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Page updated 9 October 2007

8.0. Instrument Quarantine Procedure

Designated training staff will deal with the instruments wearing appropriate protective clothing including protective gloves and either a visor or goggles. Care must be taken to avoid penetrating injuries.

Re-usable instruments should be washed to remove gross soil. Care should be taken to avoid splashing and generating aerosols by holding instruments below the surface of the water in a sink into which water is running and draining continuously. Instruments should not be held directly under a flowing tap as this is likely to generate splashes.

Instruments should be placed in disposable instrument tray and allow to air dry. They should then be placed in an impervious rigid plastic container with a close fitting lid. The lid should be sealed with tape (e.g. autoclave tape) and labelled with the patient's identification (i.e. hospital number, name, and date of birth), the date of the procedure, the surgical procedure in which the instruments were used and the name of the responsible person (e.g. the theatre superintendent). The sealed box should be stored indefinitely in a suitably designated place (a locked cupboard) until the outcome of any further investigation is known. The instrument tray must be disposed of by incineration.

Decisions about whether to destroy instruments will be made by the CJD Working Group, NHNN.

If the patient is later confirmed as suffering from CJD, the box and its contents must be incinerated without further examination. If an alternative, definitive diagnosis is confirmed, the instruments may be removed from the box by the responsible person (or named deputy) and sent to the Sterile Services Department (SSD) for processing in the usual way. Recent changes in guidance may result in a requirement NOT to incinerate instruments used outside the nervous system in patients with confirmed classical CJD. The working group will make this decision.

Records must be kept of all decisions, and the SSD must be told of the decision before the instruments are sent for routine processing.

Prolonged autoclaving or supplemental disinfection is not necessary for instruments removed from quarantine, which had been used on a patient not suffering from CJD of any type.