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 that 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. ● 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 (superglue). ● The entire body should be wiped down with bleach, and special care should be 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 liter 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 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.
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. ● 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 concerning when and how to use the specific methods above at https://apps.who.int/ 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 iris/handle/10665/66707. Funerals and cremations used for an autopsy should be followed. Body donation for teaching purposes Anatomy departments should not accept, for teaching or 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.
Book Code: FTX1624
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