A craniotomy set was opened but unused during surgery on a patient later found to have sporadic Creutzfeldt-Jakob disease. The CSSD must decide how to manage the instruments that had contact with the operative field. Which reprocessing recommendation is correct for these potentially prion-contaminated reusable instruments?
- A Decontamination with 1N sodium hydroxide for 60 minutes followed by prolonged prevacuum steam sterilization at 134 degrees Celsius, or disposal of the instruments if possible ✓
- B Ethylene oxide sterilization, because prions are destroyed by alkylating agents
- C Routine cleaning followed by standard steam sterilization at 134 degrees Celsius for 3 minutes
- D Immersion in 2% glutaraldehyde for 20 minutes followed by normal rinsing
Correct answer: A. Decontamination with 1N sodium hydroxide for 60 minutes followed by prolonged prevacuum steam sterilization at 134 degrees Celsius, or disposal of the instruments if possible
Explanation
Prions resist ordinary steam cycles, ethylene oxide, formaldehyde and glutaraldehyde. Guideline recommendations for high-risk tissue contact are destruction of the instrument, or decontamination in 1N sodium hydroxide followed by an extended steam cycle at 134 degrees Celsius. Option C fails because the short 3-minute cycle does not inactivate prions, and option D is merely high-level disinfection, inadequate even against spores. Single-use neurosurgical instruments are preferred in such cases.
Reference: CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 ed.
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Written and medically reviewed by the StethoPrep medical team.