CONTAINING THE EBOLA AND HIV/AIDS VIRUS
World Health Organization 2014 Ebola precautions for funeral directors The Ebola epidemic spread to American health workers overseas and prompted the CDC and the WHO to develop standards, preparedness regulations, and guidelines to address treatment and prevention in the U.S. (CDC, 2015; NFDA, 2014). Cleaning should precede application of disinfectants. WHO recommends: ● Do not spray (i.e., fog) occupied or unoccupied clinical areas with disinfectant. This is a potentially dangerous practice that has no proven disease control benefit. ● Wear gloves, gown, and closed shoes when cleaning the environment and handling infectious waste. Cleaning heavily
avoid any unnecessary risks to individuals handling these items. For postmortem examinations, hemorrhagic fever patient remains should be limited to essential evaluations only, and trained personnel should perform those evaluations. Personnel examining remains should wear eye protection, mask, gloves, and gowns as recommended for patient care. In addition, WHO recommends that personnel performing autopsies of known or suspected hemorrhagic fever patients should wear a particulate respirator and eye protection or face shield, or a powered air- purifying respirator. WHO also recommends: ● When removing protective equipment, avoid any contact between soiled gloves or equipment and the face (i.e., eyes, nose, or mouth). ● Hand hygiene should be performed immediately following the removal of protective equipment used during postmortem examination and that may have come into contact with potentially contaminated surfaces. period after death. In addition, the study revealed that viral RNA was detectable for ten weeks (Prescott et al., 2015). The CDC published the following guidelines in 2015 to protect against the postmortem spread of Ebola infection at the site of death, prior to transport, during transport, at the mortuary, and during final disposition of remains. The guide should be followed to train staff in the safe handling of human remains that may contain Ebola virus by properly using PPE and following decontamination measures at every step of the process. blood, urine, saliva, feces, or vomit to unprotected mucosa such as eyes, nose, or mouth during postmortem care. In addition to federal laws and guidelines that apply to mortuary workers contained in this course, mortuary practices and workers may also be subject to state, tribal, territorial, and local regulations. Staff should always consult local health department officials for additional guidance on laws that affect mortuary practices. The CDC recommends that licensed funeral directors, who have agreed to accept the bagged remains, work in close collaboration with public health officials in their state or local jurisdiction to safely implement each step of the process. ● Do not remove any inserted medical equipment from the body, such as intravenous (IV) lines, endotracheal or other tubing, or implanted electronic medical devices. ● Cremate the body. If cremation cannot be done because of safety concerns, the body should be buried in a standard metal casket or other comparable burial method.
soiled surfaces increases the risk of splashes. On these occasions, staff should wear facial protection in addition to gloves, gown, and closed, resistant shoes. ● Soiled linen should be placed in clearly labeled, leak-proof bags or buckets at the site of use, and the container surfaces should be disinfected (using an effective disinfectant) before removal from the site. Linen should be transported directly to the laundry area and laundered promptly with water and detergent. For low-temperature laundering, wash linens with detergent and water, rinse, and then soak in 0.05 percent chlorine for approximately thirty minutes. Linen should then be dried according to routine standards and procedures. When handling soiled linen from hemorrhagic fever patients, use gloves, gown, closed shoes, and facial protection. ● If safe cleaning and disinfection of heavily soiled linen is not possible or reliable, it may be prudent to burn the linens to Human-to-human transmission is the principal feature in Ebola virus outbreaks; the virus is transmitted from symptomatic persons or contaminated corpses or by contact with objects acting as fomites. Contact with corpses during mourning and funeral practices, which can include bathing the body and rinsing family members with the water, or during the removal and transportation of bodies by burial teams has resulted in numerous infections. A study published by the CDC on the postmortem stability of the Ebola virus shows that it can persist for more than seven days on surfaces of bodies, confirming that transmission from deceased persons is possible for an extended Background Given the systems currently in place to identify people with Ebola virus disease (EVD), beginning with screening and interception at airports for passengers from countries with known outbreaks, Ebola-related deaths in the United States would likely occur within a hospital setting, and all Ebola cases are immediately reported to and monitored by the CDC and state and local health agencies. Ebola can be detected throughout the bodies of patients who die of the disease. Ebola can be transmitted in postmortem care by laceration and puncture with contaminated instruments; through direct handling of human remains without recommended PPE; and through splashes of Key points ● Ebola virus can be transmitted in postmortem care settings through unsafe handling of remains. ● Only personnel trained in handling infected human remains and wearing recommended PPE should touch or move any human remains from a person who has died from Ebola. ● Do not wash or clean the body. ● Do not embalm the body. ● Do not perform an autopsy unless absolutely necessary. If an autopsy is necessary, consult the state health department and the CDC regarding necessary precautions.
● Place specimens in clearly labeled, non-glass, leakproof containers and deliver directly to designated specimen handling areas. ● All external surfaces of specimen containers should be thoroughly disinfected prior to transport. ● Tissue or body fluids for disposal should be carefully placed in clearly marked, sealed containers for incineration. 2015 CDC guidance for personnel: Postmortem care in U.S. hospitals and mortuaries to protect against the spread of Ebola
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