BY ED SUSMAN
LOS ANGELES—Safety procedures for preventing prion disease are widely variable across United States neurological institutions, posing a potential risk for occupational exposure of acquired prion disease, according to a new survey reported here at the AAN Annual Meeting.
"There is a clear need for an AAN task force to create a rational policy regarding safety precautions for lumbar puncture and surgical procedures in patients with suspected prion disease," said Katherine Werbaneth, MD, a resident in neurology at Stanford University Medical Center in California.
"Standardization is needed to hold individual institutions more accountable to adherence to established guidelines, especially given the high consequences of exposure to prion diseases," Dr. Werbaneth said in her presentation. "Implementation and dissemination planning should be integrated into this task force."
She and her fellow researchers received contacted 51 hospitals and received 38 responses from the top neurology/neurosurgery institutions in the country listed by U.S. News and World Report. Of that group, 33 had written policies to prevent transmission of prion diseases, three hospitals declined to share their policies, and two facilities said they had no policies.
"We believe our sample is representative of tertiary and quaternary referral centers. Smaller community hospitals may not have policies due to the rare (1:1,000,000) nature of the disease and the likelihood of triage to tertiary center for diagnostics," she said.
Overall, Dr. Werbaneth said, 40 percent of the facilities failed to regularly implement policies that minimized the number of persons in the operating theater when lumbar puncture or neurological surgery was performed; 20 percent of the facilities failed to comply with cleaning surfaces.
"There is a lack of clarity in infection control precautions for lumbar puncture in World Health Organization (WHO) guidelines," she said. "The WHO 1999 guideline states that lumbar puncture can be performed at bedside, but care should be taken to ensure ease of environmental decontamination. Environmental precautions are not well defined in the WHO guidelines."
"This is an important study," said Raymond P. Roos, MD, FAAN, the Marjorie and Robert E. Straus professor of neurological sciences at the University of Chicago, who was not involved with the survey.
"I don't know the reasons that people are not following the guidelines. My guess is that is because certain hospitals and clinicians don't see the disease frequently because of its rarity Therefore, they may not be up-to-date with respect to what the WHO guidelines are and not have a policy in place."
"Following the guidelines is important because a certain percentage of prion diseases are iatrogenic — they occur as the result of the practice of the medical profession," Dr. Roos told the Neurology Today Conference Reporter. He said that in the past corneal transplants transmitted prion disease — so now corneal transplants from demented individuals cannot be performed; intracerebral electrodes were found to transmit prion disease, and hence there are now disposable intracerebral electrodes.
Dr. Roos said procedures such as lumbar punctures in patients believed to have prion disease should only be attended by personnel who are familiar with prion diseases and respect their dangers. He said that prions can survive on surfaces for long periods of time and therefore their surfaces used in surgery on in lumbar puncture have to be cleaned thoroughly to inactivate the prions that may be present.
LINK UP FOR RELATED INFORMATION:
AAN Annual Meeting Abstract S28.004: Werbaneth K, Tummalapalli P, Kraler L, Gold C. Variability of safety policies related to prion disease among top neurological institutions.