Definitions of terms in the CDC guidance Contaminated area – areas that may contain Ebola virus, including the patient treatment room. Only workers wearing PPE that conforms to CDC’s Guidance on Personal Protective Equipment for Healthcare Workers are allowed in the contaminated area. Decontamination area – area directly accessible to the contaminated area. Workers will perform final decontamination in the decontamination area before passing the human remains to the clean area. Clean area – noncontaminated area used for planning and staging. Only workers who have not entered the contaminated Equipment list The following equipment should be used in the contaminated area: ● A hospital gurney containing three pre-opened cremation- compatible body bags with the following specifications: ○ First bag (top layer on gurney): vinyl or other chlorine- free material, minimum of 6 mil thickness (152 micrometers). To prevent any leakage of fluids, all seams should be factory heat-sealed or welded, not sewn, and the zipper should be on top. ○ Second bag (middle layer on gurney): chlorine-free material impervious to fluids that can be heat-sealed around the body to form a leakproof body bag. This bag should be specifically designed for the containment and transport of infectious human remains. The material should be precut to provide sufficient material to envelop the body and first bag. ○ Third bag (bottom layer on gurney): laminated vinyl or other chlorine-free material, minimum of 18 mil thickness (457 micrometers), with handles that are not sewn on, such as riveted handles reinforced with handle straps that run under the pouch. To prevent any leakage of fluids, all seams should be factory heat- sealed or welded, not sewn, and the zipper should be on top. ● Thermal sealer for sealing the second bag. ● PPE recommended for personnel entering the room of a patient with EVD as described in the CDC’s Guidance on Personal Protective Equipment for Healthcare Workers. ● Scissors for cutting excess material from heat-sealed bag. Postmortem preparation in a hospital room The following points are important considerations for postmortem preparation of human remains contaminated with Ebola virus: ● Ensure that workers handling the body and the trained observer wear the recommended PPE and follow all of the procedures in the CDC’s Guidance on Personal Protective Equipment for Healthcare Workers. ● Follow the cleaning and disinfecting recommendations found in the CDC’s Guidance for Environmental Infection Control in Hospitals for Ebola Virus. According to this guidance, PPE surfaces, equipment, and patient care area surfaces
area or who have properly doffed their PPE after being in the contaminated area are permitted in the clean area. Workers put on clean PPE in the clean area under the direction of a trained observer. Cremation – the act of reducing human remains to ash by intense heat. Leakproof bag – a body bag that is puncture-resistant and sealed in a manner to contain all contents and prevent leakage of fluids during handling, transport, or shipping. ● Device capable of taking and securely transferring photographs electronically via Wi-Fi, email, or text message (such as a digital camera or mobile phone). ● EPA-registered hospital disinfectant and wipes with a label- claim for use against a nonenveloped virus. ● Alcohol-based hand rub (ABHR). ● Red biohazard bag for medical waste. ● Zip tie for locking the third bag shut at the zipper. ● Enlarged copy of the Ebola Mortuary Guidance Job Aid: Steps for Postmortem Preparation of Ebola Infected Human Remains in a Hospital and tape for posting these step-by- step guidelines to a wall in the contaminated area. The following equipment should be used in the clean area: ● Hospital gurney or mortuary stretcher. ● Adhesive-backed pouch that is applied to the decontaminated body bag. ● Single-use (disposable) gloves with extended cuffs and a long-sleeved disposable gown. ● Biohazard spill kit, including recommended PPE; absorbent materials such as paper towels, kitty litter, or a solidifier; an EPA-registered hospital disinfectant; and biohazard waste bags. ● Infectious substance labels to be applied to the decontaminated body bag, including the following: ○ Black and white “infectious substance” label. ○ United Nations (UN) 2814 label. ○ “Do not open” label. ○ Name and phone number of the hospital administrator. that become visibly soiled should be decontaminated immediately using an EPA-registered hospital disinfectant with a label claim for use against a nonenveloped virus. ● Place all waste produced during postmortem preparation and decontamination into red biohazard bags in the contaminated area, following the CDC Guidelines for Ebola- Associated Waste Management. Highlights from these CDC guidances and guidelines are included in this course. ● Use the camera or other device to take a photograph of the decedent’s face for identification purposes. The photograph should be securely transferred electronically to the pre- identified site manager. The device must be decontaminated before being removed from the contaminated area or reused. If not decontaminated, the device should be discarded along with other medical waste. ● Position the gurney with the three pre-opened body bags next to the hospital bed with the body. ● Pull the bed sheet(s) that are under the body up and around the front of the body. Do not wash or clean the body. Do not remove any inserted medical equipment such as IV lines or endotracheal or other tubing from the body. ● Remove the first bag from the gurney. Gently roll the body wrapped in sheets while sliding the first bag under the body.
CDC step-by-step guidelines for postmortem preparation in a hospital setting These step-by-step guidelines are intended to protect workers involved in the postmortem preparation of the body in a hospital setting. The size and weight of the body being prepared and the ability of the workers to lift the body and assist with managing the body bag will determine the number of workers needed for the process. For the death of an average-size adult, for example, a minimum of three healthcare workers or other workers properly trained in handling infectious bodies should assist with the
process: two to lift the body and one to hold the body bag open. CDC recommends posting an enlarged copy of the following step-by-step guidelines in the contaminated area. The workers should read the guidelines aloud as they perform each step of the procedure. ● Turn on the thermal sealer to allow it to warm up during the initial preparation of the body. This sealer will be used to seal the second body bag.
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