Simplifying the changes in the latest guidance

The Department of Health (England) recently updated its decontamination guidance for surgical instruments and endoscopes.1,2 The guidance documents have been retitled as Health Technical Memoranda, rather than the previous ‘Choice Framework for Policies and Procedures’ or CFPPs. This change has been welcomed by an industry traditionally accustomed to HTM nomenclature. The changes within the HTMs have been driven by research commissioned by the Department of Health to understand the epidemiology of Creutzfeldt-Jacob Disease, and the risk of the transmission of prion protein.3

Prions

Prion diseases are a rare group of uniformly fatal neurodegenerative disorders characterised by a rapid decline in cognition and movement, with features of cerebral and cerebellar dysfunction.4 Although they differ in their specific clinical and pathological manifestations, the diseases result in an accumulation of small proteins traditionally known as prions, which are capable of self-propagation.5 In sporadic disease the prions are primarily confined to the central nervous systems, while in variant CJD (vCJD), infectivity is also detected within peripheral lymphoreticular tissues and blood, though the concentration of prion proteins in peripheral tissues is considerably less than within central nervous tissue. One of the most challenging areas for the decontamination industry is that due to a conformational change, prion proteins are inherently resistant to conventional decontamination technologies.6