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Prions, prion diseases and decontamination.

Prions are extremely resistant to disinfection and sterilization methods used so far. The pathogenic prion protein core (called prion) consists of 142 amino-acids, is resistant to proteolytic enzymes, has a mass of 15 pikograms and is filtrable. Fixed by desiccation or chemicals may retain infectivity for years. It survives dry heat at 200 degrees C for 1-2 hours. Prions are fixed to stainless steel within minutes and remain infectious for long periods. Their pathogenetic properties depend on tertiary spatial structure (conformation) which is specific and transmissible in experiment. The prion decontamination appears by far the most important area of the prion science because very little, or nothing, has been done in the majority of world hospitals to prevent iatrogenic transmission. The number of potentially infectious patients is not known. Therefore, patients undergoing neurosurgery, laryngeal or ophthalmic operations, orthodental treatments and even anaesthetic or endoscopic applications should be classified into risk groups, even if clinically priondisease inapparent. The use (or misuse) of disposable instruments is certainly not the final answer for all cases and classic decontamination procedures, if possible because of the character of medical devices, appear still of greatest importance. We consider the high pathogen safety (HPS) autoclave from FEDEGARI as the best actual equipment for the effective decontamination of prions in the hospital practice. The investment costs are moderate and the handling is simple but must be careful. It appears practicable even in small specialized units.