Several guidelines recommend specific treatments for endoscopes, procedures of quarantine for endoscopes, or additional treatments for the endoscope washer disinfector (EWD) in suspected or confirmed cases of Creutzfeldt-Jakob disease (CJD) or variant CJD (vCJD) but vary in many details. This study therefore reviewed guidelines on reprocessing flexible endoscopes after use in patients with suspected or confirmed prion disease. In addition, a literature search was performed in Medline on prion, CJD, vCJD, chemical inactivation, transmission healthcare, epidemiology healthcare, concentration tissue human and endoscope. Thus far, no case of CJD or vCJD transmitted by flexible endoscope has been reported. In animals it has been shown that oral uptake of 0.1-5 g of bovine spongiform encephalopathy (BSE)-infected brain homogenate is necessary for transmission. The maximum prion concentration in other tissues (e.g., terminal ileum) is at least 100-fold lower. Automated cleaning of endoscopes alone results in very low total residual protein ≤5.6 mg per duodenoscopes. Recommendations vary between countries, sometimes with additional cleaning, use of alkaline cleaners, no use of cleaners with fixative properties, use of disinfectants without fixative properties or single-use disinfectants. Sodium hydroxide (1 M) and sodium hypochlorite (10,000 and 25,000 mg/L) are very effective in preventing transmission via contaminated wires implanted into animal brains, but their relevance for endoscopes is questionable. Based on circumstantial evidence, it is proposed to consider validated reprocessing as appropriate in the case of delayed suspected prion disease when immediate bedside cleaning, routine use of alkaline cleaners, no fixative agents anywhere prior to disinfection and single use brushes and cleaning solutions can be assured.

中文翻译：

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病毒病和灵活的内窥镜后处理推荐程序-回顾世界范围内的政策并提出简化方法的建议。

在可疑或确诊的克雅氏病（CJD）或变异性CJD（vCJD）病例中，一些指南建议对内窥镜进行特定处理，对内窥镜进行隔离或对内窥镜清洗消毒器（EWD）进行其他处理，但在许多细节上有所不同。因此，本研究回顾了在疑似或确诊的pr病毒病患者使用后对内窥镜进行再处理的指南。此外，在Medline中对on病毒，CJD，vCJD，化学灭活，传播医疗保健，流行病学医疗保健，人体浓缩组织和内窥镜进行了文献检索。迄今为止，还没有报道过由柔性内窥镜传输的CJD或vCJD病例。在动物中，口服摄入量为0。1-5克牛海绵状脑病（BSE）感染的脑匀浆是传播所必需的。其他组织（例如回肠末端）中的最大病毒浓度至少低100倍。单独使用内窥镜进行自动清洁会导致每个十二指肠镜的总残留蛋白质非常低，≤5.6 mg。建议因国家而异，有时需要额外清洁，使用碱性清洁剂，不使用具有固定性的清洁剂，不具有固定性的消毒剂或一次性消毒剂。氢氧化钠（1 M）和次氯酸钠（10,000和25,000 mg / L）在防止通过植入动物脑中的污染电线传播方面非常有效，但是它们与内窥镜的相关性值得怀疑。根据间接证据，