Clinical Article - August 2019
Postanesthesia care of patients being ruled out for Creutzfeldt-Jakob disease.
Jennifer Nopoulos, MSNEd, RN, CPAN
Although extremely rare, a sudden and progressive decline in cognitive functioning not attributable to an easily identifiable cause may include in the differential diagnosis Creutzfeldt-Jakob disease. This central nervous system disease is fatal. Caused by an infectious prion, and related to Bovine spongiform encephalopathy or “mad cow” disease, death can come as quickly as six months after diagnosis (Krause, Singh, et.al. 2016). A brain tissue biopsy confirms or rules out the disease, and the procedure requires specialized protocols in the operating room that include protective equipment and use of disposable instruments (Karasin, 2014).
Transmission of the disease has occurred by transfusion, inadequately sterilized instruments, and corneal and dura mater grafts (Stride, Hunter, & Bailey, 2009). Information and recommendations for operating room nurses has been published, but the pathology is not discussed in American Society of Perianesthesia Nurses (ASPAN) Standards. The following are recommendations synthesized from the available information on disease transmission and the potential risk to care givers.
According to Stride, Hunter, and Bailey (2009), the greatest risk of transmission is from contact with central nervous system and ocular tissues. There is also a possible risk of transmission from contact with cranial or lumbar drains, and cerebral spinal fluid (CSF). Exposure to other body fluids, such as mucous, sputum and urine have not resulted in disease transmission, and there are no cases of health care worker disease due to exposure.
Although isolation is not required, some authors recommend contact precautions to reduce the number of PACU personnel interacting with the patient (Stride, Hunter, & Bailey, 2009). Disposal of any CSF soiled linen or equipment require special handling, ideally double biohazard bags and incineration. Alcohol gels have not been shown to provide effective disinfection, so hand washing is required. Use of disposable equipment such as thermometers, stethoscopes, moisture barrier pads, and cleansing wipes provide best protection against disease transmission to other patients. Finally, concise communication during nurse hand off ensures the continuation of best disease transmission prevention interventions (Karasin, 2014).
During the recovery period, patients with this type of spongiform encephalopathy might experience seizures, aphasia, symptoms of dementia, and incontinence. A basic care plan during the immediate post-operative phase should include a low stimulation environment, limited movement and touch, and fall precautions (Karasin, 2014).
Karasin, M. (2014). Special needs populations: perioperative care of the patient with Creutzfeldt-Jakob disease. Aorn, 100(4), 391-404.
Krause, E.Z., Singh, N.N., et al (2016). Variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy. from https://emedicine.Medscape.com/article/1169688