Re: Creutzfeldt-Jakob Proc.

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From:Ron Rainbow <>
To:"Stace. Burton" <>
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Hi Histonetters!

According to CAP Checklist Question # ANP.24300, we all need to have a 
procedure for Creutzfeldt-Jakob Disease.
The only procedure information I've been able to find pertains to surgery.
At our hospital, we would prefer to send any questionable specimens out.  
Does anyone know of a specialty lab for this?

Does anyone have a procedure set up in case this comes through?
Let me know.
Conway Regional Medical Center
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Dear Stacey,

I have enclosed our routine method for you. Hope this helps.




Creutzfeldt Jakob Disease is a rare degenerative disorder of the
central nervous system which occurs sporadically at an annual rate of
about 1 case per million people. It is one of several fatal
neurodegenerative diseases occurring in humans and animal species, and
is characterised by microscopic  vacuoles in the brain, astrocytosis
and loss of neurones. Dementia appears after a period of vague
prodromal symptoms and rapidly progresses to coma and death, usually
within 2 years of onset. Because the causative agent resists
inactivation by boiling in water, immersion in 10% formalin or 70%
ethanol and ionizing and UV radiation, there has been concern
expressed over the handling of contaminated body fluids, including
CSF, blood and tissues. Four cases of transmission of the agent in
medical laboratory personnel have been documented. Therefore, it is
essential to institute the most stringent safety measures in
laboratories and autopsy rooms where the possibility of encountering
the CJD infectious agent exists.

Specimens from patients with suspected CJD must be treated using
"UNIVERSAL PRECAUTIONS". In the Anatomical Pathology laboratory
appropriate containment and decontamination procedures are necessary
when handling brain tissue and other surgical specimens from suspected
CJD patients. Cut-up / blocking of tissue samples should be performed
in a biohazard hood, preferably located in a separate area. Because of
the known resistance of CJD infectivity to aldehydes and alcohols, the
safest manner in which to handle  biopsy material is by fixation of
small blocks of tissue followed by immersion in 96% formic acid for 1
hour. After washing, these blocks can then be processed routinely for
histology. According to Browne1 the inclusion of a formic acid step in
routine formaldehyde tissue fixation will thus provide histologic
sections of excellent quality, and virtually eliminate the risk of
handling infectious material in the subsequent neuropathologic
processing of tissues from patients with CJD.

Although the fixation of small blocks of tissue followed by immersion
in 96% formic acid for 1 hour virtually eliminates the risk factor, it
is still necessary to clean up the cut up area  and instruments with
0.6% sodium hypochlorite in the normal manner as required for routine
cut up procedures. Gloves, tissue, waste sections, etc. should be
incinerated after use.

1. Brown, P., Wolff, A., Gajdusek D.C. (1990). A simple and 
    effective method for inactivating virus infectivity in 
    formalin fixed  tissue samples from patients with 
    Creutzfeldt Jakob Disease.  Neurology. 40. 887-890.
 2. Creutzfeldt Jakob Disease: Guidelines on Patient Management 
       and Infection Control. (May 1995). National Health and 
       Medical Research Council of Australia. Report by Working 
      Party of the Public Health Committee of the NHMRC. 
3.   Ellis, R.C., and Perry, D. I. (1994). Precautions, Hazards and 
      Laboratory Safety in Woods, 	A.E., and Ellis, A.E. Ed. 
     Laboratory Histopathology - a Complete Reference. Churchill 
    Livingstone. 1.2-18.

ISSUE DATE:     .15/10/99 ....
AUTHORISED BY:   RD Rainbow...................................	  
AMENDED DATE...............  AMENDED BY.......................
REVIEW DATE..............        .REVIEWED BY....................... 

Safety Manual	                                             Page1 of 1

Ron Rainbow
Scientist in Charge
Department of Anatomical Pathology
Royal Hobart Hospital
GPO Box 1061L
Australia 7001
Ph 0362228771
Facsimile 0362228191

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