John Erik Troyer is a leading author and researcher addressing the social and technological control of the dead body, including legal, scientific, and medical protocols and aesthetics. Troyer cautions that people addressing the issues of infectious disease in mortuary services; “need a dose of humility and effective approaches at household, community, societal and global levels. At the household level, we need to promote family-centered interactions and interventions. Cultural practices such as embalming, burial, and caregiving are family-based as well as community-based activities.”(Troyer, 2010) Professionals in the funeral industry must have knowledge concerning different types of infectious disease, their modes of transmission, and the virulence that make them dangerous and difficult to contain. The global nature of travel today leads to the rapid spread of contagious disease throughout the world. Certain diseases are not endemic to the United States; however, they can easily cross borders before they are observed or diagnosed. Individuals can carry colonies of disease and be non-symptomatic for weeks or even months as they spread disease to those they contact at home, work, or throughout their community. This course includes information on infectious diseases that rise to the level of serious public health concern. Major health organizations of the federal, state, and county epidemiology departments would be aware of the presence of individuals with serious infectious disease from the moment they were identified at the point of entry to the U.S. These agencies have jurisdiction in these cases, though in many states, if the person dies, the body would be released to the local funeral home. At this point, the director could refuse the case or the local health agency would assist them if they chose to proceed. This course provides specific references for downloading guidelines and training resources from the CDC, OSHA, and the WHO for further information. Individual states may have additional regulations and guidelines that must be reviewed on the state government website. Information is included for the control of infectious disease encountered during mortuary services to ensure the safety of personnel, funeral attendees, the general public, and the environment. procedures for preparation at the hospital, cleaning, sterilization, transport, embalming, waste disposal, viewing, burial, or cremation. Some highly contagious, drug-resistant diseases require specific regulations for postmortem care, and current regulations are included in this course. ○ The immune state at the time of exposure to an infectious agent. ○ Interaction between pathogens. ○ Virulence factors of the pathogen. ○ Host factors, such as age, and underlying disease, such as diabetes, HIV/AIDS, malignancy, transplants, or other chronic illness. ○ Medications that alter normal flora such as antimicrobial agents, gastric acid suppressors, corticosteroids, anti-rejection drugs, antineoplastic agents, and immunosuppressive drugs. ● Infection – invasion and multiplication of pathogenic microorganisms in the body. Pathogens invade the body and may lead to infection or disease that disrupts the functioning of the body. Pathogenic microorganisms are found particularly in the respiratory and gastrointestinal tracts but may live anywhere in or on the body. ● Infectious agents – four main classes: bacteria, viruses, fungi, and parasites, transmitted primarily from human sources but also inanimate environmental sources as well. ● Lumina – the inner open space or cavity of a tubular organ or cell, such as in a blood vessel or an intestine.
Creutzfeldt-Jakob Disease (CJD); and transmissible spongiform encephalopathy (TSE). This course will address the facts and detail the CDC, WHO, and OSHA standards and guidelines to address procedures to contain these diseases during all phases of mortuary practice. The National Funeral Directors Association (NFDA) is the guiding funeral service association, with more than 20,000 individual members and serving over 11,000 funeral homes in the United States and fifty countries (NFDA, 2022). The NFDA offers resources and materials to assist members to comply with federal, state, and county laws along with conducting and funding research on topics of health, safety, environmental, and consumer concerns. During the height of the COVID-19 pandemic, the NFDA maintained an information hub to help funeral directors with concerns about the acquisition of personal protective equipment (PPE) and about the prioritizing of funeral personnel for the newly developed vaccines. The organization made clear that they were not suggesting that vaccinations should be mandatory, merely that funeral directors, by the very nature of their work, were in greater danger from the disease than members of the general public and should be prioritized for the vaccines (NFDA, 2020, 2021). Guidance concerning the postmortem handling of COVID-19 patients evolves as more is learned about the disease, how it spreads, and whether a body can harbor the virus after death (OSHA, n.d.a). Valkenburg and colleagues (2021) state succinctly that “the infectivity of severe acute respiratory syndrome coronavirus 2 [COVID-19] in deceased persons and organisms remains unclear.” They conclude, however, that with proper biosafety precautions and personal protective equipment, “the burial or cremation process is unlikely to spread disease.” One document, most recently updated in April of 2020, addresses the emotional difficulty experienced by mortuary and death care workers having to deal with the onslaught of COVID-19 deaths (U.S. Department of Health and Human Services, 2020). Transmission of infectious agents in healthcare settings The CDC, WHO, and OSHA organizations include mortuaries, funeral homes, cemeteries, and crematory settings under the classification of health care when issuing regulations and guidelines for universal precautions. Some documents contain specific information for practitioners dealing with postmortem Definitions ● Alkaline hydrolysis – an alternative to flame cremation that uses water and alkaline under high temperatures and pressure. ● Colonization – development of a bacterial infection, though the infected person may or may not have signs or symptoms of infection. ● Diathesis – predisposition or susceptibility to suffer from a disease. ● Enveloped virus – the outermost shell is made of proteins and lipids. SARS-CoV-2, which causes COVID-19, is an enveloped virus (CDC, 2021d). ● Non-enveloped virus – contain a capsid coat made of protein, are more virulent, and can retain infectivity even after drying. ● Fomites – objects or materials, such as dishes, utensils, or clothing, that may carry infection and lead to transmission of disease. ● Flora – microorganisms such as bacteria or fungi that live in or on the body. ● Immunity – the host’s ability to resist the pathogens that cause disease. Factors related to immunity include the following:
Book Code: FTX1624
Page 87
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