Infectious Prions The Reality Within The Body Piercing Industry

The knowledge of Prions have been known about since the 1920s.  But the concept of CJD,etc are just recently coming to light and what not within the health care industry.

In regards to the Body Piercing Industry and Prions, Piercing Free-hand and going Disposable IS an option for the piercing industry. Although there is a way to process infectious prion contaminated equipment, but its quite often more economically feasible to incinerate or go disposable,etc.  However one thing to also question is the possibility of infectious prion contaminated jewelry.  However the chance of infectious prions spreading via blood and saliva,etc is listed as being very rare.

The reasons Prions were brought up within our industry is via discussions within the Suspension community, pertaining to the re-use of hooks. A few years back during a Dallas Suspension Convention (from what I’ve been told), the concept/concern was brought up.  But of course this was a result of piercers that read medical textbooks/websites (websites probably for the most part, but I’m merely assuming/speculating) and obtained inaccurate or partial statements/quotes,etc. And than they tossed it about the community at an infectious pace much like said prions.  Because the piercing industry (myself included at the time) is very quick to latch onto any new concept, especially when it involves the medical industry, is spread like wildfire.

Due to these inaccuracies in the understanding of prions, piercers for a few years now have talked about prions but are improperly educated on the topic.  So I’ve decided to post the info I have in my Sterile Supply Processing textbooks to educate and inform piercers about prions and why they aren’t really a concern within our environment.  And if a piercer does interact with an infectious prion patient, its going to be extremely rare to almost non-existent.

Central Service Technical Manual 7th Edition (Pg 324-Pg 325):

Prions:

Creutzfeldt-Jakob Disease (CJD)

It is rare that Central Service Technicians in the United States receive instrumentation exposed to Creutzfeldt-Jakob Disease (CJD) but, when they do, they must know and apply proper processing procedures.

This section considers reprocessing concerns for instruments and medical devices that have been exposed to patients known or suspected to have CJD. The processing of this instrumentation requires a shift from the use of standard precautions where all items are processed in the same manner.

CJD is caused by abnormal forms of normal proteins called prions. These are transmissible pathogenic agents that are smaller than viruses, and are extremely resistant to inactivation by heat and disinfecting agents. The incubation period can be many years long, and fatality is almost certain within several months after initial onset of the symptoms.

CJD is named after the German psychiatrists who first described the disease in the 1920s. It, along with other similar diseases, is classified as a “transmissible spongiform encephalopathie” (TSE). These diseases are appropriately named because:

1) They can be spread from one person to another (They are transmissible.)

2) They cause the brain to degenerate. (Under microscope, infected tissue has a sponge-like appearance.)

3) They affect the brain (”Encephalopathy” refers to disease of the brain.)

The CJD has a relatively long incubation time (up to 30 years) during which the disease is unnoticed. Therefore patients with CJD who have brain, spinal, or eye surgery or another purpose may contaminate instruments with the infectious agents. This makes plans and policies for control of CJD very important.

Prions are most frequently found in the brain, dura mater (the tough membrane that encases the nerves of the spinal cord), and eyes.  They are also detected less frequently in cerebrospinal fluid, and the spleen, lymph nodes, kidney and liver. They are seldom (but could be) located in blood, urine, skin, muscle, bone, adrenal gland, heart, feces, peripheral nerves, nasal mucous, gingival, saliva, sputum, and tears. When a suspected CJD patientundergoes a procedure, the facility’s plans and policies include notification of all personnel involved with that patient.

The guidelines outlined below should be followed for instruments used for brain biopsies on patients in whom no specific lesion has been demonstrated (for example, by magnetic resonance imaging (MRI) or computerized tomography (CT) scans). Alternatively, instruments used for such patients could be disposable, or the instruments could be quarantined until the pathology of the brain biopsy is reviewed, and CJD is excluded. These recommendations apply to devices and equipment contaminated with high-risk tissues such as brain, spinal cord, eye tissue from high-risk patients (those known or suspected to have CJD):

1) The use of proper cleaning procedures is an important tactic to inactivate prions. Surfaces contaminated by infected material should be disinfected with a solution of sodium hydroxide. Keep the surface wet at room temperature for one hour of contact time. Then rinse three times with water, and clean according to established routine. Note: Because this solution is caustic, it is important to carefully follow recommendations of applicable Material Data Safety Sheets for proper handling/disposing.

2) Devices such as surgical instruments that are constructed to enable cleaning procedures to result in effective tissue removal can be cleaned, and then steam sterilized at:

i) 275F-278F (135C-137C) for 18 minutes in a prevacuum or porous load unit.

ii) 270F (132C) for one hour in a gravity displacement unit.

iii) 250F (121C) for four and one-half hours in a gravity displacement unit.

- Devices that are impossible or difficult to clean must be incinerated.

- Devices should be kept moist until cleaned and decontaminated to minimize the drying of tissues and body fluids on objects.

- Flash sterilization cannot be used to reprocess these devices.

- Contaminated items that have been in contract with high-risk tissue, and have not been processed according to these recommendations (for example, medical devices used for brain biopsy prior to diagnosis) should be recalled and appropriately and appropriately reprocessed.

- A tracking system, if used, may be helpful to recall devices used on high-risk tissue and high-risk patients. The system should permit identification of the patient on which the devices were used, the date they were used, the procedure performed, and the surgeon’s name. Facilities that do not have a commercially available or automated tracking system should create a manual system.

- Environmental (non-critical) surfaces contaminated with high-risk tissues (for example, laboratory surfaces that have come in contact with the brain tissue of a person infected with CJD) should be cleaned with a detergent, and thaen spot-decontaminated with 5,000 ppm sodium hypochlorite. Note: this concentration usualy results from a 1/10 dilution of a household bleach. However, the label should be checked for the amount of sodium hypochlorite present; concentrations in the U.S. products can range from 3% to over 6% sodium hypochlorite.

- Non-critial equipment contaminated with high-risk tissue should be cleaned, and then disinfected with 5,000 ppm hypochlorite or in NaOH (Sodium Hydroxide) depending on material compatibility. All contaminated surfaces must be exposed to the disinfectant.

- Equipment that requires special prion reprocessing must be tagged after use. Clinicians and Central Service Technicians should be thoroughly trained on the proper tagging of equipment and on special prion reprocessing protocols.

- The use of power drills or saws that are likely to contact high-risk tissue should be avoided. These items are, by their very nature and design, difficult to clean, and too expensive to discard.

The following recommendations apply to devices and equipment contaminated with low-risk tissues such as cerebrospinal-fluid, kidney, liver, spleen, lung, and lymph node tissue from high-risk patients:

- Devices can be cleaned and disinfected or sterilized using conventional protocols of high-level disinfection, thermal sterilization, or chemical sterilization.

- Endoscopes (except neurosurgical endoscopes) are likely to be contaminated only with low-risk materials so standard cleaning and high-level disinfection processing protocfols are adequate.

- Environmental surfaces contaminated with low-risk tissues or fluids require only standard disinfection using disinfectants recommended by OSHA for decontaminating blood-contaminated surfaces (for example, 500 to 5,000 ppm sodim hypochlorite).

Please note: Additional information about CJD can be found at: http://www.cdc.gov/ncidod/dvrd/cjd/qa_cjd_infection_control.htm#reprocessed

SURGICAL TECHNOLOGY PRACTICE AND PRINCIPLE 5TH EDITION (Pg 104-105):

The prion (a proteinaceous infectious particle) is a unique pathogenic substance. It is a protein particle that contains no nucleic acid. It is believed to be a modified form of normal cellular protein that arises through mutation. It then is transmitted by ingestion or direct contact, especially during medical or surgical procedures. Prions are resistant to all forms of disinfection and sterilization normally used in the medical setting. They cannot be cultured in the laboratory, and the immune system does not react to them. Only a few prion diseases affect human beings. The most important is Creutzfeldt-Jakob DIsease (CJD) and newly emergent variant CJD, which are always fatal.

CJD is a rare transmissible disease of the nervous system that is progressive and always fatal. THe virus cannot be killed by ordinary sterilization processes, and the disease has no cure. The disease may have an incubation period of up to 20 years. Although CJD is not contagious, it is transmissible. The mechanism of transmission currently is unknown. CJD represents a threat int he health care setting, because it is known to be transmitted y contaminated electrodes during neurosurgical stereoactic surgery, corneal grafts, and direct contact with neurosurgical instruments that have been used on patients with CJD. For these reasons, current infection control standards require the use of disposable instruments for these types of surgical procedures or specialized decontamination procedures. Protocols for CJD have been established to help prevent transmission.