Strategies for Inactivating Prions

Abstract

The purpose of this chapter is to briefly review general guidelines that are given to hospital central sterilization service departments for reprocessing instruments and medical devices that have been exposed to patients known or suspected to have Creutzfeldt-Jakob disease (CJD). CJD is a degenerative neurological disorder of humans with an incidence in the United States of approximately 1 case/million population/year. The disease is caused by a proteinaceous infectious agent that is referred to as a prion. The agent has no DNA or RNA. Prion diseases do not elicit an immune response, result in a noninflammatory pathologic process confined to the central nervous system, have an incubation period of years, and usually are fatal within one year of diagnosis. Disinfection and sterilization recommendations for CJD are based on the belief that infection control measures should be predicated on epidemiologic evidence linking specific body tissues or fluids to transmission of CJD, quantitative infectivity assays demonstrating that body tissues or fluids are contaminated with infectious prions, cleaning data using biological indicators and proteins, inactivation data on prions, the risk of disease transmission with the use of instruments or devices, and a review of other recommendations.