Steam processing is adequate to kill prions, which is the current standard for surgical instruments. Tissue is a completely different story, as it obviously can't be steam sterilized and still viable for transplant. When I had my ACL reconstructed, I chose harvesting my own tendon over using cadaver tissue precisely because of the risk of prions being in the donor tissue. I think the biggest risk, and perhaps where studies should be focused, are with corneal transplants and the like, as the referenced Alzheimers amyloids are found in the eyes.

@Amzungu2 The problem with that, is most decontam departments are understaffed, underpaid, and under-trained.
The spread of MRSA and other contagions are a constant battle.
As someone who worked for years in the field, I am deeply concerned
that most departments are woefully unprepared for what is coming.
As far as individual medical practices go, my concern is even greater.

@KKGator exactly why I chose my own tendon. Very little regulated oversight with these practices. I do all of the processing of instruments in our office and it's easy to see how individual actions can come into play. Not on my watch, though. ?

@Amzungu2 Hmmm I thought prions were indestructable, which a gillion moons ago scared the crud out of me about having any sort of surgical procedure.
"Prions are Forever"
[blogs.scientificamerican.com]

@Qualia That's a somewhat misleading article title, but most are. They are not impossible to destroy it's just very difficult, and, without proper sterilization processes CAN 'live' seemingly forever. Steam processing at higher than normal processing temps is effective at destroying them as well as two or three other specialized processing methods. NiH has a page detailing these processes but my phone won't let me post it. There hasn't been a documented case of prion transmission from surgical instruments since 1980 when many of these processes were improved based on new knowledge of how prions function and survive.

@Amzungu2 My continued point is that most medical facilities, i.e. doctors' offices, will not be cleaning their equipment to the extent needed to eliminate prions.
Most medical office equipment, especially the kind most likely to spread the prions, are never subjected to steam sterilization, or the other "specialized processing methods" you alluded to. Most of what passes for "cleaning" is getting swabbed with an alcohol wipe.

These are the places which are going to be the most at risk for the spreading of these prions.
These are the places where specialized processing methods are least likely to occur.

@Amzungu2 Ah well, documented cases yanno. Who's being screened for prion disease? ?
I imagine that would be spendy & a dr would blow you(global) off since there's nothing that can be done once you've got it.
Not trying to be argumentative but have long ago learned to question everything and everyone when it comes to medical issues. I lost 10 years of my life as a zombie for not questioning. I was the sinusitis ca$h cow. Not one GP suggested I be allergy tested. Just one of many experiences.

@Qualia You're correct, no one screens for prion diseases, as the only way to confirm a diagnosis is brain biopsy or autopsy, so risks far outweigh the benefit to the pt.in most cases. There are helpful diagnostics, but none offer a definitive diagnosis. You should absolutely question your healthcare providers about your medical issues. Every time a patient apologizes for all their questions, my response is that no one cares more about your health than you do, so any question you have is worth an answer. If your provider cannot answer your questions or doesn't respond to your concerns, I'd encourage anyone in that position to find one who will.

@KKGator I have to continue to disagree (to some degree) in so much that 1. No one is doing brain surgery in an office setting, and while prions themselves are found in many organs throughout the body, the infectious kind that cause prion diseases are found nearly exclusively in the brain, though new research has recently shown CJD prions in the eyes as well. So yes, perhaps invasive eye procedures done in offices are at greatest risk of contamination based transmission and I hope there is more research being done there.
2. I work in a surgical based doctors office. WE DO NOT CLEAN OUR INSTRUMENTS WITH ALCOHOL WIPES and anyone who felt this was appropriate sterilization would be terminated. We have an autoclave and a hundred thousand dollar industrial grade endoscope sterilization system. I've worked in multiple surgical practices and none of them have sterilization practices such as what you describe. If you are aware of ones who do, I suggest you report them forthwith.

@Amzungu2 I'm talking about ophthalmology offices, not brain surgery.
Slow your roll, sister.
That's where the greatest danger is going to be.
The equipment in eye doctors' offices isn't the same as surgical practices.
It doesn't get the same sterilization procedures.
Stop acting like you know everything. We are talking about different things.

@KKGator Actually, we are talking about the same thing. Copied from my recent response: "So yes, perhaps invasive eye procedures done in offices are at greatest risk of contamination based transmission and I hope there is more research being done there." I couldn't have agreed with you more. Though initially you did not clarify the only medical and doctors offices you were referring to were ophthalmology focused, so I apologize for that misunderstanding.

@Amzungu2 Accepted. Thank you.

It doesn't even have to be invasive procedures. It can be routine exams, like pressure checks. If the prions can exist on the surface of the eye, and an infected person transfers them during a routine pressure-check, the next person to be checked with the same equipment can have prions transferred to their eyes, and so on. We both know a simple alcohol swab isn't going to do the job, and that's how most small equipment gets cleaned between patients. Especially when said small equipment is ridiculously expensive.
It's that simple.
Change comes very slowly to many medical practices, especially ones run by older doctors.
Alzheimer's could become a damned epidemic specifically for these reasons.

@KKGator I've been told to slow my roll and stop acting like I know everything so here's my balancing act. I am ophthalmology ignorant on both the patient and practice end, but yes, certainly can see the inherent risk. I would like to think reputable practices are aware of recent research and have at least revisited their contamination risks and processing procedures in light of it, but unfortunately not all practices are that proactive. Aside from that, might be a new market opportunity for devising more disposable one time use items or more durable ones that can withstand higher level decontamination. Just hoping I don't need cataract surgery any time soon.