Transmissible spongiform encephalopathy agents: safe working and the prevention of infection: Guidance from the Advisory Committee on Dangerous Pathogens' TSE Working Group | National Resource for Infection Control (NRIC)

Transmissible spongiform encephalopathy agents: safe working and the prevention of infection: Guidance from the Advisory Committee on Dangerous Pathogens' TSE Working Group

Best practice, Review
Abstract: 
As part of its remit, the ACDP TSE Working Group produces the guidance document Transmissible spongiform encephalopathy agents: safe working and the prevention of infection. The aim of the guidance is the minimisation of the risk of transmission of CJD and vCJD. This revised guidance was published from June 2003 in sections, as they were prepared and endorsed by the then Joint ACDP and SEAC Working Group. This group were uncoupled in 2004 to become the ACDP TSE Working Group The current guidance was published in June 2003, replacing the March 1998 edition. The guidance has evolved in the years since, with new annexes being added and current guidance being updated as further scientific information becomes available or future policy decisions need to be reflected. The ACDP TSE Working Group regularly update individual sections of this guidance as further scientific information becomes available or future policy decisions need to be reflected. The date of publication for updated or revised sections is clearly indicated The format is essentially the same as the earlier 1998 publication but is now significantly expanded with additional annexes. The revised guidance contains the following: Statement on ACDP/SEAC Abbreviations Part 1 – Introduction (June 2003) Part 2 – Health and Safety management of TSEs (2 June 2003) Part 3 – Laboratory containment and control measures (15 December 2003 ) Part 4 - Infection control of CJD, vCJD and other human prion diseases in healthcare and community settings (revised and updated July 2010) (Updated 13 December 2010) http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@ab/documents/digitalasset/dh_122647.pdf Annexe A.1 – Revised Annex A1: Distribution of TSE infectivity in human tissues and body fluids. Updated 13 December 2010 Annexe A.2 – Distribution of infectivity in animal tissue and body fluids - 2 June 2003 , updated: 7 February 2007 Annex B – Diagnostic criteria - Published: 2 June 2003 updated: 22 October 2008 Annex C – General principles of decontamination and waste disposal - Published: 16 November 2009 Annex D – Transport of TSE-infected material, this Annex has recently been updated - Published: December 2003, updated: 23 January 2009 http://www.advisorybodies.doh.gov.uk/acdp/tseguidance/tseguidance_annexd.pdf Annex E – Quarantining of surgical instruments - Published: 2 June 2003, revised October 2009 Annex F – Endoscopy – Revised 2 February 2010 - Updated July 2010 Consensus statement from the BSG Decontamination Working Group and the ACDP TSE Working Group Published: November 2005, revised and updated: 2 June 2008 - Endoscopy and individuals at risk of vCJD for public health puposes – Annex G – Decontamination of other specialised equipment – This annex is currently being revised and will be available soon Annex H – After death - Updated May 2010 Information sheet for funeral directors, relatives and others following a CJD death Annex I – Outline Protocol for Management of Instruments and Tissues from Brain Biopsy Procedures on patients with progressive neurological disorders - Published: 2005, updated: May 2007 Annex J - Assessment to be carried out before surgery and endoscopy to identify patients with, or at risk of CJD - revised 2 February 2010; Updated 13 December 2010 Annex K - Guidelines for pathologists and pathology laboratories for the handling of tissues from patients with, or at risk of, CJD or vCJD - Published: March 2009 Annex L - Managing CJD vCJD risk in ophthalmology - Published September 2009; updated May 2010 and updated July 2010 Acknowledgements If you would like to receive email notification of updates to this guidance, please email easo@hpa.org.uk with the subject 'TSE guidance update'
Authors: 
Department of HealthACDP and SEAC
Category: 
Control
Management
Prevention

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Summary:
This guidance replaces the edition issued in March 1998. It follows the monitoring of new scientific information and results from a wide range of research projects that has led to the need to update the existing guidance in areas where new scientific evidence is available. The format is essentially the same as the earlier 1998 publication but is now significantly expanded with additional annexes.The revised guidance contains the following: Statement on ACDP/SEACAbbreviationsPart 1 – IntroductionPart 2 – Health and Safety management of TSEsPart 3 – Laboratory containment and control measuresPart 4 - Infection control of CJD and related disorders in the healthcare setting (revised July 2005) Annexe A.1 – Distribution of TSE infectivity in human tissues and body fluids Annexe A.2 – Distribution of infectivity in animal tissue and body fluidsAnnex B – Diagnostic criteria Annex C – Decontamination and waste disposalAnnex D – Transport of TSE-infected materialAnnex E – Quarantining of surgical instrumentsAnnex F – Decontamination of endoscopes – amended November 2005 Endoscopy and individuals at risk of vCJD for public health puposes – Published November 2005 : a consensus statement from the BSG Decontamination Working Group and the ACDP TSE Working Group Endoscopy sub-groupAnnex G – Decontamination of other specialised equipment – This annex is currently being revised and will be available soonAnnex H – After deathAnnex I – Outline Protocol for Management of Instruments and Tissues from Brain Biopsy Procedures on patients with progressive neurological disordersAcknowledgementsIf there is no link to a specific section or annex this is because it is not yet available. Until a section is posted on the site refer to the advice given in the 1998 guidance
Questions Addressed:
The guidance provides advice to those responsible for the management of work that involves a risk of exposure to TSE infectivity and their staff working with human or animal TSEs in the laboratory, in management and care of patients in handling of deceased patients and in minimisation of risk to other patients and staff.
Type of Study:
Review, Best Practice
Methods Valid:
Yes
Methods Valid Detail:

When the first edition of this document was published a number of uncertainties for example on routes of infection, infection dose, inactivitation of the agent, the potential number of people who may be incubating vCJD and the differences between sporadic and vCJD were acknowledged and a commitment was made to keep the guidance under review as more scientific information became available and the implications of the differences between the different forms of CJD became clearer

Results Reliability:
Yes: Guidance prepared and endorsed by the ACDP, SEAC and the JWG and published on Department of Health CJD website.
Problems or Biases:

No published as prepared and endorsed facilitates easier updating of individual sections as further scientific information becomes available or future policy decisions need to be reflected

Keywords:
Transmissible spongiform encephalopathy (TSE’s) Creutzfeldt-Jakob Disease (vCJD) communicable diseases decontamination of endoscopes endoscopy
Reviewer Name:
Sue Wiseman
Reviewer Post:
Nurse Consultant –Infection Control, DH
Reviewer Affiliations:
Member Advisory Committee on Dangerous Pathogens Health Protection Adviser Royal College of Nursing P/T Member Infection Control Nurses Association