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Eurosurveillance, Volume 7, Issue 25, 19 June 2003
Articles

Citation style for this article: Oakley K. Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. Guidance from the UK Advisory Committee on Dangerous Pathogens and the Spongiform Encephalopathy Advisory Committee. Euro Surveill. 2003;7(25):pii=2245. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2245

Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. Guidance from the UK Advisory Committee on Dangerous Pathogens and the Spongiform Encephalopathy Advisory Committee

Katie Oakley (Katie.Oakley@hpa.org.uk), Health Protection Agency Communicable Disease Surveillance Centre, London, England

Revised guidelines have been issued in the United Kingdom (UK) on reducing the occupational risk of exposure to TSE infectivity (http://www.doh.gov.uk/cjd/tseguidance). The guidance is aimed at employers and others, such as staff working in infection control and the reprocessing of medical devices. It is also relevant to pathologists and others handling deceased infected patients and people working with human and animal TSEs in the laboratory, including those working with diagnostic specimens (potentially) infected with TSEs.

The guidance was prepared by a Joint TSE Working Group, drawn from members of the Advisory Committee on Dangerous Pathogens (ACDP, http://www.doh.gov.uk/acdp/) and the Spongiform Encephalopathy Advisory Committee (SEAC, http://www.seac.gov.uk), and other experts. Their remit was to consider the risks from exposure to TSE agents that may arise as a result of work activities, and to provide advice on the minimisation of such risks and other related matters. This revised edition has been produced in the light of enhanced scientific knowledge and the practicalities of working with the 1998 guidance.

The format is the same as the 1998 edition but the document is significantly expanded and web based with the main changes being:

  • The risk categorisation of patients (definite, probable or possible Creutzfeldt-Jakob disease (CJD) and variant Creutzfeldt-Jakob disease (vCJD) is now based on established, published, diagnostic criteria.
  • A new category of symptomatic patients 'with neurological disease of unknown aetiology where the diagnosis of CJD is being actively considered' has been included to encourage appropriate handling of surgical instruments, on a precautionary basis, recognising that CJD is sometimes difficult to diagnose in the early stages of the disease.
  • A clearer description of the asymptomatic 'at risk' patient groups, divided into those at risk from familial forms of the disease and those at risk from iatrogenic exposure.
  • Abandonment of the earlier recommendation for enhanced reprocessing of certain surgical instruments in particular circumstances. The regimen previously recommended is now known not to be reliably effective and may even render instruments more difficult to decontaminate.
  • A recommendation to quarantine instruments pending diagnosis in certain circumstances. This was recommended in a Health Services Circular issued in 1999. The advice has now been subsumed into this guidance (http://www.doh.gov.uk/cjd/hsc199179.pdf).
  • Extensive scientific information on the distribution of abnormal prion protein in human tissues and body fluids, which forms the basis of the guidance.
  • Extensive cross referencing to other relevant guidance.

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