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NEW JERSEY Funeral Continuing Education
Elite Learning
The courses in this book fulfill your 5-hour NJ funeral homestudy hours. Also included is the mandatory course: “OSHA and CDC Compliance for NJ Funeral Professionals.”
5-hour Continuing Education Package $49.95
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WHAT’S INSIDE
THIS COURSE MEETS YOUR OSHA LAWS AND REGULATIONS REQUIREMENT Chapter 1: OSHA and CDC Compliance for NJ Funeral Professionals (Mandatory) [1 CE hour] There are many health hazards working with or near human remains. By using common sense, OSHA’s bloodborne pathogen standards and universal precautions these risks can be greatly reduced. [2 CE hours] Funeral directors and embalmers often play an active role in the aftermath of mass fatality incidents (MFIs). This course will define MFIs and their classification levels, as well as the preparation, consideration, coordination, and communication required to best serve the victims and families affected. Chapter 2: Mass Fatalities and Funeral Service Chapter 3: Opioids: Contributing to Both Health and Death [2 CE hours] Opioids are pain relievers administered through prescriptions. When someone takes too many opioids or reaches a tolerance threshold, an overdose occurs. With the increase of opioid deaths in the United States, it is imperative that the death-care industry recognizes and respects the hidden dangers. The funeral arrangements, visitation, and funeral can be complicated because of the circumstances surrounding the death. Opioids can affect the vessels and tissues of the body and cause embalming issues for embalmers. Funeral directors and embalmers need to be aware of safety procedures before embalming and to incorporate strict personal protective equipment. There are different embalming techniques for embalming an individual who was on opioids at the time of death as well as those who have overdosed on opioids. This course will also describe strategies to help combat overdoses in the funeral home.
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Final Examination Answer Sheet
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©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials. i FUNERAL CONTINUING EDUCATION Book Code: FNJ0524
What are the requirements for license renewal? Licenses Expire CE Hours Required Frequently Asked Questions
Mandatory Subjects
• 2 hours of preneed funeral arrangements (must be completed in-person) • 3 hours of funeral directing ethics and in New Jersey laws and rules relating to the practice of mortuary science (must be completed in-person) • No more than 3 hours of Board-approved OSHA laws and regulations per biennium renewal
Licenses expire on February 28, of the odd year
10 (5 hours allowed through home-study)
How much will it cost? If you are only completing individual courses in this book, use the code that corresponds to the course when completing online
COURSE TITLE
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OSHA and CDC Compliance for NJ Funeral Professionals (Mandatory)
1
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Chapter 1:
2 2 5
$19.95 $19.95 $49.95
FNJ02MF FNJ02OP FNJ0524
Chapter 2:
Mass Fatalities and Funeral Service
Chapter 3:
Opioids: Contributing to Both Health and Death
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How do I complete this course and receive my certificate of completion? See the following page for step-by-step instructions to complete and receive your certificate. Are you a New Jersey board-approved provider? Colibri Healthcare, LLC’s courses are approved by the State Board of Mortuary Science of New Jersey. Are my hours reported to the New Jersey board? No. The board requires licensees to certify at the time of renewal that they have complied with the continuing education requirement. The Board performs audits at which time proof of continuing education must be provided. What information do I need to provide for course completion and certificate issuance? Please provide your license number on the test sheet to receive course credit. Your state may require additional information such as date of birth and/or last 4 of Social Security number; please provide these, if applicable. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Funeral you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-888-857-6920, Monday - Friday 9:00 am - 6:00 pm and Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
Licensing board contact information: State Board of Mortuary Science of New Jersey
PO Box 45009 | Newark, New Jersey 07101 I Phone: (973) 504-6425 Website: https://www.njconsumeraffairs.gov/mor/Pages/default.aspx
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Book Code: FNJ0524
FUNERAL CONTINUING EDUCATION
How To Complete This Book For Credit
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If you are only completing individual courses in this book, enter the code that corresponds to the course below online.
OSHA and CDC Compliance for NJ Funeral Professionals (Mandatory)
1
$14.95
FNJ01OS
Mass Fatalities and Funeral Service
2
$19.95
FNJ02MF
Opioids: Contributing to Both Health and Death
2
$19.95
FNJ02OP
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Complete the answer sheet and evaluation found in the back of this book. Include your payment information and email address. Mail to: Elite Learning, PO Box 997432, Sacramento, CA 95899
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iii
FUNERAL CONTINUING EDUCATION
Book Code: FNJ0524
Chapter 1: OSHA and CDC Compliance for New Jersey Funeral Professionals (Mandatory) 1 CE Hour
By: Deborah Converse Learning outcomes
system from hazardous materials in the mortuary setting according to OSHA and CDC guidelines. List five guidelines from the OSHA Formaldehyde Protection Standard. Identify and define the Standard Precautions from the Centers for Disease Control and Prevention that apply to mortuary and funeral procedures. Board of Mortuary Science and updated in June 2016 (New Jersey Division of Consumer Affairs, 2016). The OSHA and CDC guidelines will be summarized to include sections specific to the funeral profession. Recent revisions to CDC guidelines were made in response to additional precautions for handling deceased patients with Creutzfeldt-Jakob disease (CDJ); variant CDJ (vCDJ); bovine spongiform encephalopathy (BSE), or “mad cow disease”; and Ebola (CDC, 2015). health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics. Employees in the funeral profession face a variety of health hazards when recovering, handling, or working near human remains. According to OSHA, workers directly involved are susceptible to bloodborne viruses, such as hepatitis and HIV, and bacteria that cause diarrheal diseases, such as shigella and salmonella, to name a few (OSHA, 2015).
After completing this course, the learner will be able to: List and explain the OSHA guidelines for the prevention of the transmission of bloodborne pathogens in the mortuary setting. Identify the appropriate personal protective equipment to protect the eyes, face, hands, feet, and respiratory Course overview This course provides information on the Occupational Health and Safety and Administration (OSHA) guidelines for employees in the funeral profession. These guidelines, including bloodborne pathogen training, are based on the Centers for Disease Control and Prevention (CDC) Universal Precautions to protect workers against infection and transmission of disease. Employees in the funeral profession are required to complete a course on this topic according to The New Jersey Administrative Code: Title 13 Law and Public Safety, Chapter 26, developed by the professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact Introduction The New Jersey Administrative Code: Title 13 Law and Public Safety, Chapter 26 details the health and safety guidelines to protect all employees in the funeral profession. Chapter 26 references standards and guidelines from The Occupational Health and Safety Administration (OSHA) and the Centers for Disease Control and Prevention (CDC). Implicit bias in healthcare Implicit bias significantly affects how healthcare
UNIVERSAL PRECAUTIONS
The CDC includes the mortuary and funeral personnel under the category of health care workers (HCW.) The UP guidelines were the foundation for OSHA’s 1991 development of precautions to prevent occupational exposure to bloodborne pathogens in health care settings that include the funeral industry. OSHA defines bloodborne pathogens as pathogenic microorganisms that are present in human blood and can cause disease in humans (OSHA, 2012). These pathogens include, but are not limited to, hepatitis B virus (HBV) and human immunodeficiency virus (HIV).
Universal Precautions (UP) is the practice of avoiding contact with bodily fluids by means of the wearing of nonporous articles, such as gloves, goggles, and face shields (Siegel et al., 2007). The practice was introduced in 1985. In 1996, this term was replaced with Standard Precautions. The CDC defines Standard Precautions as, “a set of precautions designed to prevent transmission of HIV, Hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care” (Siegel et al., 2007). Under Standard Precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV, and other bloodborne pathogens (Siegel et al., 2007).
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According to OSHA (2015), there is no direct risk of contagion or infectious disease from being near human remains if not directly involved in recovery or procedures that require handling remains. Viruses associated with human remains do not pose a risk to someone walking
nearby, nor do they cause significant environmental contamination. The smell of human decay is unpleasant; however, it does not create a public health hazard (OSHA, 2015).
CDC STANDARD PRECAUTIONS
The following information is summarized from the 2007 CDC Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings and is referenced in Title 13 Law and Public Safety, Chapter 26 (Siegel et al., 2007). ● Standard Precautions are based on the principle that all blood; body fluids; secretions; excretions, except sweat; nonintact skin; and mucous membranes may contain transmissible infectious agents. ● Standard Precautions include hand hygiene; use of gloves, gown, mask, eye protection, or face shield, The New Jersey Administrative Code: Title 13 Law and Public Safety, Chapter 26, contains a number of sections that include references to OSHA and CDC guidelines. These sections are included below, and the applicable OSHA and CDC guidelines are listed as referenced. This one-hour course does not include all of Chapter 26, but it should be reviewed in its entirety at the website included on the reference page (New Jersey Division of Consumer Affairs, 2016).
depending on the anticipated exposure; and safe injection practices. ● Equipment or items in the environment contaminated with infectious body fluids must be handled in a manner to prevent transmission of infectious agents. This includes containing heavily soiled equipment and properly cleaning, disinfecting or sterilizing reusable equipment.
● Education and training on the principles and rationale for recommended practices are critical elements of Standard Precautions. THE NEW JERSEY ADMINISTRATIVE CODE: TITLE 13 LAW AND PUBLIC SAFETY, CHAPTER 26
13:36-5.6: Equipment requirements 10) For each licensee and trainee, protection, apparel and/ or equipment as required by all applicable standards of the Occupational Safety and Health Administration Agency (OSHA) and N.J.A.C. 7.26-3A, the Department of Environmental Protection regulations, which implement the Comprehensive Regulated Medical Waste Management Act, N.J.S.A. 13.1E-48.1 et seq (New Jersey Division of Consumer Affairs, 2016).
PERSONAL PROTECTIVE EQUIPMENT: OSHA 29 CFR PART 1910: BLOODBORNE PATHOGENS
Personal protective equipment Provision: When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, pocket masks, or other ventilation devices (OSHA, 2014). PPE refers to a variety of barriers and respirators, used alone or in combination, to protect mucous membranes, airways, Gloves Gloves are used to prevent contamination of when: ● Anticipating direct contact with blood or body fluids, mucous membranes, nonintact skin, and other potentially infectious material. ● Having direct contact with remains colonized or infected with pathogens transmitted by the contact route, such as VRE, MRSA, RSV. ● Handling or touching visibly or potentially contaminated equipment and environmental surfaces (Siegel et al., 2007). Gloves manufactured for health care purposes are subject to FDA evaluation and clearance. Nonsterile disposable medical gloves are made of a variety of materials, including latex, vinyl, and nitrile. The selection of glove type is based on a number of factors, including the task that is to be performed, anticipated contact with chemicals and chemotherapeutic agents, latex sensitivity, sizing, and facility policies for creating a latex-free environment. For contact with blood and body fluids during nonsurgical procedures, a single pair of gloves generally provides adequate barrier protection. CDC studies have shown that
skin, and clothing from contact with infectious agents. The selection of PPE is based on the nature of the interaction or the likely mode of transmission. Hand hygiene is always the final step after removing and disposing of PPE. The following sections highlight the primary uses and methods for selecting PPE equipment (OSHA, 2014).
vinyl gloves have higher failure rates than latex or nitrile gloves (Siegel et al., 2007). Either latex or nitrile gloves are preferable for procedures that require manual dexterity or will involve more than brief contact with potentially infectious materials. Heavier, reusable utility gloves are indicated for such activities as handling or cleaning contaminated equipment or surfaces. During contact with remains, transmission of infectious organisms can be reduced by adhering to the principles of working from “clean” to “dirty,” and confining or limiting contamination to areas essential to the procedure. It may be necessary to change gloves if interaction also involves touching portable computer keyboards or other mobile equipment. Gloves must not be washed for subsequent reuse because microorganisms cannot be removed reliably from glove surfaces and continued glove integrity cannot be ensured. Glove reuse has been associated with transmission of MRSA and gram- negative bacilli (Siegel et al., 2007). When gloves are worn in combination with other PPE, they are put on last. Gloves that fit snugly around the wrist are preferred for use with an isolation gown because they cover the gown cuff and provide a continuous barrier for arms,
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wrists, and hands. Gloves removed properly will prevent hand contamination. Hand hygiene following glove removal further ensures that the hands will not carry potentially Face protection: Masks, goggles, face shields II.E.3.a.: Masks are used to protect against contact with infectious material from secretions and sprays of blood or body fluids. Masks may be used in combination with goggles to protect the mouth, nose and eyes, or a face shield may be used to provide more complete protection for the face. The mucous membranes of the mouth, nose, and eyes are susceptible portals of entry for infectious agents, as can be other skin surfaces if skin integrity is compromised. Procedures that generate splashes or sprays of blood, body fluids, secretions, or excretions, including suctioning or invasive vascular procedures, require either a face shield or mask and goggles. The use of masks, eye protection, and face shields in specified circumstances when blood or body fluid exposures are likely is mandated by the Bloodborne Pathogens Standard. Two mask types are available, which are surgical masks cleared by the FDA, and are required to have fluid-resistant properties and procedure or isolation masks. Procedure/isolation masks are not regulated by the FDA and have more variability in quality and performance than surgical masks have (Siegel et al., 2007). II.E.3.b.: The eye protection chosen for specific work situations, goggles or face shield, depends upon the circumstances of exposure, other PPE used, and personal vision needs. Personal eyeglasses and contact lenses are not adequate eye protection. The CDC National Institute for Occupational Safety and Health (NIOSH) states: “Eye protection must be comfortable, allow for sufficient Respiratory protection II.E.4.: Respiratory protection requires the use of a respirator with N95 or higher filtration to prevent inhalation of infectious particles. Respiratory protection is broadly regulated by OSHA under the general industry standard for respiratory protection, which requires that U.S. employers in all employment settings implement a program to protect employees from inhalation of toxic materials. CDC
infectious material that might have penetrated through unrecognized tears or could contaminate hands during glove removal.
peripheral vision, and must be adjustable to ensure a secure fit” (Siegel et al., 2007). Indirectly vented goggles with a manufacturer’s antifog coating may provide the most reliable practical eye protection from splashes, sprays, and respiratory droplets from multiple angles. Newer styles of goggles may provide better indirect airflow properties to reduce fogging, as well as better peripheral vision and more size options for fitting goggles to different workers. Many styles of goggles fit adequately over prescription glasses with minimal gaps. Protection for the eyes, nose, and mouth is necessary when there may be a splash or spray of body fluids. Disposable or nondisposable face shields may be used as an alternative to goggles. Compared to goggles, a face shield can provide protection to other facial areas in addition to the eyes. Face shields extending from chin to crown provide better face and eye protection from splashes. Face shields that wrap around the sides may reduce splashes around the edge of the shield. Removal of a face shield, goggles, and mask can be performed safely after gloves have been removed, and hand hygiene performed. The ties, ear pieces, and headband used to secure the equipment to the head are considered “clean” and therefore safe to touch with bare hands. The front of a mask, goggles, and face shield are considered contaminated. recommends N95 or higher level respirators for personnel exposed to diseases that could be transmitted through the airborne route by aerosol-generating procedures. A Respirator may be reused if not damaged or soiled, the fit is not compromised by change in shape, and the respirator has not been contaminated with blood or body fluids (Siegel et al., 2007).
THE OSHA FORMALDEHYDE STANDARD (29 CFR 1910.1048)
The OSHA standard and equivalent regulations in states with OSHA-approved state plans protects workers exposed to formaldehyde and apply to all occupational exposures to formaldehyde from formaldehyde gas, its solutions, and materials that release formaldehyde (OSHA, n.d.). The permissible exposure limit (PEL) for formaldehyde in the workplace is 0.75 parts formaldehyde per million parts of air (0.75 ppm) measured as an eight-hour time-weighted average (TWA). The standard includes a second PEL in the form of a short-term exposure limit (STEL) of 2 ppm, the maximum exposure allowed during a 15-minute period. The action level, which is the standard’s trigger for increased industrial hygiene monitoring and initiation of worker medical surveillance, is 0.5 ppm when calculated as an eight-hour TWA.
Formaldehyde is a colorless, strong-smelling gas often found in aqueous, water-based solutions and commonly used as a preservative in mortuaries (OSHA, n.d.). Formaldehyde is a sensitizing agent that can cause an immune system response upon initial exposure and is a cancer hazard. Acute exposure is highly irritating to the eyes, nose, and throat and can make anyone exposed cough and wheeze. Subsequent exposure may cause severe allergic reactions of the skin, eyes, and respiratory tract. Ingestion of formaldehyde can be fatal, and long-term exposure to low levels in the air or on the skin can cause asthma-like respiratory problems and skin irritation, such as dermatitis and itching. Concentrations of 100 ppm are immediately dangerous to life and health (IDLH). Note: The National Institute for Occupational Safety and Health (NIOSH) considers 20 ppm of formaldehyde to be IDLH. (OSHA, n.d.). Provisions of the OSHA Standard Provisions of the OSHA Standard require employers to do the following: ● Identify all workers who may be exposed to formaldehyde at or above the action level or STEL through initial monitoring and determine their exposure.
● Reassign workers who suffer significant adverse effects from formaldehyde exposure to jobs with significantly less or no exposure until their condition improves. ● Implement feasible engineering and work practice controls to reduce and maintain worker exposure to formaldehyde at or below the eight-hour TWA and the STEL. If these controls cannot reduce exposure to or
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● Select, provide, and maintain appropriate personal protective equipment (PPE). Ensure that workers use PPE, such as impervious clothing, gloves, aprons, and chemical splash goggles to prevent skin and eye contact with formaldehyde. ● Provide showers and eyewash stations if splashing is likely. ● Provide medical surveillance for all workers exposed to formaldehyde at concentrations at or above the action level or exceeding the STEL, for those who develop signs and symptoms of overexposure, and for all workers exposed to formaldehyde in emergencies.
below the PELs, employers must provide workers with respirators. ● Label all mixtures or solutions composed of greater than 0.1% formaldehyde and materials capable of releasing formaldehyde into the air at concentrations reaching or exceeding 0.1 ppm. For all materials capable of releasing formaldehyde at levels above 0.5 ppm during normal use, the label must contain the words “potential cancer hazard.” ● Train all workers exposed to formaldehyde concentrations of 0.1 ppm or greater at the time of initial job assignment and whenever a new exposure to formaldehyde is introduced into the work area. Repeat training annually. Recordkeeping requirements Employers are required to do the following regarding worker formaldehyde exposure records: ● Retain exposure records for 30 years. ● Retain medical records for 30 years after employment ends. a) Every person, while engaged in the actual embalming of a human body, shall be attired in a clean and sanitary smock or gown, which does not permit blood or other potentially infectious materials to pass through to or reach the employee’s work clothes, street clothes, Isolation gowns II.E.2.: Isolation gowns are used as specified by CDC Standard and Transmission-Based Precautions to protect the HCW’s arms and exposed body areas and prevent contamination of clothing with blood, body fluids, and other potentially infectious material. The need for and type of isolation gown selected is based on the nature of the interaction, including the anticipated degree of contact with infectious material and potential for blood and body fluid penetration of the barrier. The OSHA Bloodborne Pathogens Standard mandates the wearing of isolation gowns and other protective apparel (Siegel et al., 2007). ● Clinical and laboratory coats or jackets worn over personal clothing are not PPE. ● An isolation gown is worn only if contact with blood or body fluid is anticipated. ● The donning of both gown and gloves upon room entry is indicated to address unintentional contact with contaminated environmental surfaces.
● Allow access to medical and exposure records to current and former workers or their designated representatives upon request.
13:36-6.2: DRESS REQUIREMENT FOR EMBALMING (NEW JERSEY DIVISION OF CONSUMER AFFAIRS, 2016)
undergarments, skin, eyes, mouth or other mucous membranes, and shall while so engaged wear protective apparel in compliance with OSHA regulations set forth at 29 CFR 1910.1030, incorporated herein by reference (OSHA, 2012). ● Isolation gowns are always worn in combination with gloves and with other PPE when indicated. Gowns are usually the first piece of PPE donned. ● Full coverage of the arms and body front from neck to the midthigh or below will ensure that clothing and exposed upper body areas are protected. ● Several gown sizes should be available in a health care facility to ensure appropriate coverage for staff members. ● Isolation gowns should be removed before leaving the work area to prevent possible contamination of the environment outside the room. ● Isolation gowns should be removed in a manner that prevents contamination of clothing or skin. ● The outer contaminated side of the gown is turned inward and rolled into a bundle and then discarded into a designated container for waste or linen to contain contamination.
13:36-6.4: DISPOSAL OF BLOOD AND EXCRETION
due care to prevent any spread of infection in the handling of a dead human body during transportation, in preparing and during embalming, and after contact with such body, and shall also include the disinfecting of hands and the removal of any soiled clothing (New Jersey Division of Consumer Affairs, 2016). (OPIM); contaminated items that would release blood or OPIM in a liquid or semiliquid state if compressed; items caked with dried blood or OPIM and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or OPIM (OSHA, 2012). In general, regulated wastes, other than contaminated sharps, must be placed in containers that are:
All blood and excretions of a body shall be disposed of in a sanitary manner. Licensees shall comply with OSHA regulations set forth at 29 CFR 1910.1030 in the operation of a licensed funeral establishment and shall use Universal Precautions according to the Centers for Disease Control recommendations. These precautions shall include taking Applicable OSHA bloodborne pathogen guidelines The disposal of regulated waste must be in accordance with applicable regulations of the United States, states and territories, and political subdivisions of states and territories. This section applies to all occupational exposure to blood or other potentially infectious materials (OSHA, 2012). OSHA’s Bloodborne Pathogens Standard provides for the protection of employees during the containment, storage, and transport of regulated waste other than contaminated sharps. The standard defines regulated waste as liquid or semiliquid blood or other potentially infectious material
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● Closable. ● Constructed to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping. ● Labeled or color-coded in accordance with paragraphs (g) (1)(i). ● Closed prior to removal to prevent spillage or protrusion of contents during handling, storage, transport, or shipping (OSHA, 2012). Ergonomic considerations Lifting or moving heavy objects, particularly when done repetitively, can result in injuries to the workers involved. Human remains that have been in water for some time are likely to be even heavier than normal. Having more than 13:36-6.5: Marking receptacles All receptacles containing embalming fluid, formaldehyde, or any poisonous or dangerous substances shall be marked to indicate the contents. Receptacles containing blood or waste, refrigerators, and freezers containing potentially infectious material and other containers used to store, transport, or ship potentially infectious materials. ● Labels required by this section shall include the following legend: 1. These labels shall be fluorescent orange or orange- red with lettering and symbols in a contrasting color. 2. Labels shall be affixed as close as feasible to the container by string, wire, adhesive, or other method that prevents their loss or unintentional removal. 3. Red bags or red containers may be substituted for labels. conduct of the practice of mortuary science shall: 3) Represent that state or local law requires that any condition be placed upon the provision of funeral services for any deceased person based upon the cause of death. b) In the preparation for burial or transportation of a dead body, the funeral director, the embalmer, intern, and assistants shall comply with OSHA regulations set forth at 29 CFR 1910.1030 (OSHA, 2012) and shall use Universal Precautions according to Centers for Disease Control (Siegel et al., 2007). Standard precautions II.D. Hand hygiene : Hand hygiene is the single most important practice to reduce the transmission of infectious agents in health care settings and is an essential element of Standard Precautions. Hand hygiene includes both hand washing with plain or antiseptic-containing soap and water, and use of alcohol-based products, gels, rinses, and foams that do not require the use of water. In the absence of visible soiling of hands, approved alcohol-based products for hand disinfection are preferred over antimicrobial or plain soap and water because of their superior microbicidal activity, reduced drying of the skin, and convenience (Siegel et al., 2007).
It is the employer’s responsibility to determine the existence of regulated waste. This determination is not based on actual volume of blood but rather on the potential to release blood, such as when compacted in the waste container. If OSHA determines that sufficient evidence exists that the Bloodborne Pathogen Standard has been violated, a citation carrying monetary penalties may be issued to the employer. one person involved in lifting the human remains will help to reduce the potential for injury. Following appropriate lifting techniques will also help to protect against injury, as will the use of mechanical lifts or other devices (Siegel et al., 2007).
other potentially infectious materials shall be placed in a container that prevents leakage during collection or storage (New Jersey Division of Consumer Affairs, 2016).
Applicable OSHA bloodborne pathogen guidelines: Communication of hazards to employees: Labels and signs (OSHA, 2012) ● Warning labels shall be affixed to containers of regulated
4. Individual containers of potentially infectious materials placed in a labeled container during storage, transport, shipment, or disposal are exempted from the labeling requirement. 5. Labels required for contaminated equipment shall be in accordance with this paragraph and shall also state which portions of the equipment remain contaminated. 6. Regulated waste that has been decontaminated need not be labeled or color coded. Labels required by this section shall include the following legend:
CHAPTER 13: SUBCHAPTER 7. SPECIAL RULES OF PRACTICE 13:36-7.1: HANDLING AND EMBALMING BODIES DEAD OF AN INFECTIOUS OR CONTAGIOUS DISEASE (NEW JERSEY DIVISION OF CONSUMER AFFAIRS, 2016) a) Except as otherwise provided by law, no person in the
These shall include taking due care to prevent any spread of infection in the handling of such body during transportation, in preparation and during embalming, and after contact with such body, and shall disinfect their hands and remove any soiled clothing. All instruments, gloves, coverings, and utensils used in embalming or in handling the body shall be disinfected immediately after being used. All fluids or other matters removed from such body in the process of embalming shall be disposed of in accordance with all applicable state, federal, and local laws and regulations governing medical and infectious waste. The effectiveness of hand hygiene can be reduced by the type and length of fingernails. Individuals wearing artificial nails have been shown to harbor more pathogenic organisms, especially gram-negative bacilli and yeasts, on the nails and in the subungual area than those with natural nails. CDC recommends that artificial fingernails and extenders not be worn by HCWs who have contact with high-risk remains due to the association with outbreaks of gram-negative bacillus and candidal infections. There is less evidence that jewelry affects the quality of hand hygiene though hand contamination with potential pathogens is increased with ring wearing (Siegel et al., 2007).
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Applicable OSHA bloodborne pathogen guidelines (OSHA, 2012) ● General: Employers shall ensure that the worksite is maintained in a clean and sanitary condition. All equipment and environmental and working surfaces shall be cleaned and decontaminated after contact with blood or other potentially infectious materials. ● Contaminated work surfaces shall be decontaminated
on a regularly scheduled basis and cleaned and decontaminated immediately or as soon as feasible upon visible contamination. ● The surfaces of doors, walls, floors, and ceilings in the work area shall be water resistant so that they can be easily cleaned. Penetrations in these surfaces shall be sealed or capable of being sealed to facilitate decontamination. ● Each work area shall contain a sink for washing hands and a readily available eye wash facility. The sink shall be foot, elbow, or automatically operated and shall be located near the exit door of the work area. ● A ducted exhaust-air ventilation system shall be provided. This shall create directional airflow that draws air into the work area through the entry area. The exhaust air shall not be recirculated to any other area of the building, shall be discharged to the outside, and shall be dispersed away from occupied areas and air intakes.
with an appropriate disinfectant after completion of procedures, immediately or as soon as feasible, and at the end of the work shift if the surface may have become contaminated since the last cleaning. ● Protective coverings— such as plastic wrap, aluminum foil, or imperviously backed absorbent paper used to cover equipment and environmental surfaces—shall be removed and replaced as soon as feasible, when they become overtly contaminated, or at the end of the work shift if they may have become contaminated during the shift. ● All bins, pails, cans, and similar receptacles intended for reuse, which have a likelihood for becoming contaminated, shall be inspected and decontaminated
CDC GUIDELINES: CREUTZFELDT-JAKOB DISEASE
Practitioners at funeral homes, cemeteries, and crematories have encountered many potentially fatal and infectious diseases yet have found ways to both serve families and Transporting Funeral service workers can safely remove the body of a CJD patient from the place of death and transport it to the funeral home preparation room for mortuary procedures using appropriate standard infection control measures, which includes wearing personal protective gear. The World Health Organization (WHO) recommends placing the body Preparation and dressing An autopsied or traumatized body of a suspected or confirmed CJD patient can be embalmed using the precautions outlined in the WHO/ CJD infection control guidelines (CDC, 2015). CJD patients who have not been autopsied or whose bodies have not been traumatized can be embalmed using Standard Precautions. Family members Embalming bodies not autopsied Embalming bodies of CJD patients who have not been autopsied can be performed using Standard Precautions. However, it may be prudent to place the body on a waterproof sheet to collect bodily fluids and use disposable instruments. The bodily fluids should be collected in a Embalming autopsied bodies Embalming bodies of CJD patients who have been autopsied can also be safely performed. Adherence to standard infection control measures is paramount when embalming an autopsied body of a suspected or clinically diagnosed CJD patient. Autopsies on these individuals are often restricted to removal of the brain; therefore, special precautions should Bodies of autopsied CJD patients Bodies of autopsied CJD patients should be placed on a waterproof sheet to collect all fluids. It is strongly recommended that disposable instruments, masks, gowns, and puncture-resistant gloves be used whenever possible. The entire body should be washed with bleach, rinsed, and
protect the health of the public. Creutzfeldt-Jakob disease (CJD) is no exception. (CDC, 2015). The following sections on CJD are from the CDC website. (CDC, 2015). in a leakproof pouch prior to moving (CDC, 2015). The bag should be lined with absorbent material to prevent leakage of body fluids. In instances where there is excess fluid, a double bag can be utilized. After transporting, all surfaces, stretchers, and cots should be disinfected with bleach (CDC, 2015). of CJD patients should be advised to avoid superficial contact, such as touching or kissing the patient’s face, with the body of a CJD patient who has been autopsied. However, if the patient has not been autopsied, such contact need not be discouraged (CDC, 2015).
suitable container. Incision sites should be closed with super glue and wiped down with bleach, and the body washed prior to dressing. Cosmetic restorative work may also be undertaken (CDC, 2015).
be taken, including placing a plastic sheet with absorbent wadding and raised edges underneath the head to ensure containment of fluids and prevent any spillage. In instances where sutures do not completely control leaking, the cranial cavity should be packed with absorbent material that has been soaked with bleach and tightly sutured (CDC, 2015). sanitized before dressing. Special care should be taken to limit fluid leakage when performing restorative work on a CJD patient. All fluids should be collected in a suitable container (CDC, 2015).
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Book Code: FNJ0524
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Casketing and viewing Avoid unnecessary manipulation of the body that would force purging of body fluids and risk opening of incision sites. If warranted, the casket can be lined with a leak proof sheet. An open casket for viewing should not be prohibited. However, Terminal disinfection and waste removal According to the World Health Organization Infection Control Guidelines for Transmissible Spongiform Encephalopathies, (CDC, 2015), all collected fluids should be disinfected by adding 40 grams of sodium hydroxide pellets per liter of collected 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 like other mortuary waste. Plastic sheets and other disposable items that have been exposed to 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, Final disposition: Cremation and burial There are no special interment, entombment, inurnment, or cremation requirements for patients with CJD. Interment of bodies in closed caskets does not present a significant risk of environmental contamination. Cremated remains can be
if an autopsy has been performed, family members of CJD patients should be advised to avoid superficial contact with the body, such as touching or kissing the patient’s face (CDC, 2015). then, using gloves, mopped up with absorbent disposable rags and surface swabbed with water sufficient to remove any residual disinfectant solution (CDC, 2015). Work surfaces can be disinfected by flooding with undiluted bleach. Although the use of disposable instruments is preferred, reusable instruments and tools can be cleaned and disinfected by using CJD sterilization protocols recommended by the CDC. All contaminated solid materials should be disposed of as hazardous waste. Disposing of body fluids, tissues, and hazardous chemicals should be handled in accordance with funeral home policy and state and federal regulations. considered sterile, as the infectious agent does not survive incineration-range temperatures (CDC, 2015). The CDC provides guidance for mortuaries in the handling of the remains of Ebola patients at http://www.cdc.gov/vhf/ ebola/healthcare-us/hospitals/handling-human-remains.html
13:36-10.3: MINIMUM CREDIT HOURS FOR BIENNIAL LICENSE RENEWAL (NEW JERSEY DIVISION OF CONSUMER AFFAIRS, 2016)
4) A licensee shall receive training in applicable Occupational Safety and Health Administration (OSHA) laws and regulations as required by OSHA. Licensees OSHA’s Bloodborne Pathogens Standard OSHA’s Bloodborne Pathogens Standard requires employers to provide information and training to workers. Employers must ensure that their workers receive regular training on all elements of the standard, including, but not limited to information on bloodborne pathogens and diseases, methods to control occupational exposure, hepatitis B vaccinations, and medical evaluation, including postexposure follow-up procedures. The employer shall train each employee with occupational exposure in accordance with OSHA requirements. Training must be provided at no cost to the employee and during working hours. The employer shall institute a training program and ensure employee participation in the program. Employers must offer this training on initial assignment, at least annually thereafter, and when new or modified tasks or procedures affect a worker’s risk of occupational exposure. The training program shall contain at a minimum the following elements: ● Training at an educational level in a language that workers understand. ● The opportunity to ask questions. ● A copy of the regulatory text of this standard and an explanation of its contents. ● An explanation of the epidemiology and symptoms of bloodborne diseases.
who seek continuing education credit for such training must attend a course or program approved by the Board.
● An explanation of transmission of bloodborne pathogens. ● An explanation of the exposure control plan and how the employee can obtain a copy of the plan. ● An explanation of tasks and other activities that may involve exposure. ● An explanation of the use and limitations of methods that will prevent or reduce exposure. ● Information on the types, proper use, location, removal, handling, decontamination, and disposal of personal protective equipment. ● An explanation for the selection of personal protective equipment. ● Information on the hepatitis B vaccine, its efficacy, safety, method of administration, benefits of being vaccinated, and that vaccination will be offered free of charge. ● Information on actions to take and persons to contact in an emergency involving blood or other infectious materials. ● An explanation of the procedure to follow if an exposure occurs including the method of reporting the incident and the medical follow-up that will be made available. ● Information on the post-exposure evaluation and follow- up that the employer is required to provide for the employee following an exposure incident. ● An explanation of the signs and labels or color coding.
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Book Code: FNJ0524
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Conclusion It is critical for all funeral and mortuary professionals to have a working knowledge of the CDC Standard Precautions and OSHA Bloodborne Pathogen Standards for the protection of all employees. The degree and type of application of the safety guidelines are dictated by the potential for transmission, type of pathogen, degree of exposure, and specific role of the employee. Hand hygiene guidelines must be followed along with proper assessment of potential safety hazards to determine the appropriate PPE and procedures for disinfection, labeling, isolation, and ventilation to protect all employees from contact with infectious material.
WORKS CITED https://qr2.mobi/Funeral_osha-cdc
OSHA AND CDC COMPLIANCE FOR NEW JERSEY FUNERAL PROFESSIONALS Final Examination Questions Select the best answer for each question and mark your answers on the Final Examination Answer Sheet found on page 28 or for faster service complete your test online at EliteLearning.com/Book
6. Employers are required to do the following regarding worker formaldehyde exposure records: Retain exposure records for 30 years. { True { False 7. Full coverage of the arms and body front from neck to the midthigh or below will ensure that clothing and exposed upper body areas are protected. { True { False 8. Hand hygiene includes both handwashing with plain or antiseptic-containing soap and water and use of anti microbial-based products, gels, rinses, and foams that do not require the use of water. { True { False 9. Contaminated work surfaces shall be decontaminated with an appropriate disinfectant after completion of procedures, immediately or as soon as feasible, and at the end of the work shift if the surface may have become contaminated since the last cleaning. { True { False 10. A ducted exhaust-air ventilation system shall be provided. This shall create directional airflow that draws air into the work area through the entry area. { True { False
1. When there is occupational exposure, the employer shall provide, at no cost to the employee, appropriate personal protective equipment, such as, but not limited to, gloves, gowns, laboratory coats, face shields or masks and eye protection, and mouthpieces, pocket masks, or other ventilation devices. { True { False 2. Disinfecting surfaces is always the final step after removing and disposing of PPE. { True { False 3. Either latex or nitrile gloves are preferable for procedures that require manual dexterity or will involve more than brief contact. { True { False 4. The use of masks, eye protection, and face shields in specified circumstances when blood or body fluid exposures are likely is mandated by the CDC Universal Standards. { True { False 5. Formaldehyde is a sensitizing agent that can cause an immune system response upon initial exposure but is not a cancer hazard. { True { False
Course Code: FNJ01OS
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Book Code: FNJ0524
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