EMBALMING
place them into the biohazard bin. To reduce contamination, double bag the first bag. At this point, the facial features may be set, and you may choose to use Saran wrap instead of the disposable mask as it allows the embalmer to observe the facial features during the embalming operation while keeping aerosolization at a minimum. Because COVID is surrounded by a lipid bilayer, use soap to wash and lather the entire body. The soap breaks down this fatty cell wall, destroying the DNA. This is why it has been recommended to wash your hands with soap and water for a minimum of 20 seconds for destruction of the virus. Do not wash this thick layer of soap off, as it should remain on the body throughout the entire embalming procedure. Choosing your fluid selection here should be much more substantial. This, for preservation, but more importantly, allows for better disinfection. The suggested solution should be at 5%. Also, use either Halt GX or Dis-Spray as a co-injection in the arterial solution. Before you begin to raise vessels, incorporate a drain tube for a closed drainage system. The tube will extend down the entire table into the sink (Black et al., 2020). Because of the aerosolization of droplets from drainage or aspiration, the sink should have either a plastic or Plexiglas covering over the entire upper portion of the sink. At the very minimum, place a thick bedsheet over the top of the sink and wrap around the drainage tube. An important step here is to isolate the bronchial tubes of the lungs from direct access to the nose and mouth. As you make your incision as you normally would on the right clavicle, be sure to continue the incision slightly medial toward the throat. What you are doing here is tying off the trachea, which leads to the lungs. Through the incision, move your index finger medially to locate the trachea. Once located, use your index finger to scoop the posterior area of the trachea and isolate it from the surrounding tissues. Wrap waxed ligature around the entire trachea and ligate. This technique will separate the direct pathway leading from the lungs to the mouth and nose. Do not cut the trachea, as that incision would allow an open pathway from the bronchioles to the throat, making the barrier of saturated cotton in the mouth and nose that you just created ineffective. Raise the carotid artery and jugular as you usually would and attach the drain tube to the jugular vein. With these established steps, you have created a barrier through the nose and mouth orifices with 70% isopropyl alcohol, and you have isolated the pathway from the nose and mouth leading to the lungs. Set your embalming machine to low pressure and low rate of flow to reduce swelling and distention. It has been shown that COVID causes severe blood coagulation. During the embalming operation, as you massage, flex, and manipulate the extremities for proper fluid distribution, use extreme caution not to move the torso or press on the chest. These maneuvers can potentially expel unwanted dangers. After completing the operation, the embalmer should not aspirate; instead, you shall be introducing cavity fluid into the lungs. To make a point of insertion, do not use the tip of the trocar by pushing into the abdomen. This pressure can cause an internal exhalation from the lungs through the trachea to the nares or mouth. This step will require a small perforation through the wall of the abdomen with the tip of a sharp scalpel or the tip of sharp scissors. Again, this is not an incision but rather a “poke” from the tip. There is no need to go deep, just enough so the trocar can easily glide through the wall. Immediately cover the perforation with a small cloth that is saturated with a recommended disinfectant. Insert the trocar and have a disinfectant-saturated cloth on top of the perforation and wrapped around the trocar tube itself. As you are continually pushing and pulling the trocar out of the cavity wall, the disinfectant cloth will create a safe barrier. Introduce one bottle
It is important to note that many funeral homes, especially in New York City, have completed the embalming operations 24 to 48 hours after death. The thought here is to utilize the duration of time to reduce the risk and potential spread of the disease. Before embalming a COVID positive case, it is imperative to have all your PPE in place. These items include goggles or face shield, heavy-duty or nitrile gloves, Tyvek suit or appropriate gown, respirator, and shoe coverings. Also readily available should be the cotton that will be going in the nose and mouth, the 70% isopropyl alcohol, a sheet or disposable mask to cover the face, the drain tube for the jugular vein, angular or packing forceps, Plexiglas or plastic for the sink, a mop bucket with bleach and water, a spritz bottle with bleach and water, and all your instruments that you will use for the operation. By having everything readily available, you will not be tracking around the prep room with unnecessary movements, and it will allow you to follow the steps for safe embalming. Restrict access to the prep room as soon as the door closes. The room lacks negative pressure, so as soon as the preparation door is opened, the aerosolization of droplets can be sucked out of the room and infiltrate other areas of the funeral home. As you have read previously, a surgical mask does not offer you any protection, and is highly recommended that you do not wear these. This is especially true when you are embalming a COVID positive case. The N-95 respirator is used at a minimum. For the most superior protection, use a P100 respirator. There should be only one or two designated embalmers to embalm a COVID positive case. There are several reasons for this. First, it prevents cross- contamination within the funeral home administration. If too many individuals are in the prep room, there are more variables for mistakes. Second, having one or two designated embalmers allows the individual to become familiar with the steps needed to safely accomplish the embalming procedures and keeps everyone in the funeral home safe. Third, the more times the embalmer prepares a COVID positive, the better and more efficient they will become. As soon as the COVID positive case is in the prep room, it should become off-limits or have restricted access to other embalmers and employees. With a selected embalmer, you are isolating the exposure to just that one employee. In other words, the more people involved, the more risk there is. Carefully place the body bag on the embalming table and spray it down with Dis-Spray. The ventilation system should be on at this point, but turn off any air conditioning to prevent aerosolization from turbulent airflow. From the head end, slowly unzip a small portion of the body bag and generously spray Dis-Spray inside the body bag, and let sit for approximately 10 minutes. As you recall, we previously discussed the importance of having both zipper paddles of the body bag on the head end. The reason for this is that you are not opening the whole body bag just to access the mouth and nose. By unzipping at the head end, it gives you immediate and direct access to the head first instead of having to open the entire bag or cause any unnecessary movements. With the cotton in the nares and mouth still in place, generously pour 70% isopropyl alcohol on the disposable face mask, which will also saturate the cotton in the nose and mouth. It is worth noting that the cotton in the nose should not stretch out the walls of the nares. Once you begin your embalming operation, the nares walls will be permanently fixated. Some funeral homes have been using cavity fluid in the nose and mouth. It is unknown if this solution works in destroying the virus. However, what is known is that cavity fluid does cause bleaching and is extremely caustic. Additionally, the 70% isopropyl alcohol solution has been proven to destroy the virus. Open the body bag slowly and saturate the entire body with Dis- Spray (Black et al., 2020). If the individual is wearing clothing, spray the clothing down first before cutting them off and then
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