KEY POINTS:
Surgery using instruments potentially contaminated with the fatal brain disease CJD continued for five days after suspicions arose at Auckland City Hospital while the instruments were tracked down.
The hospital said on Monday that 43 patients might be at risk - although the risk was extremely low - of developing Creutzfeldt-Jakob disease (CJD) because they had surgery with some of the $90,000-worth of instruments previously used on a woman suspected of having the illness.
Hospital doctors started to suspect CJD on March 23. The woman, who has not been named, was not recovering properly from surgery done in early March. It took until March 28 to track down all the non-disposable instruments used on her, which were then quarantined for destruction.
It is thought the woman, now "effectively" unconscious, contracted the disease through a graft of tissue from a cadaver when she had brain surgery in 1984. If confirmed, she would be the third New Zealand patient to contract the disease, which produces severe dementia and leaves its victims unable to walk or breathe properly, in this way.
Australian neurosurgeon Professor Andrew Kaye, who has had to deal with a worse CJD crisis, said yesterday that Auckland City Hospital should improve its instrument tracking systems to prevent a repeat.
"In fact, the only way of really trying to minimise the damage from this sort of thing in the neurosurgery unit is to have single instrument tracking," said Professor Kaye, director of neurosurgery at Royal Melbourne Hospital.
Auckland City Hospital says it can already track individual instruments through the packs they are placed in before sterilisation, but will consider adopting the Australian facility's practice of having separate instruments for neurosurgery.
Chief medical officer Dr David Sage said yesterday the hospital had discussed the case with Royal Melbourne.
"[Separate instruments mean] you have got a much smaller search, so that if this sort of incident happened again you could pull the instruments in a day, instead of four to five. That means fewer patients potentially exposed."
It would cost well over $100,000, Dr Sage said. Royal Melbourne was one of few hospitals to have done it.
In 2004, Royal Melbourne had to contact more than 1000 brain and spinal patients after CJD was confirmed in a patient who had two operations at the hospital in 2003.
Dr Sage said Auckland City Hospital had some specialised instruments that were used only in neurosurgery, but many others, such as scalpels and forceps, were used for any kind of operation.
It had taken five days to track the instruments after March 23 because when they returned to the cleaning and sterilising unit after the woman's operation, they would have been processed and the common ones dispersed throughout the hospital in different instrument packs. The more times they were used, the more widely they could be dispersed.
Professor Kaye, who was consulted after the Auckland City Hospital incident, said it should implement single instrument tracking, despite its high costs.
"It's not foolproof, but it will minimise the problems later."
Professor Kaye said Auckland Hospital had done a good job under the circumstances.
"The usual situation is if you think the patient has CJD, then you stop using the instrument. But that's a pretty dramatic step to take.
"There's a jump between could this person possibly have CJD - and everybody you see with a dementing illness could possibly have CJD - to making the diagnosis.
"It's a very difficult situation, very hard to handle, and it can arise again tomorrow. In fact, the only way of really trying to minimise the damage from this sort of thing in the neurosurgery unit is to have single instrument tracking.
"The only thing that was unusual about Auckland was it was picked up so quickly, and they only had to notify 40 patients."
