Reused Devices, Surgery's Deadly Suspects

Blejer's daughter, Ariella, and widow, Hatte, who says contaminated surgical instruments may have caused her husband's death. Sterilization may not remove CJD-carrying prions.
Blejer's daughter, Ariella, and widow, Hatte, who says contaminated surgical instruments may have caused her husband's death. Sterilization may not remove CJD-carrying prions. (By Susan Biddle -- The Washington Post)

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By Alec Klein
Washington Post Staff Writer
Friday, December 30, 2005

One day, Daniel Blejer took a shower. The next, he couldn't recognize soap.

Over the following eight months, the scientist from Alexandria deteriorated quickly. In June, he could barely speak. Three months later, he lost his vision. And on Jan. 2 last year, he died in a Washington hospice at the age of 52.

"There is no person there," said his wife, Hatte. "All that's left is the body."

While she learned the cause of her husband's death -- a rare brain disease called Creutzfeldt-Jakob disease, or CJD -- she still does not know how he got it. She believes he may have contracted the disease from contaminated surgical devices when he underwent a series of brain operations from 1977 to 1980 in Texas and Massachusetts to relieve cranial pressure and remove a tumor, or from human cadaver tissue used in one of the operations.

Surgical devices used during brain surgery frequently are reused on other patients after being sterilized. But medical experts say traditional sterilization methods do not always eradicate the infectious agent from surgical instruments exposed to CJD because it is not a conventional bacteria or virus; it is believed to be an abnormal protein, or prion. In addition, CJD and other prion diseases are difficult to detect and can take years to emerge -- through dementia or neurological impairments.

As a result, when hospitals reuse such devices, medical experts say, there is a small risk that they may be exposing patients to a fatal disease with no known cure. Over the past five years, dozens of patients in at least four U.S. hospitals have been potentially exposed to the disease because their surgeons reused medical instruments first used on patients who had the rare brain disorder, according to documents and interviews.

Blejer, shown at a picnic, underwent a series of brain operations in the late '70s to relieve cranial pressure and remove a tumor.
Blejer, shown at a picnic, underwent a series of brain operations in the late '70s to relieve cranial pressure and remove a tumor.
In 2000, at Tulane University Hospital and Clinic in New Orleans, an autopsy revealed that a patient who underwent brain surgery had CJD. But the hospital had already reused some of the surgical instruments on eight other patients whose identities it did not disclose. The hospital said it has changed its procedures to protect against a recurrence.

Also that year, at Exempla Saint Joseph Hospital in Denver, a patient who did not show prion symptoms underwent a brain biopsy, according to the Joint Commission on Accreditation of Healthcare Organizations. Three weeks later, the pathology report confirmed the patient had CJD, but by then, six other undisclosed patients had undergone brain procedures using the same instruments.

One of those patients, 73-year-old David Thomsen of Littleton, Colo., said he was in "disbelief and shock" when his doctor told him that some of the instruments used in his surgery may have been contaminated. Thomsen said the devices should have been quarantined or destroyed. For about five years, Thomsen said, he has struggled with depression and sleepless nights, wondering if he will contract the deadly disease.

Jeffrey D. Selberg, president and chief executive of Exempla Healthcare, which operates St. Joseph Hospital, said it has revised its instrument procedures to protect against another such accident.

Creutzfeldt-Jakob victim Daniel Blejer died last January.
Creutzfeldt-Jakob victim Daniel Blejer died last January.(Family Photo)
Then, in 2001, at Madigan Army Medical Center in Tacoma, Wash., a shunt was placed in a patient to reduce cranial pressure during a brain operation, according to hospital officials. Later, at a California hospital, she was diagnosed with CJD. Madigan said it suspended its neurological surgeries and destroyed all equipment reused in such cases, but not before five unnamed patients may have been exposed.

In 2004, at Harborview Medical Center in Seattle, up to 12 patients whose names were not released were potentially exposed to a prion disease. During brain surgery on a patient who showed signs of dementia, a surgeon used a reusable biopsy forceps, said Richard G. Ellenbogen, chairman of neurological surgery at the University of Washington, which manages Harborview.


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© 2005 The Washington Post Company

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