Infection Control in Hospitals

DebbieOney DebbieOney at AOL.COM
Wed May 20 16:26:21 EST 1998

There was a request a couple days ago about infection control in hospitals.  I
feel the following may be of interest.:

Issued jointly by the Department of Health and the Health and Safety
Updated guidance for laboratory and health care workers on safe
working with transmissible spongiform encephalopathies (TSEs) such as
CJD and BSE was jointly published today by the Department of Health,
the Health and Safety Executive and the Ministry of Agriculture
Fisheries and Food.
The revised guidance follows a review of earlier advice on laboratory
and experimental work, and the management of patients with or
suspected to have, or at risk from, CJD and related diseases.  The
review was prompted by the emergence in 1995 of a new variant of
Creutzfeldt-Jakob Disease (nvCJD) and the possibility of a link to
Bovine Spongiform Encephalopathy.
The guidance gives advice on safe working practices to prevent the
transmission of CJD in health care settings, and updates the health
and safety requirements for laboratory work with TSE agents.  It does
not cover incidental exposure, such as on farms, in abattoirs or in
the course of other work with animals, which is addressed in separate
In the clinical context, the guidance stresses that in most cases
there is no need for extra precautions for CJD patients beyond those
used for other patients.  However, because transmission can occur in
specific situations associated with clinical interventions, it is
important to ensure that special precautions are taken where
The guidance makes strict recommendations about the handling of
clinical instruments which have been used on patients with symptoms
of CJD.  It extends previous Department of Health advice, which
recommended disposal of instruments that had been in contact with the
brain, spinal cord or eye, to apply to all instruments used in the
clinical care of this small group of patients.  This extra
precautionary measure aims to reduce still further the remote
possibility of transmitting infection from one patient to another.
The recommendations for patients categorised in the guidance as "at
risk" from CJD, but who do not have any symptoms of the disease,
remain unchanged from those given in earlier guidance.
The guidance also sets out precautionary measures for laboratory work
with BSE, scrapie and other TSE agents.  In addition to the general
requirements for safe working, it gives more detailed information
about experimental work with TSE agents.  It includes the new
stricter requirements for laboratory work with BSE.  This follows the
addition of BSE to the 1998 edition of the UK list of pathogenic
A joint working group of experts from the Advisory Committee on
Dangerous Pathogens (ACDP) and the Spongiform Encephalopathy Advisory
Committee (SEAC) produced the revised guidance which has been
endorsed by both committees.  They recognised the considerable
uncertainties about TSEs, and nvCJD in particular, and stressed the
need to review the guidance regularly as more information becomes
Notes to Editors
1.  Copies of the new guidance, Transmissible spongiform
encephalopathy agents: safe working and the prevention of infection,
ISBN 0-11-322166-5, are available, price BP10, from The Stationery
Office.  Press copies only are available from the Department of
Health Press Office.
2.  The ACDP provides advice to the Health and Safety Commission, the
Health and Safety Executive, and Health and Agriculture Ministers on
all aspects of hazards and risks to workers and others from exposure
to dangerous pathogens, i.e. all infectious agents (bacteria, viruses,
fungi and parasites) capable of causing disease.
The Committee, first set up in 1981, consists of experts in
microbiology and infectious disease and includes representatives of
employers and employees.  Working groups of the ACDP commonly co-opt
others with specialist expertise.
3.  SEAC provides scientifically-based advice to the Ministry of
Agriculture, Fisheries and Food, the Department of Health and
Territorial Departments on matters relating to spongiform
encephalopathies, taking account of the remits of other bodies with
related responsibilities.
4.  In 1997, following the identification of nvCJD, the European
Commission reviewed the EU classification of biological agents.  This
led to a number of amendments to the list to reflect new scientific
knowledge of the disease.  These along with other changes recommended
by ACDP, are included in the 1998 edition of the Approved List of
Biological Agents, which is approved by the Health and Safety
Commission under Section 15 of the Health and Safety at Work Act
1974.  The changes include the addition of nvCJD and BSE, stricter
precautions for E. coli O157 and the addition or reclassification of
rare viruses such as Equine Morbillivirus, simian herpes virus and
hepatitis G.
The new list - Categorisation 98 - is published as a free supplement
to the 1995 ACDP guidance, Categorisation of biological agents
according to hazard and categories of containment.  It is available
from HSE Books, PO Box 1999, Sudbury, Suffolk, CO10 6FS.
It is also available on the HSE's Internet site
at: http//www.open.gov.uk/hse/agents.htm.
BP = [British] pounds sterling

J Ralph Blanchfield, MBE
Food Science, Food Technology & Food Law Consultant
Chair, IFST External Affairs
Web Editor, Institute of Food Science & Technology
IFST Web address <http://www.easynet.co.uk/ifst/>
e-mail: <jralphb at easynet.co.uk>       ICQ# 6254687. 

[This is a bargain. Allowing for postage & packing this should be no more
than US$20.00. - Mod.MHJ]

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