Mortuary care and disposition of remains The guidance below is primarily intended to protect workers involved with the disposition of human remains either by cremation (recommended) or burial. ● Ensure that anyone handling the body bag wears single-use (disposable) gloves with extended cuffs and a long-sleeved disposable gown. ● Do not open the body bags. ● Do not embalm the body. ● Do not remove any implanted medical devices. ● Cremate the remains. An oversized cremation container may be needed to contain the bagged body for cremation. Cremated remains are no longer infectious and can be handled and provided to the family using normal procedures. ● Consult your authorized state regulator and EPA regulations governing required cremation temperatures. Cremation and ● Waste generated from caring for or cleaning up after an Ebola patient may pose a risk to workers if it is not handled safely or treated and disposed of properly. ● Safe handling, treatment, transport, and disposal of waste that is suspected or known to be contaminated with Ebola virus begins at the point of origin (where the waste is generated) and continues through final disposal. Waste may be generated at the point of origin during activities such as: Waste management steps at point of origin ● Take steps to minimize solid and liquid wastes. ● Identify a complete chain for waste handling, collection, treatment, transport, and disposal before the waste is generated. Ensure that waste, including incinerator ash or other completely treated materials, has a final place for disposition. ● Create a waste management plan and secure necessary contracts and permits ahead of time in order to help avoid potential exposure hazards, security risks, and storage problems. Pre-identify waste management facilities prior to waste generation; waste management facilities may have their own requirements that may need to be considered. ● Place materials in double, leakproof bags, and store in a rigid, leakproof container to reduce the risk of worker exposure. ● If waste ultimately will be transported, follow U.S. Department of Transportation (DOT) guidance for packaging from the outset to minimize repackaging or additional handling: https://www.phmsa.dot.gov/transporting- infectious-substances/packaging-of-ebola-contaminated- waste. ● Employers should follow manufacturer instructions on product labels and Safety Data Sheets for EPA-registered disinfectants when selecting PPE for their workers. ● Use a puncture-proof container for sharps. See https://www. cdc.gov/niosh/docs/97-111. ● Mark and label outer packaging according to the OSHA Bloodborne Pathogens standard (29 CFR 1910.1030) and DOT general marking requirements for non-bulk packagings (49 CFR 172.301). ● Ensure that the outsides of waste containers are not contaminated. Use a combination of administrative controls
cremation temperatures may be subject to state, local, and EPA regulations. ● Bury the remains in instances where cremation cannot be safely performed. For example, some crematoriums may have concerns about cremating bodies containing implanted electronic medical devices. Some of these medical devices can explode, potentially damaging the cremation chamber. Most other medical devices can be cremated safely. Where damage to the chamber is a concern, the body should be buried in a standard metal casket or other comparable burial method in accordance with state and local burial requirements. The casket containing the bagged remains can be handled without PPE.
Highlights from the OSHA fact sheet for safe handling, treatment, transport, and disposal of ebola-contaminated waste (2016) ● Workers involved in handling, treatment, transport, and disposal of medical, laboratory, and other waste must be protected from exposure to Ebola virus and from physical and chemical hazards that may be associated with waste management tasks. ○ Using and discarding sharps, dressings, and other supplies while caring for a patient with suspected or confirmed Ebola. ○ Discarding supplies used for clinical laboratory testing of samples from a patient with suspected or confirmed Ebola. ○
Cleaning hospital rooms; ambulances, airplanes, and other vehicles; airport and other transportation facilities; residences; or other areas with suspected or confirmed Ebola-virus contamination. ○ Removing and discarding disposable personal protective equipment (PPE) after working in an environment with suspected or confirmed Ebola-virus contamination. and work practices to avoid contaminating a container when placing waste into it. ● Implement protocols for effectively decontaminating the outside of bags that go into containers, and the containers themselves if they come into contact with potentially infectious waste. ● If porous containers, such as corrugated cardboard boxes, become contaminated, they should be placed into another container. ● Disinfect the outsides of waste bags with an EPA-registered disinfectant with label claims for use against nonenveloped viruses (e.g., norovirus, rotavirus, adenovirus, poliovirus). (See “Disinfectants for Ebola Virus,” below.) Follow manufacturer recommendations for wiping or spraying the bags with an appropriate disinfectant. Follow manufacturer instructions on product labels for concentration, application method, and contact time for the specific disinfectant. ● If practicable, consider autoclaving waste on-site using an appropriate autoclave before it is packaged and sent out of a facility for disposal. Porous materials may require multiple autoclave cycles to ensure sufficient penetration of heat and steam. This approach may be more effective than just using a longer cycle. ● Follow CDC guidelines and DOT Hazardous Materials Regulations (HMR), at https://www.cdc.gov/vhf/ebola/ clinicians/cleaning/waste-management.html and https:// www.phmsa.dot.gov/transporting-infectious-substances/ transporting-infectious-substances-safely.
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Book Code: FTX1624
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