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Saturday, 15 December, 2001, 05:30 GMT
U-turn over tonsil operations
surgeon
Surgeons have been told not to use single-use devices
The government has been forced to make a u-turn on the use of re-usable surgical instruments for tonsil and adenoids surgery.

They had originally been withdrawn in January because doctors feared there was a theoretical risk of transmission of variant Creutzfeldt-Jacob Disease (vCJD) from re-usable surgical instruments.

However, following the change surgeons, found more patients than before were being harmed during surgery.

There was even one death linked linked to single-use instruments.

Some doctors - inexperienced with the single-use instruments - may not have been using the instruments properly, it has been suggested.

Now doctors have been told they can return to using the re-usable instruments.

This represents an actual risk to patients, compared with a theoretical risk of transmission of vCJD

Department of Health
The Department of Health (DoH) has now issued fresh instructions to surgeons after meetings with the British Association of Otorhinolaryngologists (BAO) about the adverse events caused by single-use instruments and the balance of risks to patients.

The DoH said: "This represents an actual risk to patients, compared with a theoretical risk of transmission of vCJD."

All incidents were investigated by the DoH and the Medical Devices Agency.

Most involved increased bleeding, but earlier this month a single-use diathermy forceps tool which cauterises the wound to halt bleeding was suspended from use following a patient's death.

The routine use of single-use diathermy was suspended on December 4.

vCJD risk

The recommendation to move to single-use instruments came after advice from the Spongiform Encephalopathy Advisory Committee (SEAC).

The fear was that the infective prion agent of vCJD was not completely destroyed by normal sterilisation of reusable instruments.

It recommended a pilot scheme to see how single-use instruments would work in practice.

SEAC has stressed that the key steps in reducing any risk of vCJD transmission is the rigorous implementation of washing, decontamination and general hygiene procedures in the health care setting.

The department said that given the balance of risks, surgeons could return to using re-usable surgical equipment which should be sterilised in the normal way.

Those who do not have immediate access to re-usable instruments, can choose to continue using single-use instruments if they are comfortable with their use and they have not had an increase in adverse events.

Approximately 6,500 tonsillectomies are carried out each month.

Some surgeons did not routinely use diathermy, particularly on children, but had it available as a back-up in case there was extensive bleeding.

See also:

04 Dec 01 | Health
Patient death leads to device ban
04 Jan 01 | Health
Hospital drive to cut CJD risk
16 Jan 01 | Health
BSE risk halts tonsil operations
19 Jul 01 | Health
CJD risk from eye operations
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