Prion Infection Control

Prions primarily reside in the central nervous system, which includes your brain, spinal cord, and cerebrospinal fluid (the watery fluid that bathes the brain and spinal cord). Therefore, regular interaction with people who have CJD should not put you at risk of getting it, too.

Social Contact

There is no evidence to suggest that you can catch CJD through regular social contact – touching, sharing utensils, kissing, or sexual contact. You don't need to wear gloves when touching a loved one with CJD or when handling their belongings. As a general rule, you should always wash your hands thoroughly with soap and water after touching anyone who is ill. Still, spouses and other household members of sporadic CJD patients have no higher risk of contracting the disease than the general population.

Universal Precautions

Prions are very stable molecules that do not readily break down. Standard sterilization procedures, such as cooking, washing, and boiling, do not destroy them. Caregivers should use "universal precautions" when providing any type of medical care beyond social contact. These precautions include:

  • Wash your hands and exposed skin before eating, drinking, or smoking.
  • Cover any cuts or abrasions you might have with waterproof dressings.
  • Wear surgical gloves when dressing any wounds on a person with prion disease.
  • Avoid cutting or sticking yourself with instruments that have also come into contact with the person with prion disease's blood, spinal fluid, or other tissues.

Tissue Infectivity for Health Care Providers

The central nervous system tissues, specifically the brain, dura mater, spinal cord, and eyes, are highly infectious. In vCJD, lymphoreticular tissues are also highly infectious. Cerebrospinal fluid (CSF) and several organs outside the CNS (lungs, liver, kidneys, spleen, and placenta) are considered less infectious but should still be handled with caution.

Only vCJD has been shown to be transmissible by blood transfusion from human to human. Although transmission from blood in other human prion diseases (not vCJD) has not been shown, there is a theoretical risk. Therefore, any exposure with confirmed or suspected prion disease (or with a relative with CJD) must be considered exposure to prion disease.

It is not clear how cautious one needs to be in performing non-neurosurgical invasive procedures on patients with prion disease. Most medical centers treat such procedures and equipment with universal precautions. At our center, given the high number of patients with prion disease, we are more cautious about invasive medical procedures.

When working or caring for patients with prion disease, casual and even intimate contact is not considered a risk factor. When dealing with bodily fluids and excretions, such as blood, urine, or feces, we recommend universal precautions (including disposable gloves and proper disposal of any material that comes into contact with these fluids).

Route of Exposure for Health Care Providers

Human prion diseases are not known to spread by social contact, but transmission can occur during invasive medical interventions, exposure to infected human cadaveric-derived pituitary hormones, dural and cornea grafts, and contaminated neurosurgical instruments.

While there is no evidence of occupational transmission of CJD to healthcare workers, it is prudent to be cautious. The highest potential risk is from transcutaneous exposure to high infectivity tissues (CNS) through needle-sticks, puncture wounds, "sharps" injuries, or contamination of broken skin. Exposure by splashing of the mucous membranes (notably the conjunctiva) must also be avoided. Healthcare personnel who work with patients with confirmed or suspected prion disease, or with their tissues, should be appropriately informed about the nature of the hazard and relevant safety procedures.

Needle-Stick Procedure

  1. Wash the affected area with 1N sodium hydroxide (NaOH) solution for 2–3 minutes.
    1. 1N NaOH = 40 grams of NaOH per liter of water.
    2. Another option is to combine 2 parts 5.25% household bleach (sodium hypochlorite) with 3 parts water to make a 2% solution.
    3. Working solutions should be prepared daily.
  2. Rinse well afterward with soap and water to neutralize the base.
    1. Sodium hydroxide is caustic but relatively slow-acting at room temperature and can be removed from skin or clothing by thorough rinsing with water for 15–30 minutes.
    2. DO NOT use sodium hydroxide or bleach in the eyes or mouth, or on any other mucous membrane. For a splash to the eye or exposure of the mucous membranes, rinse well with saline or tap water.
  3. Cover wound with a waterproof dressing to prevent secondary contamination.
  4. Report your exposure.

 

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