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From: TSS ()
Subject: Medical Waste and CJD 2003 guidelines CDC ?
Date: May 2, 2006 at 7:34 am PST

##################### Bovine Spongiform Encephalopathy #####################

Medical Waste and CJD 2003 guidelines CDC ?
Mon May 1, 2006 16:56
71.248.145.247


Managing Fluid Disposal
Part I of II
By Kathy Dix

Operating room (OR) personnel are frequently overwhelmed by their numerous responsibilities of not only “fixing” the patient, but also preventing infection, maintaining a sterile field, utilizing only sterile instruments, and in general, ensuring the patient’s safety, as well as that of the OR staff. Proper fluid management is one of those crucial steps to preserving the wellbeing of both staff and patient.

Has your OR personnel been trained in the disposal of liquid waste? Are they aware of state and/or city regulations? Is their bloodborne pathogen training recent? Is annual competency testing required?

snip...

Of special interest, APIC’s guidelines also point out the more recent anxiety related to Creutzfeldt-Jakob disease (CJD). “Concerns also have been raised about the need for special handling and treatment procedures for wastes generated during the care of patients with CJD or other transmissible spongiform encephalopathies (TSEs),” the guidelines observe. “Prions, the agents that cause TSEs, have significant resistance to inactivation by a variety of physical, chemical, or gaseous methods. No epidemiologic evidence, however, links acquisition of CJD with medical-waste disposal practices. Although handling neurologic tissue for pathologic examination and autopsy materials with care, using barrier precautions, and following specific procedures for the autopsy are prudent measures, employing extraordinary measures once the materials are discarded is unnecessary. Regulated medical wastes generated during the care of the CJD patient can be managed using the same strategies as wastes generated during the care of other patients. After decontamination, these wastes may then be disposed in a sanitary landfill or discharged to the sanitary sewer, as appropriate.”1

http://www.infectioncontroltoday.com/articles/651feat3.html

Guidelines for Environmental Infection Control

in Health-Care Facilities

Recommendations of CDC and the Healthcare Infection Control

Practices Advisory Committee (HICPAC)

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention (CDC)

Atlanta, GA 30333

2003

snip...

6. Medical Waste and CJD

Concerns also have been raised about the need for special handling and treatment procedures for wastes

generated during the care of patients with CJD or other transmissible spongiform encephalopathies

(TSEs). Prions, the agents that cause TSEs, have significant resistance to inactivation by a variety of

physical, chemical, or gaseous methods.1427 No epidemiologic evidence, however, links acquisition of

CJD with medical-waste disposal practices. Although handling neurologic tissue for pathologic

examination and autopsy materials with care, using barrier precautions, and following specific

117

procedures for the autopsy are prudent measures,1197 employing extraordinary measures once the

materials are discarded is unnecessary. Regulated medical wastes generated during the care of the CJD

patient can be managed using the same strategies as wastes generated during the care of other patients.

After decontamination, these wastes may then be disposed in a sanitary landfill or discharged to the

sanitary sewer, as appropriate. .........

snip...

http://www.apic.org/AM/Template.cfm?Section=Search§ion=CDC1&template=/CM/ContentDisplay.cfm&ContentFileID=342

VARIANT CREUTZFELDT-JAKOB DISEASE (vCJD) and BLOOD

COMPONENTS

INFORMATION FOR PATIENTS, February 2006

http://www.hpa.org.uk/infections/topics_az/cjd/BC-InfoforP.pdf

http://www.hpa.org.uk/infections/topics_az/cjd/frameworkannex1-Aug2005.pdf

© 2006 American Society for Investigative Pathology

Detection and Localization of PrPSc in the Skeletal Muscle of Patients with Variant, Iatrogenic, and Sporadic Forms of Creutzfeldt-Jakob Disease
Alexander H. Peden, Diane L. Ritchie, Mark W. Head and James W. Ironside
From the National Creutzfeldt-Jakob Disease Surveillance Unit and Division of Pathology, School of Molecular and Clinical Medicine, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom


Variant Creutzfeldt-Jakob disease (vCJD) differs from other human prion diseases in that the pathogenic prion protein PrPSc can be detected to a greater extent at extraneuronal sites throughout the body, principally within lymphoid tissues. However, a recent study using a high-sensitivity Western blotting technique revealed low levels of PrPSc in skeletal muscle from a quarter of Swiss patients with sporadic CJD (sCJD). This posed the question of whether PrPSc in muscle could also be detected in vCJD, sCJD, and iatrogenic (iCJD) patients from other populations. Therefore, we have used the same high-sensitivity Western blotting technique, in combination with paraffin-embedded tissue blotting, to screen for PrPSc in muscle tissue specimens taken at autopsy from 49 CJD patients in the United Kingdom. These techniques identified muscle PrPSc in 8 of 17 vCJD, 7 of 26 sCJD, and 2 of 5 iCJD patients. Paraffin-embedded tissue blotting analysis showed PrPSc in skeletal muscle in localized anatomical structures that had the morphological and immunohistochemical characteristics of nerve fibers. The detection of PrPSc in muscle tissue from all forms of CJD indicates the possible presence of infectivity in these tissues, suggesting important implications for assessing the potential risk of iatrogenic spread via contaminated surgical instruments.

http://ajp.amjpathol.org/cgi/content/abstract/168/3/927


SEAC 2006

21. Dr Matthews noted that data are now available on the infectivity of

a wide range of bovine tissues. In September 2005, the World

Health Organisation had updated its assessment of the risk of TSE

infectivity in tissues. These data, although incomplete, should

increase confidence in the safety of particular tissues, particularly if

the age of the source animal is also considered. As a result, less

reliance need now be placed on the status of the country of origin.

Members agreed, but noted that it would be important to assess

the quality of the data on which assessments are based. As it

seems highly likely that blood, at least from humans infected with

vCJD, can be infectious, tissues and organs with a significant

blood supply may also confer higher risk.

http://www.seac.gov.uk/minutes/draft-91.pdf

THE ENVIRONMENTAL RISK FACTORS FOR TSE ARE STILL UNKNOWN, but from recent science coming out lately, the risk factor seems to be increasing, rather than decreasing.

CAN SOMEONE PLEASE EXPLAIN TO ME WHY IT IS STILL ACCEPTABLE FOR sanitary landfill or discharged to the sanitary sewer, as appropriate FOR CJD, when the epidemiology of all phenotypes of sporadic CJDs are not known to date, and with apparent new ones of 'unknown' origin being documented as we speak???

http://www.cjdsurveillance.com/resources-casereport.html

THE practice of landfilling and or the discharging to the sanitary sewer, and or spreading to land as fertilizer of any human and or animal TSE should be banned immediately. ...TSS

TSS

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