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[Posted on behalf of Kathy Wilson – Moderator]
Hi,
Just need some clarification on the classification of high risk and low
risk patients, Appendix 1 (high risk)under accidentally transmitted
risk factors include treatment with human cadaver pituitary growth
hormone, gonadotrophin or human dura mater graft and exposure to
surgical instruments that have come into contact with higher infectivity
tissues previously used in a case of definite or probable human prion
disease. And in Appendix 2 (low risk) Recipients of cadaver-derived
human pituitary hormones before 1986 Dura mater grafts before 1990 and
individuals involved in a lock back from exposure to surgical
instruments that have been used on high or medium infective tissue from
patients later to be found to have contracted CJD.
What determines if these patients are high risk or low risk?Kathy Wilson
Castle Hill Day Surgery
72-74 Cecil Ave Castle Hill
NSW 2154
Phone 02 88500500
Fax 02 88503011Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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Michael Wishart
Infection Control Coordinator
St Vincent's Private Hospital Northside & St Vincent's Private Hospital Brisbane
Brisbane, QLD
michael.wishart@svha.org.auDear Kathy
I am aware that guidelines differ across the water (!) but herewith a link
to the UK guidelines.
Risk is generally assessed from a number of perspectives, eg what kind of
surgery is being proposed, what surgery has been undertaken previously,
etc etc.http://www.dh.gov.uk/health/2012/11/acdp-guidance/
There may be some useful information/definitions here.
Kind regards
*Jackie *
*Jackie Miley* MSc, PG Cert Public Health, Cert Infection Control,
Dip Rn.Senior Lecturer Infection Prevention and Control
Course Leader MSc Infection Prevention and Control
Course Leader Short Course Infection Prevention & ControlOxford Brookes University
Faculty of Health and Life Sciences
Department of Biological and Medical Sciences
Jack Straw’s Lane
Marston
Oxford OX3 0FLOn 25 February 2013 10:08, Michael Wishart wrote:
> [Posted on behalf of Kathy Wilson – Moderator]
>
> Hi,
> Just need some clarification on the classification of high risk and low
> risk patients, Appendix 1 (high risk)under accidentally transmitted risk
> factors include treatment with human cadaver pituitary growth hormone,
> gonadotrophin or human dura mater graft and exposure to surgical
> instruments that have come into contact with higher infectivity tissues
> previously used in a case of definite or probable human prion disease. And
> in Appendix 2 (low risk) Recipients of cadaver-derived human pituitary
> hormones before 1986 Dura mater grafts before 1990 and individuals
> involved in a lock back from exposure to surgical instruments that have
> been used on high or medium infective tissue from patients later to be
> found to have contracted CJD.
> What determines if these patients are high risk or low risk?
>
> Kathy Wilson
> Castle Hill Day Surgery
> 72-74 Cecil Ave Castle Hill
> NSW 2154
> Phone 02 88500500
> Fax 02 88503011
>
> Messages posted to this list are solely the opinion of the authors, and do
> not represent the opinion of ACIPC.
>
> Archive of all messages are available at http://aicalist.org.au/**archives- registration and login required.
>
> Replies to this message will be directed back to the list. To create a new
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> aicalist-request@aicalist.org.**au .
>
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> the quotes) to listserv@aicalist.org.au
>Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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Hi Kathy
I believe the difference here is symptoms. It is difficult to quantify the risk of transmission in these instances, but if symptoms are present then the risk transmission has occurred is markedly increased. Tihs group of patients has not yet been diagnosed with CJD, but are a possibility because of their possible risk of previous exposure, hence high risk.
No symptoms leaves them in a low risk.
That is how I have always understood this, anyway.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email________________________________________
[Posted on behalf of Kathy Wilson – Moderator]
Hi,
Just need some clarification on the classification of high risk and low
risk patients, Appendix 1 (high risk)under accidentally transmitted
risk factors include treatment with human cadaver pituitary growth
hormone, gonadotrophin or human dura mater graft and exposure to
surgical instruments that have come into contact with higher infectivity
tissues previously used in a case of definite or probable human prion
disease. And in Appendix 2 (low risk) Recipients of cadaver-derived
human pituitary hormones before 1986 Dura mater grafts before 1990 and
individuals involved in a lock back from exposure to surgical
instruments that have been used on high or medium infective tissue from
patients later to be found to have contracted CJD.
What determines if these patients are high risk or low risk?Kathy Wilson
Castle Hill Day Surgery
72-74 Cecil Ave Castle Hill
NSW 2154
Phone 02 88500500
Fax 02 88503011Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.
Replies to this message will be directed back to the list. To create a new message send an email to aicalist@aicalist.org.au
To send a message to the list administrator send an email to aicalist-request@aicalist.org.au.
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Dear All,
As a member of the writing group on the CJD guidelines can I direct you to
the following sections for clarification on this issue.Section 2 on assessing the risk particularly Table 1 which lists the known
infectivity of tissues (risk)
Section 2.3 which describes the risk categories for patients
Section 2.4 on risk assessment and Table 2
The appendices 1 & 2 expand on the above, and are for additional
informationWhat do you need to know:
a) Is the patient having a high risk tissue procedure
b) Do they have any S&S or have reported them – high risk patient
c) Do they fall into the lower risk category – that is a potential risk of
CJD
d) Are they background risk – that is, the rest of the population
(1:1,000,000 background risk)Depending on the above the medical officer should use the questionnaire
(Appendix 3) to further assess the risk and then inform the HCF about any
additional needs BEFORE surgery. This should be conveyed to the OR team to
give them sufficient time to facilitate single use instruments and other
arrangements where available/appropriate to PREVENT unnecessary delays in
surgery and to stop patients being held up in admissions, the ward or worse
(it has occurred) at the OR door.Theroetical risk for those involved in look-backs – classed as low because
it is thought they may have a slightly higher risk than background (it is
theoretical) but are not as ‘at risk’ as those who have been exposed to
pituitary hormones who are definitely low riskDepending on initial risk (S&S, hormone treatment, look-back links etc) and
the type of surgical procedure (table 2) you should be able to categorise
the patient and the risk.
As Michael stated with high risk patients it is about S&S.
Low risk patients having high risk tissue surgery move up to high risk
patients even without S&S.I hopes this clarifies the issue
Michael, I have copied Dr Ann Koehler into this email as the Chair of the
CJD writing group.Regards
(Embedded (Embedded image moved to file: pic21335.jpg)
image moved
to file:
pic26005.jpg)Michele Cullen
Infection Control Consultant | Communicable Disease Prevention and
Control | Public Health
Department of Health | 50 Lonsdale Street, Melbourne, Victoria,
3000
p. 03 9096 5094 | f. 1300 651 170
e. michele.cullen@health.vic.gov.au|————>
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|ACIPC Infexion Connexion |
>————————————————————————————————————————————————–|Hi Kathy
I believe the difference here is symptoms. It is difficult to quantify the
risk of transmission in these instances, but if symptoms are present then
the risk transmission has occurred is markedly increased. Tihs group of
patients has not yet been diagnosed with CJD, but are a possibility because
of their possible risk of previous exposure, hence high risk.No symptoms leaves them in a low risk.
That is how I have always understood this, anyway.
Cheers
MichaelMichael Wishart
CNC Infection Control
Holy Spirit Northside Private Hospital
627 Rode Road, Chermside, Qld 4032
t: (07) 3326 3068 | f: (07) 3326 3523
e: Michael.Wishart@hsn.org.au
w:www.holyspiritnorthside.org.au
Please consider the environment before printing this email________________________________________
Michael Wishart [michael.wishart@internode.on.net][Posted on behalf of Kathy Wilson – Moderator]
Hi,
Just need some clarification on the classification of high risk and low
risk patients, Appendix 1 (high risk)under accidentally transmitted
risk factors include treatment with human cadaver pituitary growth
hormone, gonadotrophin or human dura mater graft and exposure to
surgical instruments that have come into contact with higher infectivity
tissues previously used in a case of definite or probable human prion
disease. And in Appendix 2 (low risk) Recipients of cadaver-derived
human pituitary hormones before 1986 Dura mater grafts before 1990 and
individuals involved in a lock back from exposure to surgical
instruments that have been used on high or medium infective tissue from
patients later to be found to have contracted CJD.
What determines if these patients are high risk or low risk?Kathy Wilson
Castle Hill Day Surgery
72-74 Cecil Ave Castle Hill
NSW 2154
Phone 02 88500500
Fax 02 88503011Messages posted to this list are solely the opinion of the authors, and do
not represent the opinion of ACIPC.Archive of all messages are available at http://aicalist.org.au/archives –
registration and login required.Replies to this message will be directed back to the list. To create a new
message send an email to aicalist@aicalist.org.auTo send a message to the list administrator send an email to
aicalist-request@aicalist.org.au.You can unsubscribe from this list be sending ‘signoff aicalist’ (without
the quotes) to listserv@aicalist.org.au
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_________________________________________________________________________________Messages posted to this list are solely the opinion of the authors, and do not represent the opinion of ACIPC.
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