I. Preparation of the body for transport.
A. HCWs will wear All Barrier Precautions (ABP) personal protective equipment (PPE) when preparing the body for transport.
B. Prior to entering the room, HCWs will collect the appropriate dressing materials to apply occlusive dressings to all draining body sties. Dressings could be gauze covered over with tape or polyurethane film dressing with or without gauze sponges.
C. Preparation of the body
1. All lines and tubes should be left in place.\
2. After entering the room, occlusive dressings should be applied to all draining body sites.
3. Any blood, secretions or excretions on the body surface should be removed with disinfectant wipes. Soiled wipes should be discarded in the trash receptacle in the room.
4. Place the toe tag on one of the patient’s great toes and then place the body in the body bag with as little movement of the body as possible taking care to contain all body fluids.
5. After the body bag has been closed, wipe off the outside of the bag with disinfectant wipes.
D. Transport of the deceased patient to the morgue.
1. The Morgue should be called at the time HCWs from the floor enter the patient’s room to prepare the body.
2. Morgue personnel will obtain a stretcher.
3. The morgue personnel will proceed to the floor and don
ABP PPE on arrival.
a. Two gowns
b. Two pair of gloves
4. When the HCWs in the room have completed
preparation of the body, the morgue personnel will
push the stretcher into the room and the door will
be closed.
a. HCWs in the room and the morgue personnel
will move the deceased patient onto the
stretcher and cover the body bag with a
clean sheet. The body will be tagged with an
Infectious Diseases label.
b. The morgue personnel will push the stretcher
out of the room.
c. The transport persons will remove one pair of
gloves and one gown taking care to avoid
self contamination by carefully turning the
gloves and gown inside out and then
discarding them in a trash receptacle in the
room. These persons will then exit the room.
5. The HCWs will then remove their gloves, goggles
and gowns in the room.
6. The latter persons will exit the room, wash their
hands or apply an alcohol gel to their hands,
remove their masks, discard the masks into the
trash and again wash their hands or apply an
alcohol hand gel.
7. The persons from the morgue will then depart
for the morgue using the elevator designated for
EID patients.
8. The morgue personnel will transfer the patient from the
stretcher to the gurney for storage in the morgue.
9. The morgue personnel will remove gloves and gowns and
place them in the designated biohazard box. They will
then wash their hands or apply an alcohol hand gel.
10. The persons from the morgue will then don a gown and
gloves and wipe all surfaces of the stretcher with a
quaternary ammonium disinfectant.
11. They will then remove gloves and gown taking
care to avoid self contamination, deposit the gown and
gloves in the biohazard box and wash hands with an
antimicrobial soap and water or apply an alcohol hand
gel.
E. Storage of the body in the morgue.
1. The body must remain in the body bag until time
for the autopsy.
2. The body will be stored on the gurney in the
freezer until time for the autopsy.
3. Other than not touching the body bag or gurney
of an EID patient, no other precautions are
needed to enter the freezer when the body of an
EID patient is located there.
F. Personal protective equipment (PPE) for performing the
Autopsy
1. In general, safety procedures for human remains infected with an EID should be consistent with those used for any autopsy procedure. However, additional respiratory protection is needed during an autopsy procedure that may generate aerosols (e.g., use of oscillating saws).
2. Personal protective equipment (PPE)
a. Wear standard autopsy PPE, including a scrub suit worn under an impervious gown or apron, eye protection (i.e., goggles, face shield), double surgical gloves with an interposed layer of cut-resistant gloves, a fit tested N-95 masks, and shoe covers.
b. Autopsy personnel who cannot wear a disposable particulate respirator because of facial hair or other fit limitations will wear a PAPR.
c. If generation of a high level of aerosols is unavoidable the operator(s) must wear a PAPR. See Policy 3.8 Protection During the Conduct of High-Risk Respiratory Procedures in Patients with an Emerging Infectious Disease (EID).
d. Remove PPE before leaving the autopsy suite and dispose in accordance with facility policies and procedures. See Appendix (no. 14).
3. Engineering Controls
a. Whenever possible, perform autopsies on human remains infected with an EID in autopsy settings that have an adequate air-handling system. This includes a minimum of 6 (old construction) to 12 (new construction) ACH, negative pressure relative to adjacent areas as per recommendations for AIIRs, and direct exhaust air to the outside or pass through a HEPA filter if air is recirculated. Exhaust systems around the autopsy table should direct air (and aerosols) away from healthcare workers performing the procedure (e.g., exhaust downward).
b. Use containment devices whenever possible. Use biosafety cabinets for the handling and examination of smaller specimens. When available, use vacuum shrouds for oscillating saws to contain aerosols and reduce the volume released into the ambient air environment. See Appendix (no.9).
4. Prevention of percutaneous injuries
Follow standard safety procedures for preventing percutaneous injuries during autopsy.
G. Performance of the autopsy
1. Prior to the autopsy, the autopsy assistant will don the same personal protective equipment (PPE) as that used by the pathologist(s) performing the autopsy.
2. After donning PPE, the autopsy assistant will move the body from the freezer to the designated infectious diseases autopsy suite (room 518E).
3. Pathologists should remove their PPE following directions in the Appendix (no. 14).
4. After completion of the autopsy and prior to removing PPE, the autopsy assistant/others will place the body into a new body bag. The body bag will be placed back on the gurney. An Infectious Diseases label will be placed on the body bag.
5. The autopsy assistants should remove PPE following the procedure in the Appendix (no. 14).
6. Autopsy assistants should then don a new gown and gloves.
7. The outside of the bag and gurney will be wiped off with a quaternary ammonium compound and the gurney pushed back into the freezer.
8. Autopsy personnel will notify the funeral home director that the body is that of a person who died of an emerging infectious disease and inform the director of the name of the disease, if known.
