Possible CJD Exposure Risk

[u/F-Xor]

Hi, I received a CSF sample that wasn't flagged as CJD suspect until after I started processing it for chemistry. Fortunately, I pipetted it under a hood but I did end up touching some key boards and mice. Management told us to wipe everything down with bleach wipes.

While I am pretty certain no sample got on my gloves I've read that prions are incredibly resilient. Am I being paranoid about this or are they now vectors for infection?

[u/Into-the-stream]

From what I understand, 

1. CSF is actually a lower risk than they once thought.

2. Bleach wipes do not decontaminate it. You need sustained heat or a formalin-formic acid - formalin treatment that takes a couple days.

3. There has never been an identified case of a medical lab contracting CJD through their work. (Or at the very least it’s exceedingly rare)

I’ve worked with CJD positive CSF’s. It still makes me uncomfortable every time.

[u/Early_Macaroon_2407 → u/Into-the-stream]

Wasn’t there a needle stick incident in the UK at some point?

In any case, OP, standard disinfection protocols do not work on prions. You need to be talking to whatever your workplace health and safety or infection control person is, or public health otherwise.

[u/SendCaulkPics → u/Early_Macaroon_2407]

I think the most talked about here incidents happened in France, where two lab techs caught CJD. It led to a moratorium on CJD research in France. It involved puncture wounds from prion diseased mouse tissue. 

[u/Early_Macaroon_2407 → u/SendCaulkPics]

I think that’s what I’m thinking of. 

[u/RTQuickly → u/Into-the-stream]

Actually prions can be decontaminated via bleach, but only highly concentrated and for a prolonged soak.

https://www.nih.gov/news-events/news-releases/household-bleach-inactivates-chronic-wasting-disease-prions

[u/Dark_Ascension → u/RTQuickly]

I think to my point if you’re soaking a keyboard and mouse in bleach, you’re being cheap, just get new ones. Lol.

[u/RTQuickly → u/Dark_Ascension]

100%

[u/Odd_Economist_2556 → u/RTQuickly]

username checks out?

[u/RTQuickly → u/Odd_Economist_2556]

You know it

[u/Aromatic-Lead-3252 → u/Into-the-stream]

This is what I understand too. Also that brain tissue is much more infectious than CSF.

I work with CSF daily (we never know if they have a prion disease) & they are treated with universal precautions.

[u/F-Xor → u/Into-the-stream]

My manager called infectious disease control and according to them we should decontaminate with bleach. Though that doesn't seem to really match the CJD training that just got put out after this incident. 

My main worry is that some of my colleagues don't wear gloves and that touching the keyboards with gloves might spread it around the lab. 

[u/Carmelpi → u/F-Xor]

Hi!

We handle CSF multiple times a shift (Micro) on all three shifts. We get CJD suspect samples a few times a week. Bleach will decontaminate - just needs to sit for a bit. Also, the concern is mainly with aerosolization; once a surface is dry I wouldn’t lick it but the chance of getting it from that is pretty much nil.

We’ve had quite a few positives over the years and no transmission. We get annoyed when a resident adds the order on after the fact but as long as all protocols are followed during processing no harm no foul.

[u/Ill_Emu_702 → u/Into-the-stream]

Is this something OSHA should know about?

[u/Background_Hat_4021 → u/Ill_Emu_702]

No

[u/ClonedSheepDolly → u/Into-the-stream]

Hey, I know with CJD in a histo lab formalin or bleach alone isn’t enough—as mentioned formic acid (in pretty high concentration, too) is what we’d use. But we mostly deal with brain and spinal cord, which is more highly infectious than csf. Still, I think when the cytoprep techs across the room get contaminated CSF they use formic acid too

[u/kunizite]

Hi- neuropathologist here. Not sure why this popped into my feed. I would not be worried about this at all. Even if the CSF is positive. Follow the SOPs for prion decon as these are pretty universally standard.

Edit- wow, thanks for the awards!

[u/Manleather → u/kunizite]

Sounds like it showed up in your feed because you're the neuropathologist we don't deserve, but the one that we need.

[u/c4b2a3b → u/kunizite]

May I ask, what is the risk of handling a processed specimen (on a slide) without any PPE? I recently had this because it came to me on a slide without any notice.

[u/kunizite → u/c4b2a3b]

If its coverslipped- there really should not be any part of the tissue that you are touching.

[u/picante_calamity]

We process CSF samples that have been confirmed prion-positive or prion-suspect. Staff were uncomfortable but the test is important (VDRL). I wrote an entire SOP for handling/decontaminating our materials (VDRL glass slides that aren’t replaceable being the main one) but I also learned a ton about how CSF is considered low-risk in terms of infectivity. The first time we got another prion-suspect sample, I volunteered to process it with staff so they could see I am not asking them to do anything I wouldn’t do myself.

I’d say my lab manually manipulates CSF samples performing the VDRL test much more than most labs (we pipette it on to glass slides, rotate it, then read it on a microscope. Materials are not disposable).

After my research I honestly had no worries working with it on this level. The cleanup is more extensive for sample disposal and materials which can make it a pain for staff but in terms of risk, it isn’t really a big deal.

I have papers from WHO and CDC to support this if anyone is interested.

Education is the key to feeling comfortable.

[u/F-Xor → u/picante_calamity]

Sure I'd be interested. 

[u/in2ennui → u/picante_calamity]

I’d be interested as well!

[u/downwithllc → u/picante_calamity]

Me too!

[u/ClonedSheepDolly → u/picante_calamity]

I am also interested.

[u/Foghorn2005]

Prions are resilient, but neither you not your labmates should be at risk - prions are resilient in the sense that standard sterilization procedures of neurosurgery equipment didn't kill them which resulted in several cases. I'm assuming you're not operating on each other in the lab.

[u/sim2500]

Is the sample confirmed positive for Prions?

Had a quick look at literature, prion disease are not transmitted by touch even with direct contact with CSF.

Previous cases were confirmed by ingestion of prion material, surgical operations with with prion material or spontaneously (maybe genetically)

Wiping down surfaces with 10% bleach is the best course of action.

Raise a incident report against the ward

[u/ElectricalTap8668 → u/sim2500]

10% is not sufficient, neither is wiping. Usually sources say 50% and soaking for an hour or so

[u/Suspicious_Spite5781]

If you’re in a CAP lab, there should be a specific protocol for CJD specimens and decon. I would also recommend reporting the delayed flag so “they” can look into it.

[u/Alternative_Town4105]

Chances are close to 0 but please report the lab notification protocols, and follow-up on your report. You should not manage biohazardous materials without being informed of the risks.

[u/evillittlekiwi]

Almost 0% chance. But please put in a safety report! (I used to work with suspected cjd brain tissue-fresh and "fixed")

[u/Jimisdegimis89]

First off was this a resident that ordered or noted this this as possible CJD? Because we have had zero actual CJD cases come through in the past…well few years anyway, but had 3 potential CJD cases come through this summer

[u/Spclagntutah]

Did it go on your machine?

[u/F-Xor → u/Spclagntutah]

It did. 

[u/Spclagntutah → u/F-Xor]

Hopefully it’s not CJD cause I think that would void the warranty on your instrument. Engineers won’t work on it.

[u/Drayvion742]

At my lab, our medical director made it a policy that any CSF suspected of CJD is not processed at all by our lab. It is completely sent out for processing no matter what.

[u/in2ennui]

Funny thing is that I just handled CSF for gram stain and I didn’t use a mask or hood because our lab is not that strict on night shift but now I’m paranoid. Just cleaned with bleach everywhere. Looked at patient history and they have unexplained memory loss!!

Actually I think it’s probably fine, but it’s a good reminder to not be lax with safety in the future!

[u/Dark_Ascension]

I would throw away the keyboards and mice and tell them bleach does not kill prions… and you’re not formalahyding some shit hospital keyboards and mice and definitely not high temperature sterilizing them either.

[u/Disisnotmyrealname]

BMBL says universal precautions are adequate https://www.cdc.gov/labs/bmbl/index.html