George Kuriakose
Consultant Neurosurgeon, Salford Royal Foundation Trust , Manchester, M6 8HD , UK E-mail:
Br J Neurosurg. 2014 Apr;28(2):295. doi: 10.3109/02688697.2014.901709.
In 2006, NICE brought out guidance relating to prevention of vCJD through contaminated surgical instruments. This was with the aim of protecting patients born after 1997 who did not have any risk of developing vCJD through eating beef contaminated with BSE through the food chain. Many adult neurosurgical units did not pay much attention to this until 2013 when they were suddenly faced with these children who were now 16 and being admitted to the adult neurosurgical service rather than pediatric. The NICE guidance requires that most patients born after 1997 be operated on using a separate set of neurosurgical instruments than those born before this. This is proving to be a huge financial, as well as logistical, challenge and also a clinical risk as attention is being diverted to searching for the right kit when it should be spent on saving lives. It is now clear in 2013 that the risks that NICE feared were perhaps overstated as there is nowhere near the number of deaths from vCJD that NICE had feared would happen. Worldwide there have been only five cases whereby CJD was transmitted through contaminated neurosurgical instruments and the last case was in 1976. There have been no cases of vCJD transmission attributed to use of contaminated neurosurgical instruments. NICE should revisit this guidance urgently in view of these circumstances.
2006年，英国国家卫生与临床优化研究所（NICE）发布了关于通过受污染手术器械预防变异克雅氏病（vCJD）的指南。其目的是保护1997年以后出生的患者，这些患者不会因食物链中受牛海绵状脑病（BSE）污染的牛肉而有感染vCJD的风险。许多成人神经外科单位直到2013年才对此予以重视，当时这些1997年后出生的孩子突然年满16岁，开始进入成人神经外科接受治疗，而非儿科。NICE指南要求，对于大多数1997年以后出生的患者，手术时应使用与1997年以前出生患者不同的一套神经外科器械。事实证明，这在财务和后勤方面都是巨大的挑战，也是一种临床风险，因为注意力被转移到寻找合适的器械套件上，而这些精力本应用于拯救生命。2013年现在很清楚的是，NICE所担心的风险可能被夸大了，因为vCJD导致的死亡人数远没有达到NICE所担心的程度。全球范围内，仅有5例克雅氏病（CJD）是通过受污染的神经外科器械传播的，最后一例发生在1976年。没有vCJD传播归因于使用受污染神经外科器械的病例。鉴于这些情况，NICE应紧急重新审视该指南。
