Page updated 9 October 2007
3.0. Guidelines for Diagnosis and Care
These guidelines are based on current UK Guidelines
These guidelines are being continually reviewed in the light of new knowledge, particularly with respect to vCJD. The Infection Control Team must be informed of all procedures involving high risk patients (known or suspected), to ensure that the most recent advice is taken into account.
In addition, vCJD prion is known to involve the lymphoreticular system early in the course of incubation. The number of asymptomatic individuals harbouring the prion is not known. Therefore vCJD is of particular concern as an infection risk. Any procedure involving either the lymphoreticular system or nervous system of a patient with vCJD is regarded as a risk for transmission. Blood and blood products could be contaminated with vCJD prions and a recent report suggests that at least three incidents of transfer from donor to recipient has occurred. In the UK , all products involving human plasma are sourced from non-UK donors, and blood from transfusion is routinely leucodepleted. Organs or tissue for transplantion are not taken from any cases with suspect or proven CJD of any form. Avoiding unnecessary procedures on patients who have, or might have any form of spongiform encephalopathy is the most certain way of preventing iatrogenic infections.
Statement of Diagnosis
Only a Consultant Neurologist can label a patient as having suspected (possible or probable) CJD. If in doubt, seek expert advice. Do not perform any invasive procedure on a patient with neurodegenerative disease without considering the possibility of a diagnosis of prion disease. (Quarantine instruments used in emergency procedures)
Making a Diagnosis
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If a case is suspected
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Before doing a procedure on a patient with degenerative neurological disease,
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Those in charge of the patient must contact the local Infection Control Team
Before cerebral biopsy in patients with dementia, seek a second opinion from an expert in prion disease (see references)
Patient Care
The Department of Health publication "CJD: Guidance for Healthcare Workers" states that any patient diagnosed with prion disease is to have a key worker identified. This key worker will be constantly involved in the co-ordination of the patient's care, in both the hospital and community settings. When a patient is given a confirmed diagnosis of prion disease, a member of the team responsible for their care will inform the infection control nurse.
Because of the continuing media interest in prion disease, staff need to be particularly aware of issues concerning patient confidentiality.
Ward Care
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Routine ward care of patients with, or suspected of having prion disease, does not require special precautions, other than those routinely used in the safe handling of patients, their excreta, sharps and body fluids. Patients do not need to be nursed in isolation for infection control.
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