A patient had a spinal fusion this morning; the surgeon reports a positive 14-3-3 protein test at another facility. What is the primary infection prevention intervention you should perform?

• A. Collaborate with the sterile processing department to ensure surgical instruments are handled appropriately.
• B. Place the patient on airborne precautions.
• C. Delay the procedure and isolate the patient.
• D. Notify public health authorities.

Answer: (A)

When prion disease is suspected, the biggest infection prevention concern is preventing transmission via contaminated surgical instruments. Prions can adhere to instruments and are notoriously resistant to standard sterilization methods, so the safest course is to work with the sterile processing department to ensure instruments from the case are decontaminated using prion-specific protocols or, if indicated, disposed of as appropriate. This minimizes the risk of iatrogenic transmission to future patients and addresses the core safety risk in this scenario.

Airborne precautions aren’t the priority here because prion transmission isn’t effectively prevented by airborne measures. Delaying the procedure and isolating the patient isn’t needed for immediate infection control in this context. While public health reporting may be required in some jurisdictions for suspected prion diseases, the most immediate action to protect others is ensuring proper instrument handling and decontamination.