Hospital drive to cut CJD risk

Scalpels and other surgical instruments will be changed

The NHS is to spend millions of pounds to prevent any risk of people contracting the human form of BSE during surgery.

From now on, surgeons will have to use disposable instruments when they carry out tonsil surgery, at a cost of £25m a year.

There is a theoretical risk that it could be passed on through surgical operations from those who have yet to show symptoms of the disease

Dr Pat Troop, Deputy Chief Medical Officer

As part of the programme, the government is giving hospitals a further £200m to modernise NHS decontamination and sterilisation facilities to prevent transmission of vCJD

The Department of Health stresses that the risk of contracting variant CJD during surgery is only theoretical.

Disposable equipment for other types of surgery may be introduced at a later date.

Deputy Chief Medical Officer for England and Wales, Dr Pat Troop, said: "We still do not know how many people might be incubating variant CJD.

"There is a theoretical risk that it could be passed on through surgical operations from those who have yet to show symptoms of the disease. The highest standards of decontamination are the cornerstone of our strategy to reduce the risks."

She said the government was following advice from the Spongiform Encephalopathy Advisory Committee (SEAC) in addressing tonsillectomy operations at this stage.

She added: "This will allow us to learn valuable lessons should we decide ultimately to extend the use of single use instruments to other procedures."

Theoretical risk

Hugh Pennington: welcomed move

Tonsils are thought to be a safe haven for these prions. And the worry is that they could be carried on scalpels or other surgical instruments.

Health minister John Denham said: "We have no evidence of any patient being infected with variant CJD in hospital. But while we are still learning about the progress of variant CJD, we should take precautions to reduce the theoretical risk of transmission to patients.

"Scientists tell us that the most effective way to prevent the potential spread of this disease in hospitals is by cleaning and sterilisation to the highest standards."

He said there were no moves as yet to extend single-use instruments to other types of operations.

"SEAC said tonsils were an area where practical steps could be made and that's what we're doing.

"In other areas of surgery, it would be some time before it was practical to introduce single-use instruments. By that time, we will know more about the process of transmission and be able to take a sensible decision then."

Last December, surgeons at one hospital in Portsmouth threatened to stop operations because of faulty sterilisation facilities.

BSE expert

Hugh Pennington, a professor of bacteriology at Aberdeen University and a expert in BSE. the animal form of CJD, told BBC News Online the government's decision was a sensible move.

No-one knows how many people carry the prion agent

He added: "By focussing this approach on young people who have tonsillectomies, it's a very rational and sensible way forward that isn't going to bankrupt the NHS.

He said studies had found prions - possibly the infectious agent responsible for vCJD - present in the tonsils of those who had died of the disease, but not in any studies of tonsils removed from the general population.

Professor Pennington added that there was a theoretical risk of transmission if the same instruments were used in successive operations.

"That is always a possibility that if you cut into the tonsil of someone who's going to come down with CJD in a year or so."

He added current procedures to sterilise instruments were not strong enough to eradicate prions, and said sterilisation particularly needed to focus on forceps and other instruments that have a blade.

The number of confirmed cases of vCJD rose from 15 in 1999 to 25 last year.

The Royal College of Surgeons backed the measures, and said it would work with the Department of Health and instrument manufacturers to ensure single use instruments are available as soon as possible for tonsil surgery.

A spokesperson said: "Although the risk is theoretical and there is no evidence of any surgical patient being infected with variant CJD in hospital, it is sensible to take these precautions."

In 1996, almost 59,000 patients had tonsillectomies.

Dr John Collinge, from the Medical Research Council has been calling for action from the government for the last three years.

He said it was known prions, in addition to being found in tonsils, were concentrated in the brain and the spinal column, the spleen, and probably also in the eye.

He told the BBC: "Operations involving those kinds of areas are the ones we're most concerned about."

But he added"Tonsillectomies, which is a common procedure that's carried out on young people, particularly children, is a wise place to start."