Step-by-step guidelines for transportation of remains These step-by-step guidelines are intended to protect workers involved in the transportation of human remains from the cold zone in the hospital to the place of final disposition. A minimum of two healthcare or mortuary workers should perform this process. A plan should be in place to transport the body safely from the hospital to the hearse or vehicle used to transport the body. For example, the plan should include a pre-identified route through the hospital that is secure and either free of or with limited patient and personnel traffic. The route should take the body directly to a pre-identified hearse or vehicle to transport the body. A hospital or public health official should be designated in advance to accompany the body from the hospital to the place of final disposition to ensure the safety of all those involved in the process. There should be protocols in place so the designated official accompanying the body knows what to do if the body bag is compromised during transport and how to safely decontaminate it. For example, this official should have a biohazard spill kit with all of the equipment needed for any situation in which the body bag is compromised, including: recommended PPE, absorbent materials such as paper towels, Mortuary care and disposition of remains The guidance below is primarily intended to protect workers involved with the disposition of human remains either by cremation (recommended) or burial. ● Ensure that anyone handling the body bag wears single-use (disposable) gloves with extended cuffs and a long-sleeved disposable gown. ● Do not open the body bags. ● Do not embalm the body. ● Do not remove any implanted medical devices. ● Cremate the remains. An oversized cremation container may be needed to contain the bagged body for cremation. Cremated remains are no longer infectious and can be handled and provided to the family using normal procedures. ● Consult your authorized state regulator and EPA regulations governing required cremation temperatures. Cremation and ● Workers involved in handling, treatment, transport, and disposal of medical, laboratory, and other waste must be protected from exposure to Ebola virus and from physical and chemical hazards that may be associated with waste management tasks. ● Waste generated from caring for or cleaning up after an Ebola victim may pose a risk to workers if it is not handled safely or treated and disposed of properly. ● Safe handling, treatment, transport, and disposal of waste that is suspected or known to be contaminated with Ebola virus begins at the point of origin where the waste is generated and continues through final disposal. Waste may be generated at the point of origin during activities such as: Waste management steps at point of origin ● Take steps to minimize solid and liquid wastes. ● Identify a complete chain for waste handling, collection, treatment, transport, and disposal before the waste is generated. Ensure that waste, including incinerator ash or other completely treated materials, has a final place for disposition. ● Sharps containers must be closable, puncture-resistant, leak proof, and labeled or color-coded. ● Create a waste management plan and secure necessary contracts and permits ahead of time in order to help avoid potential exposure hazards, security risks, and storage problems. Pre-identify waste management facilities prior to waste generation; waste management facilities may have their own requirements that may need to be considered. ● Place materials in double, leak-proof bags, and store in a rigid, leak-proof container to reduce the risk of worker exposure.
kitty litter or a solidifier, an EPA- registered hospital disinfectant, additional body bags, and biohazard waste bags. ● A new set of workers in the cold zone will receive the decontaminated body bag. ● Place patient identification and any other documents that need to accompany the body, including a printout of the photograph taken before the body was bagged, in an adhesive-backed pouch that is attached to the body bag. This will serve the function of toe tags. This should be done after the bagged body enters the cold zone but before the bagged body is transported to the morgue or out of the hospital. ● Notify the mortuary if the body has any implanted electronic medical devices. ● Affix the following labels to the body bag before it is placed into the hearse or other vehicle used to transport the body: ○ Black and white “infectious substance” label. ○ United Nations (UN) 2814 label. ○ “Do not open” label. ○ Name and phone number of the hospital administrator. cremation temperatures may be subject to state, local, and EPA regulations. ● Bury the remains in instances where cremation cannot be safely performed. For example, some crematoriums may have concerns about cremating bodies containing implanted electronic medical devices. Some of these medical devices can explode, potentially damaging the crematory container or vessel known as a retort. Other medical devices can normally be cremated safely. Where damage to the retort is a concern, the body should be buried in a standard metal casket or other comparable burial method in accordance with state and local burial requirements. The casket containing the bagged remains can be handled without PPE. ○ Using and discarding sharps, dressings, and other supplies while caring for a patient with suspected or confirmed Ebola. ○ Discarding supplies used for clinical laboratory testing of samples from a patient with suspected or confirmed Ebola. ○ Cleaning hospital rooms; ambulances, airplanes, and other vehicles; airport and other transportation facilities; residences; or other areas with suspected or confirmed Ebola-virus contamination. ○ Removing and discarding disposable personal protective equipment (PPE) after working in an environment with suspected or confirmed Ebola-virus contamination. ● If waste ultimately will be transported, follow U.S. Department of Transportation (DOT) guidance for packaging from the outset to minimize repackaging or additional handling: phmsa.dot.gov/hazmat/ packaging-of-ebola- contaminated-waste ● Employers should follow manufacturer instructions on product labels and Safety Data Sheets for Environmental Protection Agency (EPA)-registered disinfectants when selecting PPE for their workers. U.S. Dept. of Health and Human Services (HHS). ● Use a puncture-proof container for sharps. See www.cdc.gov/ niosh/docs/97-111 ● Mark and label outer packaging according to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens standard (29 CFR 1910.1030) and DOT.
CDC and OSHA fact sheet for safe handling, treatment, transport, and disposal of Ebola-contaminated waste
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