Embalming bodies who have been autopsied Embalming bodies of CJD patients who have been autopsied can also be safely performed. Adherence to standard infection control measures is paramount when embalming an autopsied body of a suspected or clinically diagnosed CJD patient. Autopsies on these individuals are often restricted to removal of the brain; therefore, special precautions should be taken,
including placing a plastic sheet with absorbent wadding and raised edges underneath the head to ensure containment of fluids and prevent any spillage. In instances where sutures do not completely control leaking, the cranial cavity should be packed with absorbent material that has been soaked with bleach and tightly sutured. sites. If warranted, the casket can be lined with a leak-proof sheet. An open casket for viewing should not be prohibited. Family members of CJD patients should be advised to avoid superficial contact, such as touching or kissing the patient’s face, with the body of a CJD patient who has been autopsied. However, if the patient has not been autopsied, such contact need not be discouraged. Terminal disinfection and waste removal According to WHO infection-control guidelines, flooding with undiluted bleach can disinfect work surfaces. Although the use of disposable instruments is preferred, reusable instruments and tools can be cleaned and disinfected by using CJD sterilization protocols recommended by the Centers for Disease Control and Prevention listed above. All contaminated solid materials should be disposed of as hazardous waste. Disposing of body fluids, tissues, and hazardous chemicals should be handled in accordance with funeral home policy, local, state, and federal regulations. Final disposition for cremation and burial There are no special interment, entombment, inurnment, or cremation requirements for patients with CJD. Interment of bodies in closed caskets does not present a significant risk of environmental contamination and cremated remains can be considered sterile, as the infectious agent does not survive incineration-range temperatures.
Precautions for embalming the bodies of patients with suspected or confirmed CJD Bodies of autopsied CJD patients Bodies of autopsied CJD patients should be placed on a waterproof sheet to collect all fluids. It is strongly recommended
that disposable instruments, masks, gowns, and puncture- resistant gloves be used whenever possible. The entire body should be washed with bleach, rinsed, and sanitized before dressing. Special care should be taken to limit fluid leakage when performing restorative work on a CJD patient. All fluids should be collected in a suitable container. Decontaminating heat-sensitive instruments or materials that come in contact with suspected or confirmed CJD patients All disposable instruments, materials, and wastes that come in contact with high infectivity tissues (brain, spinal cord, and eyes) and low infectivity tissues (cerebrospinal fluid, kidneys, liver, lungs, lymph nodes, spleen, and placenta) of suspected or confirmed transmissible spongiform encephalopathy, or TSE, patients should be disposed of by incineration. Surfaces and heat-sensitive reusable instruments that come in contact with high infectivity and low infectivity tissues should be decontaminated by flooding with or soaking in 2N NaOH or undiluted sodium hypochlorite for one hour and rinsed with water. CDC NOTE: Sodium hypochlorite may be corrosive to some instruments. Casketing and viewing Staff should avoid unnecessary manipulation of the body that would force purging of body fluids and risk opening of incision
WHO GUIDELINES FOR TSE
After death Precautions for handling of the deceased patient On the death of a patient with confirmed or suspected TSE, the removal of the body from the ward, community setting, or hospice, should be carried out using universal precaution measures. It is recommended that the deceased patient be placed in a sealed body bag prior to moving following universal precautions for bodies with a known infection risk. Where the skull is open or there is cerebrospinal fluid (CSF) leakage, and where sutures do not completely control this leaking, the bag should be lined with materials to absorb any fluid, and moved in a sealed body bag. WHO guidelines for TSE note drainage Mortuary procedures using universal precautions may be performed on the bodies of patients who have died from TSE, to ensure the safety of personnel and avoid contamination of the workplace. Transportation of the unembalmed body to the mortuary should be in a sealable, impermeable plastic pouch. Contact or handling of an intact, unautopsied body does not pose a risk, and staff may undertake cosmetic work without any special precautions. If the body has undergone autopsy, care should be taken to limit contamination of the workplace by any leaking bodily fluids, especially from the cranium, when transferring the body from its transport bag to the mortuary table that has been covered with an impermeable sheet. Embalming Undertakers and embalmers General measures An intact unautopsied body can be safely managed with only minor adjustments to the usual procedures. Embalming an autopsied or traumatized body is not encouraged, but may be safely performed when the following precautions are observed: ● Disposable masks, gowns, and gloves should be worn, just as pathologists do when performing an autopsy.
from any tissues may retain infectivity and should be handled accordingly. National and international transport of bodies If there is a need to transport the deceased patient nationally or internationally, it will be necessary to comply with the International Civil Aviation Organization (ICAO), International Air Transport Association (IATA) Restricted Articles Regulations, and any additional requirements of the individual carriers. It should be noted that the IATA regulations require the embalming of the body. ● The body should be placed on an impermeable sheet or body pouch so that suture site leakage can be contained, and perfusion drain sites should be similarly arranged to avoid surface contamination. ● All drainage fluids should be collected into a stainless steel container. ● Perfusion and autopsy incision sites should be closed with cyanoacrylates. ● The entire body should be wiped down with bleach, and special care taken to ensure contact of bleach with perfusion sites and closed autopsy incisions. ● At the conclusion of the perfusion procedure, the container of drainage fluids should be decontaminated by adding sodium hydroxide pellets at the rate of 40g per litre of fluid. The mixture should be stirred after a few minutes and care should be taken to avoid spillage, as the fluid will be hot. It should then be left undisturbed for at least one hour, after which it can be disposed of as for any other mortuary waste. ● Plastic sheets and other disposable items that have come into contact with bodily fluids should be incinerated. ● Mortuary working surfaces that have accidentally become contaminated should be flooded with sodium hydroxide or
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