1 Recommendations

Decontamination

1.1 All surgical instruments that come into contact with high-risk tissues during an interventional procedure must be kept moist and separated from other instruments until they are cleaned, and then disinfected and sterilised (decontaminated). This improves the efficacy of the decontamination process and is highly cost effective.

Set integrity and tracking

1.2 Surgical instruments that come into contact with high-risk tissues must not be moved from one set to another and must remain within their individual sets. Maintaining set integrity reduces the risks associated with instrument migration (including infection) and makes it easier to trace instruments back to the patients they were used on.

Supplementary instruments

1.3 Supplementary instruments that come into contact with high-risk tissues must remain within the individual set to which they have been introduced. Supplementary instruments are those that are not part of a specific instrument set. If supplementary instruments are used with different sets, this would compromise set traceability and increases the risks associated with instrument migration.

Neuroendoscopy

1.4 Rigid neuroendoscopes (rather than flexible neuroendoscopes) should be used if possible. They should be of a type that can be steam sterilised and must be thoroughly cleaned and steam sterilised after each use.

Single-use instruments

1.5 The evidence on cost effectiveness does not support using sets of single-use instruments to reduce the risk of Creutzfeldt–Jakob disease (CJD) transmission.

Systems specifically for people born after 1996

1.6 The evidence on cost effectiveness does not support introducing systems to maintain separate sets of neuroendoscopes and reusable surgical instruments for use on high-risk tissues for people born after 1996.

1.7 Removing the requirement to use different instruments on high-risk tissues for people born after 1996 would not markedly increase the risk of surgical transmission of CJD.

Further research

1.9 NICE may update this guidance after 3 years or sooner if important new information becomes available, including evidence on:

  • the epidemiology of CJD, including data on the prevalence of CJD and its infectivity in the UK population

  • the transmission of CJD by surgical instruments, including cases of CJD in which surgery is a possible route of transmission

  • the cost effectiveness of single-use instruments for use in interventional procedures on high-risk tissues

  • commercially available decontamination methods that are safe and cost effective against prions

  • the systems for, and cost effectiveness of, maintaining set integrity and traceability of instruments.

  • National Institute for Health and Care Excellence (NICE)