Reuse of angioplasty catheters and risk of Creutzfeldt-Jakob disease

Background In 1996, the Quebec Ministry of Health and Social Services, conc erned that reuse of devices contaminated with blood or blood products could cause the transmission of Creutzfeldt-Jakob disease (CJD), discontinued it s practice of reusing angioplasty catheters despite the significant cost sa vings reuse had afforded the health care system for several years. The obje ctive of this study was to establish whether the medical literature provide s documentation of any cases in which CJD was transmitted by reused percuta neous transluminal coronary angioplasty (PTCA) equipment. Methods and Results A Medline search was performed to identify previous stu dies that examined this issue. Key words for the search included PTCA, CJD, and material and equipment reuse. A substantial amount of effort has been spent on the study of PTCA catheter reuse in relation to the risk of infect ion, toxicity, and catheter breakage as well as cost. In Quebec, studies by the Conseil d'Evaluation des Technologies de la Sante investigated the eff ectiveness of cleaning and sterilizing PTCA equipment and considered the po ssibility that reuse of single-use catheters, hemodialyzers, and cardiac pa cemakers could spread CJD. A number of other studies found evidence that ia trogenic transmission was responsible For several cases of CJD by direct im plantation in or adjacent to the central nervous system during neurosurgery CJD was also transmitted to human beings by injection of pituitary growth hormone and to mice through cerebral inoculation of contaminated blood and urine. However, there were no documented cases of CJD occurring as a compli cation of PTCA equipment reuse. Conclusions The current literature indicates that there are no known cases of CJD attributable to the reuse of PTCA devices contaminated by blood or t o the transfusion of blood or blood products. This practice is associated w ith a very low risk of CJD transmission. With the considerable cost savings made possible by reuse of PTCA equipment, reimplementation of this practic e should be considered by health delivery systems, provided that stringent methods of cleaning and sterilization are observed.