Prion diseases and iatrogenic infections II. Decontamination

We have by now methods for the safe decontamination of medical devices. They include (a) NaOH, preferably combined with autoclaving in a simultaneous process at 121-134 C (b) NaOCl, alone at ambient temperature for some delicate instruments or combined with autoclaving (but separately); (c) autoclaving alone at 134 C for 18 minutes (Consensus in most European countries); (d) chemical decontamination using alkaline detergents (pH 11-12), proteases (properase, proteinase K, pronase or others) in combination with SDS for temperature-sensitive instruments, i.e. endoscopes and (e) combination of chemicals with autoclaving for temperature-resistant devices. The way of instruments from the operation room to the department of sterilisation (decontamination) is of considerable importance to avoid dessication and fixation of proteins onto instrument surfaces. For these purpose polypropylene pans willed with 0.1N NaOH or appropriate chemicals are very useful for immersion of devices immediately after being used-and then, after transport, transferred into the autoclave using the same fluid, with some fluid added, if necessary for instruments to be immersed. Temperature-sensitive devices in pans with chemicals must not be autoclaved but treated as proposed by the chemicals producer-at ambient or low temperature. In any case devices must not be cleaned in automated washers if not previously decontaminated. The empty pans must finally be autoclaved at 134 C 18 minutes as well.