I want to make readers aware of a change involving labs and the safe handling of cerebrospinal fluid (CSF) specimens when Creutzfeld-Jacob Disease (CJD) is suspected.
CJD is a fatal and degenerative brain disease and because CJD prions resist routine sterilization and decontamination procedures, the Laboratory Accreditation Program (LAP) of the College of American Pathologists  (CAP) requires special handling procedures for autopsies in suspect cases of CJD.
In 2010 LAP added a requirement specific to handing CSF specimens:
[GEN.71230], “The laboratory has documented procedures for the special handling of cerebrospinal fluid from cases in which Creutzfeldt-Jacob disease is suspected.
“Laboratories have found the requirement difficult to impossible to implement,” explained Gerald A. Hoeltge, MD FCAP, Chair, CAP Checklist Committee in a letter to me. “Not only is the level of diagnostic suspicion unspecified in the requirement, laboratories found it impractical to separate suspect samples from other CSF samples,” he adds.
With this in mind, along with experts regarding the use of standard precautions when handling CSF specimens as adequate containment for the CJD risk, (see CLSI’s 2005 guideline M29-A3 Protection of Laboratory Workers from Occupationally Acquired Infections” ), the CAP’s Laboratory Accreditation Program has decided to delete requirement GEN.71230, says Hoeltge.
The requirement will not appear in the 2011 edition of the checklist, and “laboratories yet to be inspected under the 2010 edition may ignore the requirement,” says Hoeltge.
Although CAP is eliminating the checklist question, many laboratories are struggling with how to deal with CJD and other prions. Safety Lady LLC will present a 90 minute webinar on October 5, 2011 on Handling Prions and CJD in the Laboratory – What you need to know to protect your employees given by Peggy Prinz Luebbert , MS, MT(ASCP), CIC, CHSP, Healthcare Interventions, Inc., Omaha, NE.
The program grants 1.5 contact hours from P.A.C.E.® and covers the following:
- Transmissibility of prions
- Management of prion contamination in the laboratory
- The Spaulding classification for disinfectants
- Kill time for viruses, tuberculosis, fungi and prions
- Effective and partially effective disinfectants for equipment cleaning
- CJD and TSE risk assessments for patients, tissue and devices
- Acceptable methods for sterilizing instruments used on high risk CJD patients