● The term “hermetically sealed casket” was replaced with a recommendation to use a metal casket based on common practices in the industry. ● Additional details have been added about equipment needed for workers handling remains and step-by-step guidelines for postmortem preparation and transportation of remains. ● Additional resources have been added on PPE, decontamination, infection control, transportation of remains, and burial and cremation practices. urine, saliva, feces, or vomit to unprotected mucosa such as eyes, nose, or mouth during postmortem care. In addition to federal laws and guidelines that apply to mortuary workers contained in this course, mortuary practices and workers may also be subject to a state, tribal, territorial, and local regulations. Staff should always consult local health department officials for additional guidance on laws that affect mortuary practices. The CDC recommends licensed funeral directors, who have agreed to accept the bagged remains, work in close collaboration with public health officials in their state or local jurisdiction to safely implement each step of the process. ● Do not perform an autopsy. If an autopsy is necessary, consult the state health department and CDC regarding necessary precautions. ● Do not remove any inserted medical equipment from the body such as intravenous (IV) lines, endotracheal or other tubing, or implanted electronic medical devices. ● Cremate the body. If cremation cannot be done because of safety concerns, the body should be buried in a standard metal casket or other comparable burial method. clean PPE in the cold zone under the direction of a trained observer. ● Cremation – the act of reducing human remains to ash by intense heat. ● Leak-proof bag – a body bag that is puncture-resistant and sealed in a manner to contain all contents and prevent leakage of fluids during handling, transport, or shipping. ○ Camera or mobile phone capable of securely transferring photographs electronically via Wi-Fi, e-mail, or text message. ● U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant and wipes with a label-claim for use against a non-enveloped virus. ● Alcohol-based hand rub (ABHR). ● Red biohazard bag for medical waste. ● Zip tie for locking the third bag shut at the zipper. ● Enlarged copy of the Mortuary Guidance Job Aid: Postmortem Preparation in a Hospital Room PDF and tape for posting these step-by-step guidelines to a wall in the hot zone. The guide is included below. The following equipment should be used in the cold zone: ● Hospital gurney or mortuary stretcher. ● Adhesive-backed pouch that is applied to the decontaminated body bag. ● Single-use (disposable) gloves with extended cuffs and a long-sleeved disposable gown. ● Biohazard spill kit, including: Recommended PPE, absorbent materials such as paper towels, kitty litter or a solidifier, an EPA-registered hospital disinfectant, and biohazard waste bags. ● Infectious substance labels that are applied to the decontaminated body bag, including the following: ○ Black and white “infectious substance” label. ○ United Nations (UN) 2814 label. ○ “Do not open” label. ○ Name and phone number of the hospital administrator.
death, prior to transport, during transport, at the mortuary, and during final disposition of remains. The guide should be followed to train staff in the safe handling of human remains that may contain Ebola virus by properly using PPE and following decontamination measures at every step of the process. Revisions were made on January 20, 2015, to reflect the following: Background Given the systems currently in place to identify people with Ebola virus disease (EVD), beginning with screening and interception at airports for passengers from countries with known outbreaks, Ebola-related deaths in the United States would likely occur within a hospital setting, and all Ebola cases are immediately reported and monitored by the CDC, and state and local health agencies. The EVD can be detected throughout the bodies of patients who die of the disease. Ebola can be transmitted in postmortem care by laceration and puncture with contaminated instruments, through direct handling of human remains without recommended PPE, through splashes of blood, Key points ● EVD can be transmitted in postmortem care settings through unsafe handling of remains. ● Only personnel trained in handling infected human remains and wearing recommended PPE should touch or move any remains that contain Ebola virus. ● Do not wash or clean the body. ● Do not embalm the body. Definitions for terms in this guidance ● Hot zone – contaminated area that includes the patient treatment room. Only workers wearing PPE that conforms to CDC’s Guidance on Personal Protective Equipment for Healthcare Workers are allowed to be in this area. ● Cold zone – non-contaminated area used for planning and staging. Only workers who have not entered the hot zone or who have properly doffed their PPE after being in the hot zone are permitted in the cold zone. Workers put on Equipment list The following equipment should be used in the hot zone: A hospital gurney containing three pre-opened cremation- compatible body bags with the following specifications: ○ First bag (top layer on gurney): Vinyl or other chlorine- free material, minimum of 6 ml thickness (152 micrometers). To prevent any leakage of fluids, all seams should be factory heat-sealed or welded, not sewn, and the zipper should be on top. ○ Second bag (middle layer on gurney): Chlorine-free material impervious to fluids that can be heat-sealed around the body to form a leak-proof body bag. This bag should be specifically designed for the containment and transport of infectious bodies. The material should be precut to provide sufficient material to envelop the body and first bag. ○ Third bag (bottom layer on gurney): Laminated vinyl or other chlorine-free material, minimum of 18 ml thickness (457 micrometers), with handles that are not sewn on, such as riveted handles reinforced with handle straps that run under the pouch. To prevent any leakage of fluids, all seams should be factory heat- sealed or welded, not sewn, and the zipper should be on top. ○ Thermal sealer for sealing the second bag. ○ PPE recommended for personnel entering the room of a patient with EVD as described in CDC’s Guidance on Personal Protective Equipment for Healthcare Workers. ○ Scissors for cutting excess material from heat-sealed bag.
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