Care Of The Diseased Patient

INFECTION CONTROL POLICY FOR CARE OF THE DECEASED PATIENT. Health care workers may come into contact with recently deceased patients as part of their daily work. A number of these will have died as a result of complications of infection or infectious conditions, many of which have no immediate risk to staff handling or laying out bodies. However certain bacteria and viruses may pose a risk, if staff are exposed to the agent or fluids/material containing those agents. 1

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General Principles 1.1

This policy must be read in conjunction with other relevant policies within this Infection Control folder, the Health and Safety Policy folder, and Taunton and Somerset NHS Trust Policy folder.

1.2

Infection control in the mortuary as elsewhere is based on universal precautions, i.e. the prevention of contamination of workers, irrespective of knowledge of the deceased persons’ infection status

1.3

Appendix 1 (Table1 and Table 2) provides guidelines as to which infections are NOTIFIABLE (1).

1.4

Appendix 1 also provides guidelines with regard to the use of body bags.

Last Offices. 2.1

Blood and body fluids from the deceased remain potentially infectious, so universal precaution must be applied.

2.2

Following the completion of last offices the deceased body shall be presented in a manner that prevents leakage of body fluids. For example: Removal of or spigotting of tubes and cannulae as appropriate. Using waterproof occlusive tape or dressings over wounds or recently de-cannulated sites. If leakage from the body is large contact mortuary technician for advice. Using a body bag if subsequent leakage of fluid is suspected.

Body bags. 3.1

A supply of body bags will be available on all wards.

3.2

Body bags must only be used where indicated as, ‘advised’ or ‘yes’ on the accompanying tables. (Appendix 1).

3.3

The only exception to 3.2 is if the body is leaking large volumes of fluid and therefore the use of a body bag is to contain such fluid loss.

Transportation from wards to the mortuary. 4.1

Given that proper containment is adhered to as described in Section 2, there will be no need for protective clothing to be worn during transportation. Should body fluid leakage or improper containment be noted at time of collection, removal will be halted until the ward nursing staff have rectified the situation.

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4.2

Following transfer of the body to the mortuary or body storage room, staff involved in the transportation will wash their hands and complete the register before returning to subsequent duties.

4.3

Mortuary staff must be alerted prior to transportation of any infection risk bodies. (See Appendix 1). Out of hours contact the on call mortician via switchboard.

Body storage. 5.1

A body cold store must have a capacity appropriate for mortuary workload, and be maintained at a temperature of about 4° C.(2)

5.2

Bodies not in a refrigerated store must be kept in a cool environment (below 10°c) and dispatched to the undertaker in a maximum of 72 hours. Please note bodies will start to deteriorate (start to disfigure and smell) within 12 hours at ambient temperature.

Viewing 6.1

Relatives viewing bodies in the mortuary must be accompanied and the viewing of the body will be co-ordinated by the mortuary technician.

6.2

Relatives who have had physical contact with a body must be encouraged to wash their hands before leaving the mortuary.

6.3

Mortuary staff must advise relatives as to whether there may be any health risk for them if they wish to touch the body. If the risk of infection is significant then relatives must be discouraged from touching the body.(2)

6.4

If relatives insist on seeing the body in a high risk of infection case, they may be allowed to see the face only. They must be strongly discouraged from kissing or touching the body.(2)

6.5

Mortuary technician is responsible for ensuring the viewing room is maintained in an appropriate state of cleanliness at all times.

Handover to Undertakers. 7.1

All bodies will be presented to the undertakers in a manner conducive to infection control, i.e.:Visibly clean of body fluids In body bag if body fluids containment is problematic or the body is considered an infection risk.

7.2

Undertakers must be informed as to whether the body presented in a body bag, is considered to be an infection risk due to leaking fluid, or carriage of pathogens that present a serious risk to health. Exact specification of pathogens would breach patient confidentiality and is therefore not recommended.

Post Mortem Procedures 8.1

Post mortem examinations should be expected in the following circumstances and tubes and lines should be disconnected from fluid reservoirs and spigotted to prevent leakage but left in situ:

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unexpected deaths deaths of unknown cause within 48 hours of surgery within 48 hours of hospital admission (including death on arrival cases in A&E) deaths where there are allegations of medical malpractice

8.2

Post mortem on cases know or suspected to have Hazard group 3 or 4 pathogens must be carried out at a mortuary with appropriate facilities.

8.3

All healthcare workers and visiting professionals will adopt universal precautions and utilise appropriate personal protective clothing. (2). For those actively engaged in post mortem procedures this means: Disposable powder-free latex gloves as a minimum, with options of double gloving and of heavy-duty gloves of elbow or shoulder length. Cut resistant gloves (stainless steel mesh) to non-dominant hand. Long waterproof disposable apron. Full-face visor or goggle and fluid-shield mask. Mid-calf length, non-slip rubber boots (with steel protectors to protect against falling instruments). Long sleeved surgical gown with waterproof front and arms. Caps or hoods which completely cover the hair

8.4

Risks to health during post-mortem examination are primarily related to airborne and bloodborne infection routes. Examination techniques must ensure that liquid dispersion and splashing is minimised and that instruments likely to cause puncture wounds or cuts are only handled appropriately (2).

8.5

Cleaning and hard surface disinfection must take place at the end of each post mortem session.

8.6

Instruments must be thoroughly washed and decontaminated in accordance with Trust policy.

Issued:

December 2002

Authorised:

____________________________________________ (Dr J W Jones, Control of Infection Doctor)

Next Review: December 2005 Expiry Date:

December 2006

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TABLE 1 Guidelines for handling cadavers with infections noticeable in England and Wales Degree of Infection Bagging Viewing Embalming

Hygienic preparation

risk

Low

Medium

High High(rare)

Acute encephalitis Leprosy Measles Meningitis(except Menningococcal) Mumps Ophthalmia neonatorum Rubella Tetanus Whooping Cough Relapsing fever Food poisoning Hepatitis A Acute poliomyelitis Diphtheria Dysentery Leptospirosis (Well’s Disease) Malaria Meningococcal septicaemia (with or without meningitis Paratyphoid fever Cholera Scarlet fever Tuberculosis Typhoid fever Typhus Hepatitis B,C, and non-A, non-B Anthrax Plague Rabies Smallpox Viral haemorrhagic fever Yellow Fever

No No No No No No No No No Adv No/Adv No No Adv Adv No No

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes* Yes Yes Yes* Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Adv

Yes

Yes

Yes

Adv No Adv Adv Adv Adv Yes Adv Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes No Yes No No No No No No

Yes Yes* Yes Yes Yes No No No No No No No No

Yes Yes Yes Yes Yes No No No No No No No No

Adv = Advisable and may be required by local health regulation * = Requires particular care during embalming. Bagging = Placing the body in a plastic body bag. Viewing = allowing the bereaved to see, touch, and spend time with the body before disposal. Embalming = injecting chemical preservatives into the body to slow the process of decay. Hygienic preparation = cleaning and tidying the body so it presents a suitable appearance for viewing (an alternative to embalming). TABLE 2 Guidelines for handling cadavers with some infection that are not notifiable in England and Wales. Degree of Infection Bagging Viewing Embalming Hygienic risk preparation Low

Medium

High

Chickenpox / shingles Cryptosporidiosis Dermatophytosis Legionellosis Lymes disease Orf Psittacosis Methicillin resistant staphylococcus aureus Tetanus HIV / AIDS Haemorrhagic fever with renal syndrome Q fever Transmissible spongiform encephalopathies( i.e. CJD, invasive group A Strep infection)

No No No No No No No No No Adv No No

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes

Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes

Yes

No

No

No

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References 1.

Healing TD, Hoffman PN, Young SEG. The Infection hazards of Human Cadavers CDR Review 1995: 5: R61-73.

2.

Health Service Advisory Committee. Safe working and the prevention of infection in mortuary and post-mortem room.1991 Health and Safety Executive

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