Follow the Recipe for Successful Outcomes

Reduce TSE on “Suspect” Medical Devices

Last week, I introduced you to a novel solution and process for infection prevention for devices potentially exposed to TSE (infectious prion proteins). While Case Medical spent a decade discovering how enzymatic cleaners can do more than remove soil from contaminated devices, controlling the variables is just as important as selecting the right ingredients. When it comes to infectious prion proteins that adhere to stainless steel devices like barnacles, even sterilization and incineration may not inactivate them. Finding a solution can be very risky without controlling every parameter. That is why launching our product, BioGone, took some years as we needed to find a way to control the variables as best we can for infection prevention. As we explained in the blog last week, our prion solution, BioGone pre-treatment, is not a cure but an ounce of prevention.

How to Achieve a Successful Outcome

“The recipe for success has three ingredients: a positive mindset, a worthy goal, and inspired action,” said Jenny Watt speaking about individual achievement in a LinkedIn article. She explains that whenever she got lazy about how she mixed the ingredients or missed a step …she failed. She used an analogy, “baking”, that made sense to me. It reminds me of learning to bake with my mother. Her recipes were handwritten and included the ingredients as well as all the parameters step by step to produce a tasty apple pie, luscious ice box cookies, and the family favorite Canaster coffee cake. I learned as a child that having the right ingredients alone won’t result in the best outcome. What’s needed is to follow each step carefully in the right order of addition and understand that baking is a science. One misstep can result in your cake being a cookie, your bread a cracker, and even with the very best of intentions, the outcome is not only unexpected but tasteless.

Why a Recipe is Needed in SPD

In the case of instrument processing, a misstep or omission can be dangerous when the goal is to do no harm. In medical terms, "do no harm" (Latin: primum non nocere) is a fundamental ethical principle emphasizing the importance of avoiding harm to patients during medical care, prioritizing patient safety and well-being. In suspected CJD cases where brain or spinal instruments “suspects” may be contaminated with TSE, infectious prion proteins, the risk of harm to staff or the next patient(s) is unknown at the time, but the outcome from cross contamination is frightening. The symptoms of the disease can occur after decades, and the outcome is always fatal. Therefore, it’s time for us to evaluate how these “suspects” are handled and to consider separating, isolating, and processing these “suspect” devices separately to avoid cross-contamination. When confronted with a persistent, infectious agent with no known cure, isolation is not enough. This is where a scientific approach is needed to ensure that a validated solution and process should be followed step by step to reduce the spread from patient to patient(s) through surgical tools.

The Recipe for Treating “Suspect” Devices

Case Medical worked with USGS scientists in their prion laboratory in Madison, WI and found that an enzymatic detergent (BioGone) with a high concentration of protease has the potential to reduce Prion Proteins from contaminated surgical tools. The recipe calls for specific equipment (a dedicated sonic or water bath), high purity water, and an enzymatic detergent at a specified concentration, temperature, and contact time. But first, isolate and separate from other devices.

Ingredients and Equipment:

BioGone detergent…2 ounces/gallon
High purity water
Tabletop sonic
Measuring cup
Autoclave
Personal protective equipment

Instructions:

Add BioGone to the sonic at the prescribed dilution
Preheat the sonic to approximately < 60 C°
Submerge the instruments in the water bath
Process for 20 minutes
Rinse with high purity water
Follow with sterilization for up to 18 minutes

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Visit us anytime at www.casemed.com to learn more about our products and services. We are here to help. Case Medical is a U.S. EPA Safer Choice Partner of the Year and a Frontrunner in the Chemical Footprint Project. Contact us today to learn more about our certified eco-friendly cleaners and detergents and how we can help your facility’s bottom line with reusable and environmentally preferred products and services.

Kindest Regards,

Marcia Frieze and the Case Medical team