Date: 5 Jan 2001
From: ProMED-mail <promed@promedmail.org>
Source: BBC Online, Thu 4 Jan 2001 13.21 GMT [eited]
<http://news.bbc.co.uk/hi/english/health/newsid_1100000/1100280.stm>
Obligatory Use of Disposable Instruments in Tonsillectomy
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The National Heath Service (NHS) is to spend millions of pounds to prevent
any risk of people contracting the human form of BSE [variant CJD] during
surgery. From now on, surgeons will have to use disposable instruments when
they carry out tonsil surgery, at a cost to the NHS of £25 million a year.
As part of the program, the government is giving hospitals a further £200
million to modernize NHS decontamination and sterilization facilities to
prevent transmission of variant CJD. The Department of Health stresses that
the risk of contracting variant CJD during surgery is only theoretical.
Disposable equipment for other types of surgery may be introduced at a
later date.
Deputy Chief Medical Officer for England and Wales, Dr. Pat Troop, said:
"We still do not know how many people might be incubating variant CJD.
There is a theoretical risk that it could be passed on through surgical
operations from those who have yet to show symptoms of the disease. The
highest standards of decontamination are the cornerstone of our strategy to
reduce the risks." She said the government was following advice from the
Spongiform Encephalopathy Advisory Committee (SEAC) in addressing
tonsillectomy operations at this stage.
Health minister John Denham said: "We have no evidence of any patient being
infected with variant CJD in hospital. But while we are still learning
about the progress of variant CJD, we should take precautions to reduce the
theoretical risk of transmission to patients. He said there were no moves
as yet to extend single-use instruments to other types of [surgery]. "SEAC
said tonsils were an area where practical steps could be made and that's
what we're doing. In other areas of surgery, it would be some time before
it was practical to introduce single-use instruments. By that time, we will
know more about the process of transmission and be able to take a sensible
decision then."
The Royal College of Surgeons backed the measures, and said it would work
with the Department of Health and instrument manufacturers to ensure single
use instruments are available as soon as possible for tonsil surgery. In
1996, almost 59 000 patients had tonsillectomies.
Dr. John Collinge, a Medical Research Council Scientist, has been calling
for action from the government for the last 3 years. He said it was known
that [variant CJD] prions, in addition to being found in tonsils, were
concentrated in the brain and the spinal column, the spleen, and probably
also in the eye. He told the BBC: "Operations involving those kinds of
areas are the ones we're most concerned about." But he added:
"Tonsillectomy, which is a common procedure carried out on young people,
particularly children, is a wise place to start."
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