Severe acute respiratory syndrome (SARS) SARS is a respiratory disease that emerged in China late in 2002 and spread to several countries including Mainland China, Hong Kong, Hanoi, Singapore, and Toronto. There have been cases of laboratory evidence of SARS in the U.S. but no deaths have occurred. SARS outbreaks have occurred in healthcare settings and transmitted to large numbers of healthcare personnel and patients with evidence of droplet, contact transmission, and airborne transmission. The CDC recommends universal precautions, with emphasis on hand hygiene, and contact precautions with emphasis on environmental cleaning, because SARS CoV RNA has been identified on surfaces in the rooms of SARS patients. Airborne precautions, including use of fit- tested NIOSH-approved N95 or higher level respirators, and eye protection are also indicated. Monkey pox Monkey pox is a rare viral disease found mostly in rain forest countries of Central and West Africa. The disease is caused by an orthopoxvirus that is similar in appearance to smallpox but causes a milder disease. Transmission from infected animals and humans occurs primarily through direct contact with lesions and respiratory secretions, but airborne transmission from animals to humans cannot be excluded. Norovirus Norovirus, formerly referred to as Norwalk-like viruses, are members of the Caliciviridae family. Environmental contamination has been documented as a factor in transmission during outbreaks and of this highly contagious disease. Widespread, persistent, and undetected contamination of the environment and fomites can make outbreaks extremely difficult to control. Clinical observations and detection of norovirus DNA on surfaces five feet above levels normally touched suggest that
aerosolized particles may travel distances beyond three feet. Individuals who are responsible for cleaning the environment may be at increased risk of infection. The virus is resistant to many cleaning and disinfection agents and may survive < ten parts per million (ppm or one milligram per liter) chlorine. Hemorrhagic fever viruses (HFV) The hemorrhagic fever viruses are a mixed group of viruses that cause serious disease with high fever, skin rash, bleeding diathesis, and high mortality; the disease caused by the virus is referred to as viral hemorrhagic fever (VHF). Commonly known HFVs are Ebola and Marburg viruses (Filoviridae), Lassa virus (Arenaviridae), Crimean-Congo hemorrhagic fever and Rift Valley Fever virus, or Bunyaviridae, and Dengue and Yellow fever viruses, or Flaviviridae. Person-to-person transmission is mainly due to direct blood and body fluid contact. Percutaneous exposure to contaminated blood carries a high risk for transmission and increased mortality during the embalming process. Large numbers of Ebola viral particles can be found in the skin and the lumina of sweat glands, which indicates transmission could occur from direct contact with intact skin. Evidence to support direct transmission from intact skin is limited, but postmortem handling of infected bodies is an important risk for transmission. There have been situations where transmission occurred among individuals with no direct contact. In these rare cases, there is speculation that airborne transmission could have occurred. Airborne transmission of HFVs in humans has not been scientifically observed, though the possibility of airborne transmission exists and the CDC was not able to completely exclude droplet or indirect contact transmission. In 2015, the CDC updated infection control precautions for HVFs that are transmitted person to person, which are included in this course.
CONTAINING THE EBOLA AND HIV/AIDS VIRUS
World Health Organization 2015 Ebola precautions for funeral directors The Ebola epidemic spread to American health workers overseas and prompted the CDC and the WHO to develop standards, preparedness regulations, and guidelines to address treatment and prevention in the U.S. Cleaning should precede application of disinfectants. WHO recommends: ● Do not spray (i.e., fog) occupied or unoccupied clinical areas with disinfectant. This is a potentially dangerous practice that has no proven disease control benefit. ● Wear gloves, gown, and closed shoes when cleaning the environment and handling infectious waste. Cleaning heavily
avoid any unnecessary risks to individuals handling these items. For postmortem examinations, HF patient remains should be limited to essential evaluations only, and trained personnel should perform those evaluations. Personnel examining remains should wear eye protection, mask, gloves, and gowns as recommended for patient care. In addition, WHO recommends that personnel performing autopsies of known or suspected HF patients should wear a particulate respirator and eye protection or face shield, or a powered air-purifying respirator. WHO also recommends: ● When removing protective equipment, avoid any contact between soiled gloves or equipment and the face (i.e., eyes, nose, or mouth). ● Hand hygiene should be performed immediately following the removal of protective equipment used during postmortem examination and that may have come into contact with potentially contaminated surfaces. ● Place specimens in clearly labeled, non-glass, leak-proof containers and deliver directly to designated specimen handling areas. ● All external surfaces of specimen containers should be thoroughly disinfected prior to transport. ● Tissue or body fluids for disposal should be carefully placed in clearly marked, sealed containers for incineration.
soiled surfaces increases the risk of splashes. On these occasions, staff should wear facial protection in addition to gloves, gown and closed, resistant shoes. ● Soiled linen should be placed in clearly labeled, leak-proof bags or buckets at the site of use, and the container surfaces should be disinfected (using an effective disinfectant) before removal from the site. Linen should be transported directly to the laundry area and laundered promptly with water and detergent. For low-temperature laundering, wash linens with detergent and water, rinse and then soak in 0.05 percent chlorine for approximately thirty minutes. Linen should then be dried according to routine standards and procedures. When handling soiled linen from HF patients, use gloves, gown, closed shoes, and facial protection. ● If safe cleaning and disinfection of heavily soiled linen is not possible or reliable, it may be prudent to burn the linens to Human-to-human transmission is the principal feature in Ebola virus outbreaks; the virus is transmitted from symptomatic persons or contaminated corpses or by contact with objects acting as fomites. Contact with corpses during mourning and funeral practices, which can include bathing the body and rinsing family members with the water, or during the removal and transportation of bodies by burial teams has resulted in numerous infections. Studies published by the CDC in 2015
2015 CDC guidance for personnel: Postmortem care in United States hospitals and mortuaries to protect against the spread of Ebola
on the Postmortem Viability of the Ebola Virus show it can persist for > seven days on surfaces of bodies, confirming that transmission from deceased persons is possible for an extended period after death. In addition, the study revealed that viral RNA was detectable for ten weeks. The CDC published the following guidelines in 2015 to protect against the postmortem spread of Ebola infection at the site of
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