of CJD (by clinicians and CCDCs) was published on the NCJDSU website in August 2005.

The fourth Annual Report of the CJD Incidents Panel (the Panel) covers incidents reported between 1 September 2003 and 31 August 2004. During this fourth year of reporting to the Panel, fifty-four incidents were reported: 65 incidents were reported during the third year, and 113 during the first two years after the Panel was established. Thirty-four of the 54 incidents during the fourth year concerned past invasive health care interventions on patients (i.e. surgical incidents) with or suspected of having CJD, or considered to be ‘at-risk’ of CJD. Twenty incidents concerned transfusion of blood components from donors who later developed vCJD. As in previous years, approximately half of the surgical incidents reported involved patients with a diagnosis of sporadic CJD. Seven (20%) surgical incidents reported during this year concerned patients considered to be ‘at-risk’ of CJD. For two (6%) surgical incidents reported during this year, the Panel has advised instruments should be destroyed (or sent for research). In the majority of incidents where instruments were initially quarantined, the Panel advised that instruments could be returned to active use. The Panel advised that a total of twenty-four patients, involved in five incidents reported during this year, should be informed of their exposure and considered to be ‘at-risk of CJD for public health purposes’.

The report also described how Panel advice developed during this year in relation to a number of situations. In particular, the Panel developed its recommendations for the management of patients potentially exposed to vCJD infectivity through receipt of UK-sourced plasma-products.

A revised version of the Panel’s framework document (2) was published on the HPA website in August 2005. This document describes the basis for the Panel’s advice on the management of possible exposure to CJD through medical procedures in the UK. The revisions since the previous (March 2004) version largely concern the development of the Panel’s advice regarding management of possible exposure to vCJD through blood products (components and plasma-products).

Guidance for clinicians and Consultant in Communicable Disease Control (CCDCs) reporting cases and suspect cases of CJD can be found on the website of the national CJD Surveillance Unit (NCJDSU) (3). This guidance was last updated in August 2005. Clinicians and CCDCs (and their equivalents in the UK regions) are advised to refer to this updated guidance when a case of CJD is diagnosed or suspected. Clinicians caring for patients with CJD or suspected CJD (of all types), should inform the local CCDC whose role then includes reporting of any past incidents of invasive healthcare to the CJD Incidents Panel (1).

References

1. Health Protection Agency [online]. CJD Incidents Panel. [Accessed 20 December 2005]. Available at:
.

2. Health Protection Agecny. Management of possible exposure to CJD through medical procedures Framework document. London: HPA, August 2005. Available at:
.

3. National CJD surveillance unit (The University of Edinburgh) [online]. Guidance for local reporting by clinicians of Creutzfeldt-Jakob disease (CJD) and local action by consultants in communicable disease control (CsCDC). [Accessed 20 December 2005]. Available at .


The Health Protection Agency and the Healthcare Commission published interim findings of national survey of the management, prevention, and surveillance of Clostridium difficile in NHS acute trusts


The Health Protection Agency and the Healthcare Commission published interim findings of national survey of the management, prevention, and surveillance of Clostridium difficile in NHS acute trusts
The Health Protection Agency and the Healthcare Commission have published the interim findings of a national survey of the management, prevention, and surveillance of Clostridium difficile in NHS acute trusts (1).


Questionnaires were sent to directors of infection prevention and control. Responses were received from 118 of the 173 trusts (68%) in England. The survey showed:


• Thirty-eight per cent of trusts surveyed said they do not have restrictions in place to prevent the inappropriate use of antibiotics, which would help to minimise the risk of C. difficile infection.
• Over a third of respondents reported that they are unable to routinely isolate patients with C.difficile infection. Only 11% of trusts said they have a ward that can be used for isolating patients with C. difficile.
• Less than half of trusts surveyed use the same recognised definition of an outbreak. Forty percent reported that, in the event of an outbreak, they do not routinely follow guidance, which recommends that they should inform the consultant in communicable disease control.
• Most of the trusts surveyed also reported that they do not routinely inform the relevant authority that is responsible for monitoring their performance i.e. the strategic health authority, or Monitor in the case of NHS foundation trusts.
• Two-thirds of respondents felt that the reported incidence of C. difficile infection has increased in their trust during the past three years.
• A quarter of trusts reported they had closed wards in the past 12 months due to cases of C. difficile.
Responses confirmed that cases of C. difficile are not confined to older people: 41% of trusts estimated that one out of ten cases affected people under the age of 65 years.


Respondents thought that the most practical measures to reduce the incidence of infection from
C. difficile were: improved prescribing of antibiotics (55% of trusts); isolation of patients (39%); clean environments (32%); and improved hygiene (19%).


Over two-thirds of trusts thought that the prescribing of antibiotics and the lack of facilities for isolation represented the greatest challenges to controlling infection.


Despite concerns that the severity of the infection has increased in the past few years, most of the trusts surveyed do not routinely collect clinical data on patients with the infection. Sixty-five per cent of trusts reported that they do not routinely record information on deaths from C. difficile.


The Healthcare Commission and the Health Protection Agency will incorporate learning from these interim findings, and the final report, into their respective programmes of work. The results will also provide a context for the investigation that the Healthcare Commission is undertaking into the outbreak of C. difficile at Stoke Mandeville Hospital, part of Buckinghamshire Hospitals NHS Trust, due to be published next year.


References
1. Health Protection Agency, Healthcare Commission. Management, prevention and surveillance of Clostridium difficile. Interim findings from a national survey of NHS acute trusts in England. London: Commission for Healthcare Audit and Inspection, 2005. Available at .


http://www.hpa.org.uk/cdr/pages/news.htm#cjd

TSS



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