Funerals and cremations Relatives of the deceased may wish to view or have some final contact with the body. Superficial contact, such as touching or kissing the face, need not be discouraged, even if an autopsy has been conducted. Interment in closed coffins does not present any significant risk of environmental contamination, and cremated remains can be considered to be sterile, as the infectious agents do not survive incineration-range temperatures of 1000°C. Transport and interment are subject to national, state, and local guidelines, and transport overseas is governed by international regulations. Exhumations Standard procedures are conducted according to local and national guidelines. The body should be considered as having the same infectivity as at the time of burial, and the precautions used for an autopsy should be followed. Body donation for teaching purposes Anatomy departments should not accept, for teaching or
bleach, left undisturbed for at least one hour, then, using gloves, mopped up with absorbent disposable rags, and the surface swabbed with water sufficient to remove any residual disinfectant solution. ● Non-disposable instruments and tools should be decontaminated using one of the methods from the following Annex III recommendations in order of more to less severe treatments: 1. Incineration. 2. Autoclave/chemical methods for heat-resistant instruments. 3. Chemical methods for surfaces and heat-sensitive instruments. 4. Autoclave/chemical methods for dry goods. At the conclusion of the decontamination procedure, the instruments should be washed with water to remove residual disinfectant fluid before drying and reuse. Sodium hydroxide or bleach can be disposed of as uninfectious but corrosive waste fluid. Visit the WHO website for guidelines of when and how to use the specific methods above at http://www.who.int/csr/resources/ publications/bse/whocdscsraph2003.pdf The following information applies to infectious diseases that do not carry specific regulations for burial and cremation, as previously outlined above. Care should be taken to review the federal guidelines in this course as well as laws and regulations of the state and local jurisdictions. In the past, many personnel in the funeral industry believed that embalming was necessary to protect the public from environmental contaminates and the spread of infectious disease. It was commonly believed that the body must be interred in a sealed casket or vault to protect against contamination of soil and groundwater. Scientific research provides significant evidence to refute these beliefs and the CDC, the WHO and the Pan American Health Organization (PAHO) have published these findings. Numerous research studies, using evidence based, scientific peer-review procedures, have shown no environmental contamination or spread of disease from unembalmed bodies in countries that do not use embalming or burial in sealed caskets or vaults. There is also a myth that embalming is legally required; however, states do not routinely require embalming for viewing. New Hampshire and some others require embalming, or refrigeration, if the body has not been buried within twenty-four to forty-eight hours. Embalming is mandated when a body crosses state lines from Alabama and Alaska. Five other states, California, Idaho, Kansas, Minnesota, and New Jersey, require embalming when the body leaves those states by common carrier airplane or train (FCA, 2015). There is the belief by some that a body contains dangerous bacteria that can spread infection. A journal article written by Oliver Morgan, and published by the PAHO, a division of WHO, addresses this topic as follows: “The microorganisms that are involved in decomposition are not the kind that cause disease, and most viruses and bacteria that do cause disease cannot survive more than a few hours in a dead body. An apparent exception is the human immunodeficiency virus, HIV, which has been shown to live up to 16 days in a corpse under refrigeration.” Morgan further explains that exposure to a body with HIV, as well as most diseases, is no more dangerous in terms of contamination than exposure to a live person with HIV. The same precautions to prevent contact with bodily fluids from a person with HIV/AIDS would apply to contact with the body post mortem.
research purposes, any body or organs from persons confirmed, suspected, or at risk for TSE, unless they have specific training or research programs for TSEs, including access to specialized equipment, procedures, appropriate containment facilities, and training for managing TSE-contaminated tissues. Departments should make inquiries of those responsible for donating the body, and of the medical staff involved in the care of the donor, to ensure the rigorous adherence to this recommendation. MYTHS SURROUNDING POSTMORTEM PROCEDURES AND INFECTIOUS DISEASE CONTAMINATION
Dr. Lakshmanan Sathyavagiswaran, M.D., Chief Medical Examiner of Los Angeles, provides the following clarification: “There is no reason that an unembalmed human body should be infectious to anyone attending visitation or public services. Persons transporting and handling bodies or cutting into them may be vulnerable in rare instances, with little or no risk if proper precautions are taken. To refuse to present a body unembalmed because of public health risk is unfounded. On rare occasions of certain deaths resulting from contagious disease, our office may encourage placing a facemask on the decedent before and during transportation and containment, and disposing without embalming or viewing. In the event, however, it becomes necessary to hold a body for an extended period of time before public services can be held, arterial embalming is recommended. Riding on an airplane or a bus may be a public health risk; the presence of an unembalmed body is not.” The United States and Canada are the only countries that normally practice embalming though some religious and ethnic groups, including Jewish, Muslims, Amish, Native Americans, Buddhists, Baha’i, Hindus, and others follow traditional customs for private care of the body by family or religious members. The CDC simply states, “We have not at any point prescribed embalming as a method of protecting public health (Burden, 2006).” Another unfounded myth is that infectious disease epidemics can occur after national disasters, such as earthquakes or tsunamis, which uncover burial grounds. Both PAHO and the WHO have attempted since 1986 to dispel this myth and produced a video titled, “Myths and Realities of Natural Disasters.” Jean-Luc Poncelet, chief of PAHO’s Emergency Preparedness and Disaster Relief program states the following: “The notion that dead bodies pose an urgent health threat in the aftermath of a disaster is one of several enduring myths about disasters and relief efforts. Survivors are much more likely to be a source of disease outbreaks.” One long-held myth is that burial sites will lead to contamination of groundwater, so bodies need to be embalmed and placed in caskets and vaults to prevent this. Decomposition is a natural part of the life cycle of all living things and the human body becomes part of this cycle. When domestic and wild animals die, they are not embalmed or buried in leak-proof containers to
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Book Code: FFL1223
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