Concerns about prion disease spotlight surgical safety risks

Issues relating to ophthalmic surgery safety were reviewed in a safety conference moderated by Randall J. Olson, MD, and attended by Francis Mah, MD, and Henry Perry, MD. The potential for transmission of diseases caused by prions was a major focus of their discussion.

Prions are the non-viral, non-bacterial infectious proteins that are the cause of Creutzfeldt-Jakob disease (CJD), bovine spongiform encephalopathy, and a new variant of CJD carried by deer and elk that appears to manifest in humans with a rapidly fatal course.

Exposure to prion-mediated disease is particularly relevant to ophthalmic surgery because the eyes, along with the brain and spinal cord, are considered high-infectivity tissues.

In addition, persons infected with prions may remain asymptomatic for years, and currently there are no tests available to diagnose infection. For those reasons, any person needs to be considered as potentially infected. Moreover, unlike bacteria and viruses, it is unclear whether prions contaminating medical instruments can be destroyed using recommended sterilization techniques.

"The potential for contracting bloodborne infections, such as HIV or hepatitis C, as a result of a sharps injury has provided reason enough to implement universal safety precautions, but the potential risk of transmission of prion-mediated disease adds another layer of concern and reinforces the importance of adopting solutions for protection," said Dr. Perry, chief, cornea service, Nassau County Medical Center, East Meadow, NY and senior founding partner, Ophthal-mic Consultants of Long Island.

Safety solutions The panel members agree that recently introduced single-use, shielded blades offer an important step forward in sharps injury protection. Becton, Dickinson and Co. (BD) is marketing such products, although other ophthalmic instrument manufacturers are expected to follow suit in introducing new safety-oriented blades. The BD line of patented, safety-engineered, single-use incision products features an integrated retractable shield to protect the blade and prevent sharps injuries during instrument use and handling. The shield remains in place, covering the blade to make inadvertent injury impossible, until it is retracted by fingertip activation of its spring-assisted mechanism. After the incision has been made, the blade can be reshielded with a simple press of the finger so that the instrument can be handed off safely to an assistant.

The shield is currently available on metal blade instruments (BD Safety Knife with BD Xstar Blade). A new silicon product (BD Safety Knife with BD Atomic Edge) will be launched soon, and BD plans to make the safety shield available on other blade types in the future.