1. Patient safety and reduction of risk of transmission of Creutzfeldt–Jakob disease (CJD) via interventional procedures 2008 Implementing NICE guidance NICE interventional procedure guidance 196

2. What this presentation covers Background High-risk procedures Recommendations Costs Discussion Find out more

3. Background What is CJD? What are prions? Iatrogenic transmission

4. High-risk procedures The high-risk procedures covered by this guidance include: -intradural operations on the brain -posterior eye surgery -excision of eye -operations on vitreous body -photocoagulation of the retina for detachment (only when the retina is handled directly) -destruction of lesion of retina -other operations on the retina Please see appendix C of the full guidance for a list of all high-risk procedures covered by this guidance (www.nice.org.uk/IPG196).

5. Recommendations For high-risk surgical procedures Use separate pool of instruments for children born since 1 st January 1997. Steps should be taken to ensure that instruments that come into contact with high-risk tissues do not move from one set to another. Implement strategies to ensure that instruments stay together within sets. Practice should be audited and systems put in place to track surgical instruments. All supplementary instruments should be single use or remain with the set to which they have been introduced. Hospitals should ensure that an adequate supply of instruments is available.

6. Recommendations Neuroendoscopy: Use separate pool of neuroendoscopes for children born since 1 st January 1997. Use rigid neuroendoscopes whenever possible. Thoroughly clean and autoclave after use. All accessories should be single use.

7. Recommendations Single-use neurosurgery accessories should be: - manufactured and procured to specifications equivalent to those used for reusable instruments - quality checked

8. Other key partners Department of Health Advisory Committee on Dangerous Pathogens Spongiform Encephalopathy Advisory Committee CJD Incidents Panel National CJD Surveillance Unit

9. Costs Recommendations with significant costs Costs (£ per year) 1. Instrument tracking and tracing for high-risk proceduresQuantify locally 2. Supplementary instruments for high-risk proceduresNot quantified 3. Rigid autoclave neuroendoscopesQuantify locally 4. Neuroendoscope accessories130 5. Instruments for high-risk procedures on children355 Estimated cost of implementation484

10. For discussion Which recommendations present the greatest challenge for local practice? What changes do we need to make to neurosurgery services? What changes do we need to make to ophthalmic surgical services? How do we track instruments to stop migration between sets? What are the next steps to be considered in implementing the guidance locally?

11. Access tools online Costing tools: costing report costing template Audit criteria Available from: www.nice.org.uk/IPG196

12. Access the guidance online The guidance www.nice.org.uk/IPG196 www.nice.org.uk/IPG196 Understanding NICE guidance – a plain English version www.nice.org.uk/nicemedia/pdf/ip/IPG196publicinfo.doc www.nice.org.uk/nicemedia/pdf/ip/IPG196publicinfo.doc