Pre-surgical risk assessment for variant Creutzfeldt-Jakob disease (vCJD) risk in neurosurgery and eye surgery units

Hospitals should use the questionnaire in Annex J of the ACDP TSE Risk Management Subgroup Infection Control guidance to assess whether any patients who are about to undergo any surgery or endoscopy may have an increased risk of CJD. If a patient is found to have an increased risk of CJD prior to their surgery or endoscopy then special infection control precautions may need to be taken. The Department of Health has carried out an analysis  [1] which explores the effect of receiving a large number of blood transfusions on a patient's risk of vCJD infection. The CJD Incidents Panel reviewed this analysis and advises that patients who have received blood components from 80 or more donors may have an increased risk of variant CJD (vCJD).

Annex J of the TSE Infection Control guidance has recently been revised, and now advises that patients who are due to have high risk surgery [2 ] or neuro-endoscopy should be asked an additional question: whether they have received transfusions of blood or blood components from 80 or more donors since 1980. Only these pre-surgical patients should have their transfusion histories assessed, not all patients or those undergoing other surgery.

On 16 July 2009 the HPA wrote to the chief executives of NHS trusts asking them to ensure that the guidance is implemented. Detailed information and tools for implementing the guidance can be downloaded from the links below.

If you have any queries about the implementation of the guidance, please contact the HPA Centre for Infections CJD Section at cjd@hpa.org.uk or on 020 8327 6074/6411.

Information on this new pre-surgical assessment is contained in this Letter to chief executives - July 2009, amended April 2011 (PDF, 74 KB) written to all hospitals in England.

The new version of Annex J of the TSE Infection Control Guidance  contains a questionnaire for patients undergoing high risk surgery and neuro-endoscopy. The questionnaire in Annex J should be used to assess patients' CJD risk factors, including blood transfusion history.

Clinicians carrying out this new pre-surgical assessment should read Pre-surgical assessment vCJD - June 2010, amended April 2011 (PDF, 164 KB).  This vCJD pre-surgical assessment: roles and responsibilities for healthcare staff - June 2010 shows suggested roles and responsibilities for infection control teams, surgical teams and blood transfusion specialists.

Information on patients' transfusion histories should be collected using the Highly transfused vCJD risk assessment form - July 2009 (Word Document, 328 KB) This form is also available as a Highly transfused vCJD risk assessment form and tool - February 2010 (Excel Spreadsheet, 2.7 MB). This may help calculate the number of blood donors to a patient. The form may be posted or emailed to the HPA Centre for Infections CJD Section cjd@hpa.org.uk. If sent electronically, please either encrypt your email or from an nhs.net account please send to cjd.hpa@nhs.net

Blood transfusion laboratories may wish to use this draft Letter to other blood laboratories - July 2009 (Word Document, 31 KB) when collecting transfusion information from other hospitals.

Pre-surgical assessment teams and patients may wish to read vCJD Information for presurgical patients - July 2009 (PDF, 29 KB) about this new pre-surgical assessment.

References

[1] The risk of secondary vCJD infection of patients receiving a high number of blood transfusions.  Department of Health, July 2009.

[2] High risk surgery is defined as surgery involving any of the following organs or tissues (high risk tissues): brain, spinal cord, cranial nerves (specifically the entire optic nerve and only the intercranial components of the other cranial nerves), cranial nerve ganglia, posterior eye (specifically the posterior hyaloid face, retina, retinal pigment epithelium, choroid, subretinal fluid, optic nerve) and pituitary gland.

LINKS

Letter to chief executives - July 2009, amended April 2011 (PDF, 74 KB)

Pre-surgical assessment vCJD - June 2010, amended April 2011 (PDF, 164 KB)

Highly transfused vCJD risk assessment form - July 2009 (Word Document, 328 KB)
 

Letter to other blood laboratories - July 2009 (Word Document, 31 KB)

vCJD Information for presurgical patients - July 2009 (PDF, 29 KB)

Highly transfused vCJD risk assessment form and tool - February 2010 (Excel Spreadsheet, 2.7 MB)

Last reviewed: 8 February 2012