Collection and Submission of Postmortem Specimens from Deceased Persons with Known or Suspected COVID-19, March 2020 (Interim Guidance)

  • Criteria for fastened post-mortem tissue specimen submission to CDC’s Infectious Diseases Pathology Branch (IDPB) for COVID-19 testing

These adjustments had been made June 15, 2020.

CDC steerage for COVID-19 could also be tailored by state and native well being departments to reply to quickly altering native circumstances.

Background

Medical examiners, coroners, and pathologists ought to instantly notify their localexternal icon or stateexternal icon well being division within the occasion of the identification of a deceased individual with recognized or suspected COVID-19.

State and native well being departments can contact CDC’s Emergency Operations Center (EOC) at 770-488-7100 for pressing session if an post-mortem is being thought of for a deceased individual with recognized or suspected COVID-19 or if submission of post-mortem tissue specimens or postmortem swabs to CDC for COVID-19 testing is desired. The EOC will help native/state well being departments to gather, retailer, and ship specimens appropriately to CDC, together with throughout afterhours or on weekends/holidays.

This interim steerage relies on what’s at the moment recognized about coronavirus disease 2019 (COVID-19).

Current information helps that unfold of SARS-CoV-2 (the virus that causes COVID-19) normally occurs when an individual is in shut contact (i.e., inside about 6 ft) through respiratory droplets produced when an contaminated individual coughs, sneezes, or talks. This route of transmission is just not a priority when dealing with human stays or performing postmortem procedures. It could also be doable that an individual can get COVID-19 by touching a floor or object that has the virus on it after which touching their very own mouth, nostril, or probably their eyes. This is just not regarded as the principle approach the virus spreads, however we’re nonetheless studying extra about how this virus spreads. CDC will replace this interim steerage as further data turns into obtainable.

This doc supplies particular steerage for the gathering and submission of postmortem specimens from deceased recognized or suspected COVID-19 instances. This doc additionally supplies suggestions for biosafety and an infection management practices throughout specimen assortment and dealing with, together with throughout post-mortem procedures. The steerage can be utilized by medical experts, coroners, pathologists, different employees concerned in offering postmortem care, and native and state well being departments. Postmortem actions needs to be carried out with a deal with avoiding aerosol producing procedures and making certain that if aerosol era is probably going (e.g., when utilizing an oscillating noticed) that applicable engineering controls and private protecting gear (PPE) are used. These precautions and the usage of Standard Precautions are  applicable work practices to assist stop direct contact with infectious materials, percutaneous harm, and different hazards associated to shifting human stays and dealing with embalming chemical compounds.

Medical examiners, coroners, and different healthcare professionals ought to use skilled judgment to find out if a decedent had indicators and signs suitable with COVID-19 throughout life and whether or not postmortem testing is important. Many sufferers with confirmed COVID-19 have developed fever and/or signs of acute respiratory sickness (e.g., fever, cough, problem respiration). There are epidemiologic elements which will additionally assist information choices about COVID-19 testing, comparable to documented COVID-19 infections in a jurisdiction, recognized neighborhood transmission, contact with a recognized COVID-19 affected person, or being part of a cluster of respiratory sickness in a closed setting (e.g., a long-term care facility). Testing for different causes of respiratory sickness (e.g., influenza) is strongly inspired.

Recommended Postmortem Specimens

Recommendations about the kind of postmortem specimens to collect fluctuate based mostly on whether or not the case of COVID-19 is suspected or confirmed, in addition to whether or not an post-mortem is carried out.

The following elements needs to be thought of when figuring out if an post-mortem might be carried out for a deceased recognized or suspected COVID-19 case:

  • Medicolegal jurisdiction
  • Facility environmental controls
  • Availability of beneficial private protecting gear (PPE)
  • Family and cultural needs

If an post-mortem is carried out for a suspected COVID-19 case, assortment of the next postmortem specimens is beneficial:

  • Postmortem swab specimens for COVID-19 testing:
    • Upper respiratory tract swab: Nasopharyngeal Swab (NP swab)
    • Lower respiratory tract swab: Lung swab from every lung
  • Separate swab specimens for testing of different respiratory pathogens and different postmortem testing, as indicated
  • Formalin-fixed post-mortem tissues from lung and higher airway

If an post-mortem is NOT carried out for a suspected COVID-19 case, assortment of the next postmortem specimens is beneficial:

  • Postmortem Nasopharyngeal Swab (NP swab) specimen for COVID-19 testing
  • Separate NP swab for testing of different respiratory pathogens

If an post-mortem is carried out for a confirmed COVID-19 case, assortment of the next postmortem specimens needs to be thought of:

  • Postmortem swab specimens for testing of different respiratory pathogens,
  • Other postmortem microbiologic and infectious illness testing, as indicated
  • Formalin-fixed post-mortem tissues from lung and higher airway

In addition to postmortem specimens, any remaining specimens (e.g., NP swab, sputum, serum, stool) which will have been collected previous to dying needs to be retained. Please discuss with Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19) for extra data.

Recommended Biosafety and Infection Control Practices

Collection of Postmortem Nasopharyngeal Swab (NP Swab) Specimens Only

Instructions on this part apply if solely postmortem NP swabs are being collected from a deceased individual with recognized or suspected COVID-19. If an post-mortem is being carried out or aerosol producing procedures (AGPs) are being carried out, directions within the part Autopsy Procedures needs to be adopted.

If solely a postmortem NP swab is being collected, people within the room throughout specimen assortment needs to be restricted to healthcare personnel (HCP) acquiring the specimen. HCP ought to comply with Standard Precautions.

Engineering Control Recommendations for NP Swab Collection

Since assortment of nasopharyngeal swab specimens from deceased individuals is not going to induce coughing or sneezing, a detrimental stress room is not required if solely a NP swab is being collected from the decedent. Personnel ought to adhere to Standard Precautions as described above.

PPE Recommendations for NP Swab Collection

Since assortment of nasopharyngeal swab specimens from deceased individuals is not going to induce coughing or sneezing, NIOSH-approved disposable N-95 respirator or larger is not required if solely a NP swab is being collected from the decedent.

The following PPE needs to be worn at a minimal:

  • Wear nonsterile, nitrile, latex or rubber gloves when dealing with doubtlessly infectious supplies.
  • If there’s a threat of cuts, puncture wounds, or different accidents that break the pores and skin, put on heavy-duty gloves over the nitrile gloves.
  • Wear a clear, long-sleeved fluid-resistant or impermeable hospital isolation robe to guard pores and skin and clothes.
  • Use a plastic face protect or a face masks and goggles to guard the face, eyes, nostril, and mouth from splashes of doubtless infectious bodily fluids.

Autopsy Procedures

Standard Precautions, Contact Precautions, and Airborne Precautions with eye protection (goggles or a face shield) needs to be adopted throughout post-mortem. Many of the next procedures are in line with present pointers for protected work practices within the post-mortem setting; see Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories.

  • AGPs comparable to use of an oscillating bone noticed needs to be averted for recognized or suspected COVID-19 instances. Consider utilizing hand shears in its place chopping software. If an oscillating noticed is used, connect a vacuum shroud to include aerosols.
  • Allow just one individual to chop at a given time.
  • Limit the variety of personnel working within the post-mortem suite at any  time to the minimal variety of individuals needed to securely conduct the post-mortem.
  • Limit the variety of personnel engaged on the human physique at any given time.
  • Use a biosafety cupboard for the dealing with and examination of smaller specimens and other containment equipment every time doable.
  • Use warning when dealing with needles or different sharps, and get rid of contaminated sharps in puncture-proof, labeled, closable sharps containers.
  • A logbook together with names, dates, and actions of all employees collaborating within the postmortem and cleansing of the post-mortem suite needs to be saved to help in future comply with up, if needed. Include custodian employees coming into after hours or through the day.

Engineering Control Recommendations for Autopsies

Autopsies on decedents recognized or suspected to be COVID-19 instances needs to be carried out in Airborne Infection Isolation Rooms (AIIRs). These rooms:

  • Are at detrimental stress to surrounding areas
  • Have a minimal of 6 air adjustments per hour (ACH) for present constructions and 12 ACH for renovated or new constructions
  • Have air exhausted instantly outdoors or by means of a excessive effectivity particulate aerosol (HEPA) filter

Doors to the room needs to be saved closed besides throughout entry and egress. If an AIIR is just not obtainable, make sure the room is detrimental stress with no air recirculation to adjoining areas. A transportable HEPA recirculation unit may be positioned within the room to supply additional air filtration . Local airflow management (i.e., laminar move techniques) can be utilized to direct aerosols away from personnel. If use of an AIIR or HEPA unit is just not doable, the process needs to be carried out in probably the most protecting setting doable. AIIR room air ought to by no means be recirculated within the constructing, however instantly exhausted outside, away from home windows, doorways, areas of human site visitors or gathering areas, and from different constructing air consumption techniques.

PPE Recommendations for Autopsies

The following PPE needs to be worn throughout post-mortem procedures:

  • Double surgical gloves interposed with a layer of cut-proof artificial mesh gloves
  • Fluid-resistant or impermeable isolation robe
  • Waterproof apron
  • Goggles or face protect
  • NIOSH-approved disposable N-95 or larger respirator
    • Powered, air-purifying respirators (PAPRs) with HEPA filters might present elevated employee consolation throughout prolonged post-mortem procedures.
    • When respirators are needed to guard employees, employers should implement a complete respiratory safety program in accordance with the OSHA Respiratory Protection commonplace (29 CFR 1910.134external icon) that features medical exams, fit-testing, and coaching.

Surgical scrubs, shoe covers, and surgical cap needs to be used per routine protocols. Doff (take off) PPEpdf icon rigorously to keep away from contaminating your self and earlier than leaving the post-mortem suite or adjoining anteroom.

After eradicating PPE, discard the PPE within the applicable laundry or waste receptacle. Reusable PPE (e.g., goggles, face shields, and PAPRs) have to be cleaned and disinfected based on the producer’s suggestions earlier than reuse. Immediately after doffing PPE, wash palms with cleaning soap and water for 20 seconds. If palms usually are not visibly soiled and cleaning soap and water usually are not obtainable, an alcohol-based hand sanitizer that comprises 60%-95% alcohol could also be used. However, if palms are visibly soiled, at all times wash palms with cleaning soap and water earlier than utilizing alcohol-based hand sanitizer. Avoid touching the face with gloved or unwashed palms. Ensure that hand hygiene amenities are available on the level of use (e.g., at or adjoining to the PPE doffing space).

If the PPE provide is low, see Strategies for Optimizing the Supply of PPE.

Additional security and well being steerage is offered for employees dealing with deceased recognized or suspected COVID-19 instances on the Occupational Safety and Health Administration (OSHA), COVID-19 websiteexternal icon.

Collection of Postmortem Specimens

Implementing correct biosafety and an infection management practices is important when accumulating specimens. Please discuss with Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19) for extra data.

Collection of Postmortem Swab Specimens for COVID-19 Testing

For suspected COVID-19 instances, CDC recommends accumulating and testing postmortem nasopharyngeal swabs (NP swabs) and if an post-mortem is carried out, decrease respiratory specimens (lung swabs). If the analysis of COVID-19 was established earlier than dying, assortment of those specimens for COVID-19 testing might not be needed. Medical examiners, coroners, and pathologists ought to work with their native or state well being division to find out capability for testing postmortem swab specimens.

NP specimen is the popular alternative for higher respiratory tract swab-based SARS-CoV-2 testing. When assortment of a postmortem NP swab is just not doable, every of the next is a suitable various:

  • An oropharyngeal (OP) specimen
  • A nasal mid-turbinate (NMT) swab
  • An anterior nares (nasal swab; NS) specimen
  • Nasopharyngeal wash/aspirate or nasal aspirate (NA) specimen

Use solely artificial fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with picket shafts, as they might include substances that inactivate some viruses and inhibit PCR testing. Place swabs instantly into sterile tubes containing 2-Three ml of viral transport media.

Nasal swabs (NS) or nasal mid-turbinate (NMT) swabs needs to be positioned in a transport tube containing both viral transport medium, Amies transport medium, or sterile saline.

If each NP and OP swabs are collected, they need to be mixed in a single tube to maximise check sensitivity and restrict use of testing sources.

Upper Respiratory Tract Specimen Collection: Nasopharyngeal Swab (NP swab)

  • Insert versatile wire shaft minitip swab by means of the nares parallel to the palate (not upwards) till resistance is encountered or the space is equal to that from the ear to the nostril of the affected person, indicating contact with the nasopharynx. Swab ought to attain depth equal to distance from nostrils to outer opening of the ear. Gently rub and roll the swab. Leave swab in place for a number of seconds to soak up secretions. Slowly take away swab whereas rotating it.
  • For nasal swabs (NS), a single polyester swab with a plastic shaft needs to be used to pattern each anterior nares.
  • For further steerage, see Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19

Lower respiratory tract Specimen Collection: Lung swabs

  • Collect one swab from every lung (left and proper). Options for lung swab assortment embody the next, and will rely upon the establishment’s commonplace practices or sort of post-mortem process (e.g., full or in-situ post-mortem)
    • During the inner examination, after the heart-lung block is eliminated, insert one swab as far down into the tracheobronchial tree as doable on both facet (left and proper)
    • First wipe the floor of every lung with an iodine-containing disinfectant clear and dry the floor; then use a sterile scalpel to chop a slit of the lung and insert the swab to gather pattern on both facet.

No information are at the moment obtainable on the frequency of detection of extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, by RT-PCR on postmortem swabs collected at totally different durations after dying. If COVID-19 testing on postmortem swab specimens is being thought of for a suspected COVID-19 case, SARS-CoV-2 RNA should be detected as much as Three days postmortem and probably longer based mostly on obtainable information from experiences with MERS-CoV and SARS-CoV; nevertheless sensitivity could also be decreased with an extended postmortem interval, and length of sickness might have to be thought of in decoding a detrimental consequence.

Storage of Postmortem Swab Specimens

Store specimens at 2-8°C for as much as 72 hours after assortment. If a delay in testing or transport is predicted, retailer specimens at -70°C or under.

Collection of Postmortem Specimens for Other Routine Testing

Separate postmortem specimens (e.g., NP or lung swabs) needs to be collected for routine testing of respiratory pathogens at both medical or public well being labs. Note that medical laboratories ought to NOT try viral isolation from specimens collected from recognized or suspected COVID-19 instances.

Other postmortem specimen assortment and evaluations needs to be directed by the decedent’s medical and publicity historical past, scene investigation, and gross post-mortem findings, and will embody routine bacterial cultures, toxicology, and different research as indicated.

Collection of Autopsy Tissue Specimens

Formalin-fixed, and formalin-fixed-paraffin-embedded tissue specimens, obtained at post-mortem, can be utilized to determine a postmortem analysis of COVID-19 an infection through the use of immunohistochemical and molecular methods obtainable on the CDC’s Infectious Diseases Pathology Branch (IDPB). An vital benefit of this strategy is that it permits the preservation and retention of comparatively steady specimens that may be examined at a later date to supply a confirmatory analysis. The assortment of fastened tissues may be significantly vital when standard swab-based testing strategies usually are not obtainable or have supplied inconclusive outcomes.

Viral antigens and nucleic acids could also be focally distributed in respiratory tissues of sufferers with COVID-19 illness and the distribution and amount of virus can fluctuate amongst particular person sufferers. For these causes, we suggest accumulating:

  1.  A minimal of three consultant sections of lung parenchyma, ideally from totally different places.

AND

  1.  A minimal of two sections of airway, to incorporate trachea, bronchi, or each airways.

To decrease potential viral contamination of non-involved tissues, lung and airway specimens needs to be collected instantly following removing of the chest plate. Then place specimens right into a separate sterile specimen cup containing 10% impartial buffered formalin.

Focused sampling of those tissues, collected by autopsies restricted to the chest, or by directed assortment achieved by incision, can be utilized when deemed applicable.

If involvement of a number of different organs (e.g., coronary heart, kidneys) is usually recommended by medical historical past or laboratory findings obtained previous to dying, consultant samples of those tissues needs to be thought of for sampling and submission. Complete autopsies could possibly be warranted in sure circumstances, as decided by the medical expert, coroner, or neighborhood pathologist.

Collection of tissue samples roughly 5 mm in thickness (i.e., pattern would slot in a tissue cassette) is beneficial for optimum fixation. Tissues needs to be positioned in 10% buffered formalin, in a quantity that’s roughly 10 instances higher than the amount of tissue. Optimal fixation is three days (72 hours). Specimens needs to be shipped to CDC as quickly as doable following full fixation. Prolonged immersion in formalin (e.g., > 2 weeks) can diminish the sensitivity of virus detection assays.

Alternately, formalin-fixed, paraffin embedded tissues (unique blocks obtained at post-mortem) may be submitted for analysis.

Considerations Regarding Postmortem Serologic Testing

Serologic assessments for SARS-CoV-2 search for the presence of antibodies. It sometimes takes about one to 2 weeks after sickness onset with COVID-19 for antibodies to develop; some individuals might take longer. Depending on when somebody was contaminated and the timing of the check, the check might not discover antibodies in somebody with a present COVID-19 an infection. Per FDA steerage, antibody assessments haven’t been validated for analysis of COVID-19 an infection, and antibody assessments by themselves are of restricted worth within the fast analysis of a affected person the place COVID-19 an infection is suspected. For extra data, see: Interim Guidelines for COVID-19 Antibody Testing

Safely Preparing the Specimens for Shipment

After accumulating and correctly securing and labeling specimens in main containers with the suitable media/answer, they have to be transferred from the post-mortem suite in a protected method to laboratory employees who can course of them for transport.

  1. Within the post-mortem suite, main containers needs to be positioned into a bigger secondary container.
  2. If doable, the secondary container ought to then be positioned right into a resealable plastic bag that was not within the post-mortem suite when the specimens had been collected.
  3. The resealable plastic bag ought to then be positioned right into a organic specimen bag with absorbent materials; after which may be transferred outdoors of the post-mortem suite.
  4. Workers receiving the organic specimen bag outdoors the post-mortem suite or anteroom ought to put on disposable nitrile gloves.

Submission of Specimens for COVID-19 Testing

Medical examiners, coroners, and different healthcare professionals ought to work with their state and native well being departments to coordinate testing by means of public well being laboratories. In addition, COVID-19 testing, approved by the Food and Drug Administration underneath an Emergency Use Authorization (EUA), is offered in medical laboratories.

Postmortem swab specimens could also be shipped to CDC if testing is just not obtainable at public well being or medical laboratories in a jurisdiction, or if repeated testing outcomes stay inconclusive or if different uncommon outcomes are obtained. State or native well being departments ought to contact CDC at [email protected] previous to submitting samples.

If transport samples to CDC:  If specimens will ship directly, retailer specimens at 2-8°C, and ship in a single day to CDC on ice pack. If a delay in transport will lead to receipt at CDC greater than 72 hours after assortment, retailer specimens at -70°C or under and ship in a single day to CDC on dry ice. Additional helpful and detailed data on packing, transport, and transporting specimens may be discovered at Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19). Specimens have to be packaged, shipped, and transported based on the present version of the International Air Transport Association (IATA) Dangerous Goods Regulations external iconexternal icon.

Label every specimen container with the affected person’s ID quantity (e.g., medical document quantity), distinctive CDC or state-generated NCOV specimen ID (e.g., laboratory requisition quantity), specimen sort (e.g., NP swab) and the date the pattern was collected. Complete a CDC Form 50.34 for every specimen submitted. In the higher left field of the shape, 1) for check requested choose “Respiratory virus molecular detection (non-influenza) CDC-10401” and a couple of) for At CDC, convey to the eye of enter “Stephen Lindstrom: 2019-nCoV PUI-Autopsy”.

Please discuss with our instruction steerage for submitting CDC Form 50.34 discovered right here: Guidelines For Submitting Specimens to CDC.pdf icon

For further data, session, or the CDC transport deal with, contact the CDC Emergency Operations Center (EOC) at 770-488-7100.

Submission of Fixed Autopsy Tissue Specimens to CDC

Criteria for Fixed Autopsy Tissue Specimen Submission

At this time, CDC’s Infectious Diseases Pathology Branch is accepting formalin-fixed (moist) tissues and formalin-fixed, paraffin-embedded post-mortem tissue blocks for COVID-19 testing from decedents when the following three standards are met:

  1. Clinical or pathologic findings, and epidemiologic historical past point out want for COVID-19 testing (i.e., meets standards A OR B):
    1. Unexplained dying occurring on or after 12/1/2019 with medical or pathologic findings and epidemiologic historical past in line with doable COVID-19, (i.e., meets the entire following three standards):
      1. Death occurring on or after 12/1/2019,

        AND

      2. Clinical or pathologic findings for doable COVID-19 (i.e., meets standards a OR b under):
        1. History of fever, cough, shortness of breath, influenza-like sickness, or different signs or symptoms concerning for COVID-19

          OR

        2. Histopathologic proof in respiratory tissues in line with a doable infectious course of, together with acute lung harm (e.g., diffuse alveolar injury), interstitial pneumonitis, pneumonia, or tracheobronchitis

        AND

      3. No various believable analysis
        1. Decedents might have infectious illness testing constructive for a number of different pathogens, however evaluation of medical, pathologic, and epidemiologic data means that COVID-19 must also be thought of.

      OR

    2. Death with laboratory proof of SARS-CoV-2 by different antemortem or postmortem testing however with questions relating to the connection of outcomes to reported medical historical past, noticed gross or histopathologic findings at post-mortem, or the reason for dying

    AND

  2. Adequate specimens can be found:
    • Formalin-fixed (moist) tissues or formalin-fixed, paraffin-embedded (FFPE) tissue blocks from lung or higher airway:
      • If  >four weeks have elapsed since post-mortem, unique FFPE tissue blocks from the time of post-mortem can be found.
      • If FFPE tissue blocks are submitted, a minimal of two respiratory tissue blocks are required.

    AND

  3. Approval of applicable state or native well being division for specimen submission to CDC has been obtained.
Fixed Autopsy Tissue Specimen Pre-Approval and Submission Instructions

For instances assembly the above standards, comply with the steps outlined under to acquire pre-approval from CDC’s Infectious Diseases Pathology Branch to submit specimens for analysis:

    1. Reminder – Healthcare suppliers, pathologists, medical experts, and coroners—please first contact your state, tribal, native, or territorial well being division.
    2. Contact CDC’s Infectious Diseases Pathology Branch at [email protected] for pre-approval. Include the next data within the electronic mail:
        1. Electronically fill, save, and print each pages of the CDC Form 50.34.
        2. An outline of gross or histopathologic findings within the tissues to be submitted.
          In your electronic mail correspondence, don’t embody affected person identifiers comparable to identify, date of beginning, or medical document quantity. You should comply with all relevant federal, state, and native rules to stick to affected person confidentiality and privateness protections.
    1. After you obtain electronic mail approval from CDC:
        1. Electronically fill, save, and print each pages of the CDC Form 50.34.
        2. In the higher left field of the shape, choose Test Order Code CDC-10365 (“Pathologic Evaluation of Tissues for Possible Infectious Etiologies”).
        3. Enter “COVID-19” and supply any relevant CDC and State NCOV Case ID numbers within the Comments part on Page 2 of the CDC 50.34 kind.
        4. In addition to the CDC 50.34 kind, enclose the next within the specimen submission bundle:
          1. Surgical pathology, post-mortem report (preliminary is suitable), or each
          2. Relevant medical notes, together with admission History and Physical (H&P), discharge abstract, if relevant
    1. Mailing/Contact Info:
        1. Formalin-fixed moist tissues and/or formalin-fixed, paraffin-embedded tissue blocks needs to be shipped in appropriate packaging at ambient temperature. Do not freeze fastened tissues.
        2. Ship to: Dr. Sherif Zaki, CDC, IDPB, 1600 Clifton Rd NE, MS: H18-SB, Atlanta, GA 30329-4027
        3. Send monitoring quantity to [email protected]
        4. Tel: 404-639-3132, Fax: 404-639-3043, Email: [email protected]

Cleaning and Waste Disposal Recommendations

The following are basic pointers for cleansing and waste disposal following an post-mortem of a decedent with confirmed or suspected COVID-19. Current proof means that novel coronavirus might stay viable for hours to days on surfaces created from quite a lot of supplies.

Use routine cleansing and disinfection procedures (e.g., utilizing cleaners and water to pre-clean surfaces) previous to making use of Environmental Protection Agency (EPA)-approved disinfectantsexternal iconexternal icon that meet the standards to be used towards SARS-CoV-2, the virus that causes COVID-19.

After an post-mortem of a decedent with confirmed or suspected COVID-19, the next suggestions apply for the post-mortem room (and anteroom if relevant):

  • Keep air flow techniques energetic whereas cleansing is carried out; earlier than cleansing, wait 24 hours in a non-healthcare setting, or if you realize the air adjustments per hour of the room or space in a healthcare setting, comply with the recommended wait time earlier than cleansing.
  • Wear disposable gloves beneficial by the producer of the cleaner or disinfectant whereas cleansing and when dealing with cleansing or disinfecting options.
    • Dispose of gloves in the event that they grow to be broken or dirty and when cleansing is accomplished, as described under. Never wash or reuse gloves.
  • Use eye safety, comparable to a face protect or goggles, if splashing of water, cleaner/disinfectant, or different fluids, is predicted.
  • Wear a clear, long-sleeved fluid-resistant robe to guard pores and skin and clothes.
  • Wear a NIOSH-approved disposable N95 or larger respirator  if you’ll want to clear the room or space in lower than 24 hours or the recommended wait time can’t be met.
  • Additional PPE could also be required to guard employees towards potential hazards related to the cleansing and disinfectant merchandise used and in accordance with the label directions.
  • If PPE is in low provide, and cleansing should happen earlier than the recommended wait time has handed, take into account having employees who carried out autopsies conduct the cleansing and sanitizing of the realm.
  • When respirators are needed to guard employees, employers should implement a complete respiratory safety program in accordance with the OSHA Respiratory Protection commonplace (29 CFR 1910.134external icon) that features medical exams, fit-testing, and coaching.
  • Ensure employees are educated on OSHA’s Hazard Communication commonplace, 29 CFR 1910.1200external icon, to speak with employees concerning the hazardous chemical compounds used within the office.
  • Use Environmental Protection Agency (EPA)-approved disinfectantsexternal icon that meet the standards to be used towards SARS-CoV-2, the virus that causes COVID-19. Follow the producer’s directions for all cleansing and disinfection merchandise (e.g., focus, software technique, contact time).
    • Clean the floor first, after which apply the disinfectant as instructed on the disinfectant producer’s label. Ensure sufficient contact time for efficient disinfection.
    • Adhere to any security precautions or different label suggestions as directed (e.g., permitting sufficient air flow in confined areas and correct disposal of unused product or used containers).
    • Avoid utilizing product software strategies that trigger splashing or generate aerosols.
    • Cleaning actions needs to be supervised and inspected periodically to make sure right procedures are adopted.
  • Do not use compressed air and/or water underneath stress for cleansing, or some other strategies that may trigger splashing or may re-aerosolize infectious materials.
  • Gross contamination and liquids needs to be collected with absorbent supplies, comparable to towels, by employees conducting the post-mortem sporting designated PPE. Gross contamination and liquids ought to then be disposed of as described under:
    • Use of tongs and different utensils can decrease the necessity for private contact with dirty absorbent supplies.
    • Large areas contaminated with physique fluids needs to be handled with disinfectant following removing of the fluid with absorbent materials. The space ought to then be cleaned and given a remaining disinfection.
    • Small quantities of liquid waste (e.g., physique fluids) may be flushed or washed down odd sanitary drains with out particular procedures.
    • Hard, nonporous surfaces might then be cleaned and disinfected as described above.
  • Follow commonplace working procedures for the containment and disposal of used PPE and controlled medical waste. State and native governments needs to be consulted for applicable disposal choices.
  • Dispose of human tissues based on routine procedures for pathological waste.
  • Clean and disinfect or autoclave non-disposable devices utilizing routine procedures, taking applicable precautions with sharp objects.
  • Materials or clothes that might be laundered may be faraway from the post-mortem suite (or anteroom, if relevant) in a sturdy, leak-proof biohazard bag that’s tied shut and never reopened. These supplies ought to then be despatched for laundering based on routine procedures.
  • Wash reusable, non-launderable objects (e.g., aprons) with a detergent answer on the warmest setting doable, rinse with water, decontaminate utilizing disinfectant, and permit objects to dry utterly earlier than subsequent use.
  • Keep digicam, telephones, pc keyboards, and different objects that stay within the post-mortem suite (or anteroom, if relevant) as clear as doable, however deal with as if they’re contaminated and deal with with gloves. Wipe the objects after use with applicable Environmental Protection Agency (EPA)-approved disinfectantsexternal icon that meet the standards to be used towards SARS-CoV-2, the virus that causes COVID-19. If being faraway from the post-mortem suite, guarantee decontamination to the extent doable with applicable disinfectant based on the producer’s suggestions previous to removing and reuse.
  • When cleansing is full and PPE has been eliminated, wash palms instantly with cleaning soap and water for 20 seconds. If palms usually are not visibly soiled and cleaning soap and water usually are not obtainable, an alcohol-based hand sanitizer that comprises not less than 60% alcohol could also be used. However, if palms are visibly soiled, at all times wash palms with cleaning soap and water earlier than utilizing an alcohol-based hand sanitizer. Avoid touching the face with gloved or unwashed palms. Ensure that hand hygiene amenities are available on the level of use (e.g., at or adjoining to the PPE doffing space).

Transportation of Human Remains

If it’s essential to switch a physique to a bag, comply with Standard Precautions, together with further private protecting gear (PPE) if splashing of fluids is predicted. Standard physique bagging procedures needs to be adopted, in line with procedures used for deaths the place COVID-19 is just not suspected. Given the various weights of decedents and selection, building, and situations of physique bag supplies, postmortem care employees ought to use prudent judgement figuring out if dangers for puncture, tearing, or failure of physique luggage might happen and whether or not a second physique bag or a physique bag of thicker, stronger materials (e.g. minimal of 6 mil thickness) is important. Risk elements embody however usually are not restricted to:

  • Presence of sharp objects on the decedent that would trigger punctures or tears (e.g. jewellery, piercings, medical devices)
  • Weight of the decedent that would trigger the bag/bag deal with to fail throughout transport (if obtainable, confirm physique bag weight capacities as supplied by the producer)
  • Bodily fluids posing publicity dangers to employees transporting the physique ought to a puncture, tear, or failure happen (e.g. SARS-CoV-2 has been detected within the feces of some sufferers identified with COVID-19, although whether or not the virus in stool is infectious is unknown, Standard Precautions for bloodborne pathogens ought to at all times be taken.)
  • Damage or degradation to the physique bag which will have occurred in cargo or storage (e.g. the bag is damaged or brittle)

Follow commonplace routine procedures when transporting the physique after specimens have been collected and the physique has been bagged. Disinfect the surface of the bag with Environmental Protection Agency (EPA)-approved disinfectantsexternal icon that meet the standards to be used towards SARS-CoV-2, the virus that causes COVID-19, utilized based on the producer’s suggestions. Wear disposable nitrile gloves when dealing with the physique bag.

Additional Resources:

Leave a Comment

Item added to cart.
0 items - $0.00