COVID-19 Steerage Postmortem Specimens | CDC


  • Standards for fastened post-mortem tissue specimen submission to CDC’s Infectious Illnesses Pathology Department (IDPB) for COVID-19 testing

These modifications have been made June 15, 2020.

CDC steering for SARS-CoV-2 an infection could also be tailored by state and native well being departments to reply to quickly altering native circumstances.

Background

Health workers, coroners, and pathologists ought to instantly notify their nativeexterior icon or stateexterior icon well being division within the occasion of the identification of a deceased particular person with recognized or suspected COVID-19.

State and native well being departments can contact CDC’s Emergency Operations Middle (EOC) at 770-488-7100 for pressing session if an post-mortem is being thought of for a deceased particular person with recognized or suspected COVID-19 or if submission of post-mortem tissue specimens or postmortem swabs to CDC for COVID-19 testing is desired. The EOC will help native/state well being departments to gather, retailer, and ship specimens appropriately to CDC, together with throughout afterhours or on weekends/holidays.

This interim steering is predicated on what’s at the moment recognized about coronavirus illness 2019 (COVID-19).

Present data helps that unfold of SARS-CoV-2 (the virus that causes COVID-19) normally occurs when an individual is in shut contact (i.e., inside about 6 toes) through respiratory droplets produced when an contaminated particular person coughs, sneezes, or talks. This route of transmission just isn’t a priority when dealing with human stays or performing postmortem procedures. It might be potential that an individual can get COVID-19 by touching a floor or object that has the virus on it after which touching their very own mouth, nostril, or probably their eyes. This isn’t regarded as the primary method the virus spreads, however we’re nonetheless studying extra about how this virus spreads. CDC will replace this interim steering as further data turns into obtainable.

This doc offers particular steering for the gathering and submission of postmortem specimens from deceased recognized or suspected COVID-19 instances. This doc additionally offers suggestions for biosafety and an infection management practices throughout specimen assortment and dealing with, together with throughout post-mortem procedures. The steering can be utilized by health workers, coroners, pathologists, different staff concerned in offering postmortem care, and native and state well being departments. Postmortem actions must be performed with a give attention to avoiding aerosol producing procedures and making certain that if aerosol technology is probably going (e.g., when utilizing an oscillating noticed) that applicable engineering controls and private protecting tools (PPE) are used. These precautions and using Normal Precautions are  applicable work practices to assist stop direct contact with infectious materials, percutaneous damage, and different hazards associated to transferring human stays and dealing with embalming chemical substances.

Health workers, coroners, and different healthcare professionals ought to use skilled judgment to find out if a decedent had indicators and signs appropriate with COVID-19 throughout life and whether or not postmortem testing is important. Many sufferers with confirmed COVID-19 have developed fever and/or signs of acute respiratory sickness (e.g., fever, cough, issue respiration). There are epidemiologic elements that will additionally assist information selections about COVID-19 testing, reminiscent of documented COVID-19 infections in a jurisdiction, recognized neighborhood transmission, contact with a recognized COVID-19 affected person, or being part of a cluster of respiratory sickness in a closed setting (e.g., a long-term care facility). Testing for different causes of respiratory sickness (e.g., influenza) is strongly inspired.

Advisable Postmortem Specimens

Suggestions about the kind of postmortem specimens to acquire fluctuate primarily based on whether or not the case of COVID-19 is suspected or confirmed, in addition to whether or not an post-mortem is carried out.

The next elements must be thought of when figuring out if an post-mortem can be carried out for a deceased recognized or suspected COVID-19 case:

  • Medicolegal jurisdiction
  • Facility environmental controls
  • Availability of advisable private protecting tools (PPE)
  • Household and cultural needs

If an post-mortem is carried out for a suspected COVID-19 case, assortment of the next postmortem specimens is advisable:

  • Postmortem swab specimens for COVID-19 testing:
    • Higher respiratory tract swab: Nasopharyngeal Swab (NP swab)
    • Decrease respiratory tract swab: Lung swab from every lung
  • Separate swab specimens for testing of different respiratory pathogens and different postmortem testing, as indicated
  • Formalin-fixed post-mortem tissues from lung and higher airway

If an post-mortem is NOT carried out for a suspected COVID-19 case, assortment of the next postmortem specimens is advisable:

  • Postmortem Nasopharyngeal Swab (NP swab) specimen for COVID-19 testing
  • Separate NP swab for testing of different respiratory pathogens

If an post-mortem is carried out for a confirmed COVID-19 case, assortment of the next postmortem specimens must be thought of:

  • Postmortem swab specimens for testing of different respiratory pathogens,
  • Different postmortem microbiologic and infectious illness testing, as indicated
  • Formalin-fixed post-mortem tissues from lung and higher airway

Along with postmortem specimens, any remaining specimens (e.g., NP swab, sputum, serum, stool) that will have been collected previous to dying must be retained. Please check with Interim Tips for Amassing, Dealing with, and Testing Scientific Specimens from Individuals for Coronavirus Illness 2019 (COVID-19) for extra data.

Advisable Biosafety and An infection Management Practices

Assortment of Postmortem Nasopharyngeal Swab (NP Swab) Specimens Solely

Directions on this part apply if solely postmortem NP swabs are being collected from a deceased particular person with recognized or suspected COVID-19. If an post-mortem is being carried out or aerosol producing procedures (AGPs) are being performed, directions within the part Post-mortem Procedures must be adopted.

If solely a postmortem NP swab is being collected, people within the room throughout specimen assortment must be restricted to healthcare personnel (HCP) acquiring the specimen. HCP ought to comply with Normal Precautions.

Engineering Management Suggestions for NP Swab Assortment

Since assortment of nasopharyngeal swab specimens from deceased individuals is not going to induce coughing or sneezing, a detrimental stress room is not required if solely a NP swab is being collected from the decedent. Personnel ought to adhere to Normal Precautions as described above.

PPE Suggestions for NP Swab Assortment

Since assortment of nasopharyngeal swab specimens from deceased individuals is not going to induce coughing or sneezing, NIOSH-approved disposable N-95 respirator or larger is not required if solely a NP swab is being collected from the decedent.

The next PPE must be worn at a minimal:

  • Put on nonsterile, nitrile, latex or rubber gloves when dealing with probably infectious supplies.
  • If there’s a danger of cuts, puncture wounds, or different accidents that break the pores and skin, put on heavy-duty gloves over the nitrile gloves.
  • Put on a clear, long-sleeved fluid-resistant or impermeable hospital isolation robe to guard pores and skin and clothes.
  • Use a plastic face defend or a face masks and goggles to guard the face, eyes, nostril, and mouth from splashes of probably infectious bodily fluids.

Post-mortem Procedures

Normal Precautions, Contact Precautions, and Airborne Precautions with eye safety (goggles or a face defend) must be adopted throughout post-mortem. Lots of the following procedures are in line with current tips for protected work practices within the post-mortem setting; see Tips for Secure Work Practices in Human and Animal Medical Diagnostic Laboratories.

  • AGPs reminiscent of use of an oscillating bone noticed must be averted for recognized or suspected COVID-19 instances. Think about using hand shears instead chopping device. If an oscillating noticed is used, connect a vacuum shroud to comprise aerosols.
  • Enable just one particular person to chop at a given time.
  • Restrict the variety of personnel working within the post-mortem suite at any  time to the minimal variety of individuals vital to securely conduct the post-mortem.
  • Restrict the variety of personnel engaged on the human physique at any given time.
  • Use a biosafety cupboard for the dealing with and examination of smaller specimens and different containment tools at any time when potential.
  • Use warning when dealing with needles or different sharps, and eliminate contaminated sharps in puncture-proof, labeled, closable sharps containers.
  • A logbook together with names, dates, and actions of all staff collaborating within the postmortem and cleansing of the post-mortem suite must be saved to help in future comply with up, if vital. Embody custodian employees getting into after hours or through the day.

Engineering Management Suggestions for Autopsies

Autopsies on decedents recognized or suspected to be COVID-19 instances must be performed in Airborne An infection Isolation Rooms (AIIRs). These rooms:

  • Are at detrimental stress to surrounding areas
  • Have a minimal of 6 air modifications per hour (ACH) for current buildings and 12 ACH for renovated or new buildings
  • Have air exhausted immediately outdoors or via a excessive effectivity particulate aerosol (HEPA) filter

Doorways to the room must be saved closed besides throughout entry and egress. If an AIIR just isn’t obtainable, make sure the room is detrimental stress with no air recirculation to adjoining areas. A conveyable HEPA recirculation unit may be positioned within the room to supply additional air filtration . Native airflow management (i.e., laminar circulation programs) can be utilized to direct aerosols away from personnel. If use of an AIIR or HEPA unit just isn’t potential, the process must be carried out in probably the most protecting atmosphere potential. AIIR room air ought to by no means be recirculated within the constructing, however immediately exhausted outside, away from home windows, doorways, areas of human visitors or gathering areas, and from different constructing air consumption programs.

PPE Suggestions for Autopsies

The next PPE must be worn throughout post-mortem procedures:

  • Double surgical gloves interposed with a layer of cut-proof artificial mesh gloves
  • Fluid-resistant or impermeable isolation robe
  • Waterproof apron
  • Goggles or face defend
  • NIOSH-approved disposable N-95 or larger respirator
    • Powered, air-purifying respirators (PAPRs) with HEPA filters could present elevated employee consolation throughout prolonged post-mortem procedures.
    • When respirators are vital to guard staff, employers should implement a complete respiratory safety program in accordance with the OSHA Respiratory Safety customary (29 CFR 1910.134exterior icon) that features medical exams, fit-testing, and coaching.

Surgical scrubs, shoe covers, and surgical cap must be used per routine protocols. Doff (take off) PPEpdf icon fastidiously to keep away from contaminating your self and earlier than leaving the post-mortem suite or adjoining anteroom.

After eradicating PPE, discard the PPE within the applicable laundry or waste receptacle. Reusable PPE (e.g., goggles, face shields, and PAPRs) should be cleaned and disinfected in line with the producer’s suggestions earlier than reuse. Instantly after doffing PPE, wash arms with cleaning soap and water for 20 seconds. If arms aren’t visibly soiled and cleaning soap and water aren’t obtainable, an alcohol-based hand sanitizer that accommodates 60%-95% alcohol could also be used. Nonetheless, if arms are visibly soiled, at all times wash arms with cleaning soap and water earlier than utilizing alcohol-based hand sanitizer. Keep away from touching the face with gloved or unwashed arms. Be certain that hand hygiene amenities are available on the level of use (e.g., at or adjoining to the PPE doffing space).

If the PPE provide is low, see Methods for Optimizing the Provide of PPE.

Extra security and well being steering is on the market for staff dealing with deceased recognized or suspected COVID-19 instances on the Occupational Security and Well being Administration (OSHA), COVID-19 web siteexterior icon.

Assortment of Postmortem Specimens

Implementing correct biosafety and an infection management practices is essential when accumulating specimens. Please check with Interim Laboratory Biosafety Tips for Dealing with and Processing Specimens Related to Coronavirus Illness 2019 (COVID-19) for added data.

Assortment of Postmortem Swab Specimens for COVID-19 Testing

For suspected COVID-19 instances, CDC recommends accumulating and testing postmortem nasopharyngeal swabs (NP swabs) and if an post-mortem is carried out, decrease respiratory specimens (lung swabs). If the analysis of COVID-19 was established earlier than dying, assortment of those specimens for COVID-19 testing is probably not vital. Health workers, coroners, and pathologists ought to work with their native or state well being division to find out capability for testing postmortem swab specimens.

NP specimen is the popular alternative for higher respiratory tract swab-based SARS-CoV-2 testing. When assortment of a postmortem NP swab just isn’t potential, every of the next is an appropriate different:

  • An oropharyngeal (OP) specimen
  • A nasal mid-turbinate (NMT) swab
  • An anterior nares (nasal swab; NS) specimen
  • Nasopharyngeal wash/aspirate or nasal aspirate (NA) specimen

Use solely artificial fiber swabs with plastic shafts. Don’t use calcium alginate swabs or swabs with wood shafts, as they might comprise substances that inactivate some viruses and inhibit PCR testing. Place swabs instantly into sterile tubes containing 2-Three ml of viral transport media.

Nasal swabs (NS) or nasal mid-turbinate (NMT) swabs must be positioned in a transport tube containing both viral transport medium, Amies transport medium, or sterile saline.

If each NP and OP swabs are collected, they need to be mixed in a single tube to maximise take a look at sensitivity and restrict use of testing sources.

Higher Respiratory Tract Specimen Assortment: Nasopharyngeal Swab (NP swab)

  • Insert versatile wire shaft minitip swab via the nares parallel to the palate (not upwards) till resistance is encountered or the gap is equal to that from the ear to the nostril of the affected person, indicating contact with the nasopharynx. Swab ought to attain depth equal to distance from nostrils to outer opening of the ear. Gently rub and roll the swab. Go away swab in place for a number of seconds to soak up secretions. Slowly take away swab whereas rotating it.
  • For nasal swabs (NS), a single polyester swab with a plastic shaft must be used to pattern each anterior nares.
  • For added steering, see Interim Tips for Amassing, Dealing with, and Testing Scientific Specimens for COVID-19

Decrease respiratory tract Specimen Assortment: Lung swabs

  • Acquire one swab from every lung (left and proper). Choices for lung swab assortment embody the next, and will rely upon the establishment’s customary practices or sort of post-mortem process (e.g., full or in-situ post-mortem)
    • Throughout the inner examination, after the heart-lung block is eliminated, insert one swab as far down into the tracheobronchial tree as potential on both facet (left and proper)
    • First wipe the floor of every lung with an iodine-containing disinfectant clear and dry the floor; then use a sterile scalpel to chop a slit of the lung and insert the swab to gather pattern on both facet.

No information are at the moment obtainable on the frequency of detection of extreme acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, by RT-PCR on postmortem swabs collected at completely different durations after dying. If COVID-19 testing on postmortem swab specimens is being thought of for a suspected COVID-19 case, SARS-CoV-2 RNA should still be detected as much as Three days postmortem and probably longer primarily based on obtainable information from experiences with MERS-CoV and SARS-CoV; nevertheless sensitivity could also be lowered with an extended postmortem interval, and period of sickness could must be thought of in decoding a detrimental outcome.

Storage of Postmortem Swab Specimens

Retailer specimens at 2-8°C for as much as 72 hours after assortment. If a delay in testing or transport is predicted, retailer specimens at -70°C or under.

Assortment of Postmortem Specimens for Different Routine Testing

Separate postmortem specimens (e.g., NP or lung swabs) must be collected for routine testing of respiratory pathogens at both medical or public well being labs. Observe that medical laboratories ought to NOT try viral isolation from specimens collected from recognized or suspected COVID-19 instances.

Different postmortem specimen assortment and evaluations must be directed by the decedent’s medical and publicity historical past, scene investigation, and gross post-mortem findings, and will embody routine bacterial cultures, toxicology, and different research as indicated.

Assortment of Post-mortem Tissue Specimens

Formalin-fixed, and formalin-fixed-paraffin-embedded tissue specimens, obtained at post-mortem, can be utilized to ascertain a postmortem analysis of COVID-19 an infection through the use of immunohistochemical and molecular strategies obtainable on the CDC’s Infectious Illnesses Pathology Department (IDPB). An necessary benefit of this method is that it permits the preservation and retention of comparatively secure specimens that may be examined at a later date to supply a confirmatory analysis. The gathering of fastened tissues could be notably necessary when typical swab-based testing strategies aren’t obtainable or have offered inconclusive outcomes.

Viral antigens and nucleic acids could also be focally distributed in respiratory tissues of sufferers with COVID-19 illness and the distribution and amount of virus can fluctuate amongst particular person sufferers. For these causes, we suggest accumulating:

  1.  A minimal of three consultant sections of lung parenchyma, ideally from completely different places.

AND

  1.  A minimal of two sections of airway, to incorporate trachea, bronchi, or each airways.

To attenuate potential viral contamination of non-involved tissues, lung and airway specimens must be collected instantly following elimination of the chest plate. Then place specimens right into a separate sterile specimen cup containing 10% impartial buffered formalin.

Centered sampling of those tissues, collected by autopsies restricted to the chest, or by directed assortment completed by incision, can be utilized when deemed applicable.

If involvement of a number of different organs (e.g., coronary heart, kidneys) is recommended by medical historical past or laboratory findings obtained previous to dying, consultant samples of those tissues must be thought of for sampling and submission. Full autopsies could possibly be warranted in sure circumstances, as decided by the medical expert, coroner, or neighborhood pathologist.

Assortment of tissue samples roughly 5 mm in thickness (i.e., pattern would slot in a tissue cassette) is advisable for optimum fixation. Tissues must be positioned in 10% buffered formalin, in a quantity that’s roughly 10 occasions larger than the quantity of tissue. Optimum fixation is three days (72 hours). Specimens must be shipped to CDC as quickly as potential following full fixation. Extended immersion in formalin (e.g., > 2 weeks) can diminish the sensitivity of virus detection assays.

Alternately, formalin-fixed, paraffin embedded tissues (unique blocks obtained at post-mortem) could be submitted for analysis.

Concerns Relating to Postmortem Serologic Testing

Serologic checks for SARS-CoV-2 search for the presence of antibodies. It usually takes about one to 2 weeks after sickness onset with COVID-19 for antibodies to develop; some individuals could take longer. Relying on when somebody was contaminated and the timing of the take a look at, the take a look at could not discover antibodies in somebody with a present COVID-19 an infection. Per FDA steering, antibody checks haven’t been validated for analysis of COVID-19 an infection, and antibody checks by themselves are of restricted worth within the speedy analysis of a affected person the place COVID-19 an infection is suspected. For extra data, see: Interim Tips for COVID-19 Antibody Testing

Safely Getting ready the Specimens for Cargo

After accumulating and correctly securing and labeling specimens in main containers with the suitable media/answer, they should be transferred from the post-mortem suite in a protected method to laboratory employees who can course of them for transport.

  1. Throughout the post-mortem suite, main containers must be positioned into a bigger secondary container.
  2. If potential, the secondary container ought to then be positioned right into a resealable plastic bag that was not within the post-mortem suite when the specimens have been collected.
  3. The resealable plastic bag ought to then be positioned right into a organic specimen bag with absorbent materials; after which could be transferred outdoors of the post-mortem suite.
  4. Staff receiving the organic specimen bag outdoors the post-mortem suite or anteroom ought to put on disposable nitrile gloves.

Submission of Specimens for COVID-19 Testing

Health workers, coroners, and different healthcare professionals ought to work with their state and native well being departments to coordinate testing via public well being laboratories. As well as, COVID-19 testing, approved by the Meals and Drug Administration underneath an Emergency Use Authorization (EUA), is on the market in medical laboratories.

Postmortem swab specimens could also be shipped to CDC if testing just isn’t obtainable at public well being or medical laboratories in a jurisdiction, or if repeated testing outcomes stay inconclusive or if different uncommon outcomes are obtained. State or native well being departments ought to contact CDC at [email protected] previous to submitting samples.

If transport samples to CDC:  If specimens will ship immediately, retailer specimens at 2-8°C, and ship in a single day to CDC on ice pack. If a delay in transport will lead to receipt at CDC greater than 72 hours after assortment, retailer specimens at -70°C or under and ship in a single day to CDC on dry ice. Extra helpful and detailed data on packing, transport, and transporting specimens could be discovered at Interim Laboratory Biosafety Tips for Dealing with and Processing Specimens Related to Coronavirus Illness 2019 (COVID-19). Specimens should be packaged, shipped, and transported in line with the present version of the Worldwide Air Transport Affiliation (IATA) Harmful Items Rules exterior iconexterior icon.

Label every specimen container with the affected person’s ID quantity (e.g., medical report quantity), distinctive CDC or state-generated NCOV specimen ID (e.g., laboratory requisition quantity), specimen sort (e.g., NP swab) and the date the pattern was collected. Full a CDC Kind 50.34 for every specimen submitted. Within the higher left field of the shape, 1) for take a look at requested choose “Respiratory virus molecular detection (non-influenza) CDC-10401” and a couple of) for At CDC, deliver to the eye of enter “Stephen Lindstrom: 2019-nCoV PUI-Post-mortem”.

Please check with our instruction steering for submitting CDC Kind 50.34 discovered right here: Tips For Submitting Specimens to CDC.pdf icon

For added data, session, or the CDC transport handle, contact the CDC Emergency Operations Middle (EOC) at 770-488-7100.

Submission of Mounted Post-mortem Tissue Specimens to CDC

Standards for Mounted Post-mortem Tissue Specimen Submission

Right now, CDC’s Infectious Illnesses Pathology Department is accepting formalin-fixed (moist) tissues and formalin-fixed, paraffin-embedded post-mortem tissue blocks for COVID-19 testing from decedents when the following three standards are met:

  1. Scientific or pathologic findings, and epidemiologic historical past point out want for COVID-19 testing (i.e., meets standards A OR B):
    1. Unexplained dying occurring on or after 12/1/2019 with medical or pathologic findings and epidemiologic historical past in line with potential COVID-19, (i.e., meets the entire following three standards):
      1. Dying occurring on or after 12/1/2019,

        AND

      2. Scientific or pathologic findings for potential COVID-19 (i.e., meets standards a OR b under):
        1. Historical past of fever, cough, shortness of breath, influenza-like sickness, or different indicators or signs regarding for COVID-19

          OR

        2. Histopathologic proof in respiratory tissues in line with a potential infectious course of, together with acute lung damage (e.g., diffuse alveolar harm), interstitial pneumonitis, pneumonia, or tracheobronchitis

        AND

      3. No different believable analysis
        1. Decedents could have infectious illness testing constructive for a number of different pathogens, however evaluation of medical, pathologic, and epidemiologic data means that COVID-19 must also be thought of.

      OR

    2. Dying with laboratory proof of SARS-CoV-2 by different antemortem or postmortem testing however with questions concerning the connection of outcomes to reported medical historical past, noticed gross or histopathologic findings at post-mortem, or the reason for dying

    AND

  2. Sufficient specimens can be found:
    • Formalin-fixed (moist) tissues or formalin-fixed, paraffin-embedded (FFPE) tissue blocks from lung or higher airway:
      • If  >four weeks have elapsed since post-mortem, unique FFPE tissue blocks from the time of post-mortem can be found.
      • If FFPE tissue blocks are submitted, a minimal of two respiratory tissue blocks are required.

    AND

  3. Approval of applicable state or native well being division for specimen submission to CDC has been obtained.
Mounted Post-mortem Tissue Specimen Pre-Approval and Submission Directions

For instances assembly the above standards, comply with the steps outlined under to acquire pre-approval from CDC’s Infectious Illnesses Pathology Department to submit specimens for analysis:

    1. Reminder – Healthcare suppliers, pathologists, health workers, and coroners—please first contact your state, tribal, native, or territorial well being division.
    2. Contact CDC’s Infectious Illnesses Pathology Department at [email protected] for pre-approval. Embody the next data within the e mail:
        1. Electronically fill, save, and print each pages of the CDC Kind 50.34.
        2. An outline of gross or histopathologic findings within the tissues to be submitted.
          In your e mail correspondence, don’t embody affected person identifiers reminiscent of title, date of beginning, or medical report quantity. You need to comply with all relevant federal, state, and native rules to stick to affected person confidentiality and privateness protections.
    1. After you obtain e mail approval from CDC:
        1. Electronically fill, save, and print each pages of the CDC Kind 50.34.
        2. Within the higher left field of the shape, choose Take a look at Order Code CDC-10365 (“Pathologic Analysis of Tissues for Attainable Infectious Etiologies”).
        3. Enter “COVID-19” and supply any relevant CDC and State NCOV Case ID numbers within the Feedback part on Web page 2 of the CDC 50.34 kind.
        4. Along with the CDC 50.34 kind, enclose the next within the specimen submission bundle:
          1. Surgical pathology, post-mortem report (preliminary is appropriate), or each
          2. Related medical notes, together with admission Historical past and Bodily (H&P), discharge abstract, if relevant
    1. Mailing/Contact Information:
        1. Formalin-fixed moist tissues and/or formalin-fixed, paraffin-embedded tissue blocks must be shipped in appropriate packaging at ambient temperature. Don’t freeze fastened tissues.
        2. Ship to: Dr. Sherif Zaki, CDC, IDPB, 1600 Clifton Rd NE, MS: H18-SB, Atlanta, GA 30329-4027
        3. Ship monitoring quantity to [email protected]
        4. Tel: 404-639-3132, Fax: 404-639-3043, Electronic mail: [email protected]

Cleansing and Waste Disposal Suggestions

The next are basic tips for cleansing and waste disposal following an post-mortem of a decedent with confirmed or suspected COVID-19. Present proof means that novel coronavirus could stay viable for hours to days on surfaces created from quite a lot of supplies.

Use routine cleansing and disinfection procedures (e.g., utilizing cleaners and water to pre-clean surfaces) previous to making use of Environmental Safety Company (EPA)-approved disinfectantsexternal iconexterior icon that meet the standards to be used in opposition to SARS-CoV-2, the virus that causes COVID-19.

After an post-mortem of a decedent with confirmed or suspected COVID-19, the next suggestions apply for the post-mortem room (and anteroom if relevant):

  • Hold air flow programs lively whereas cleansing is performed; earlier than cleansing, wait 24 hours in a non-healthcare setting, or if you recognize the air modifications per hour of the room or space in a healthcare setting, comply with the advisable wait time earlier than cleansing.
  • Put on disposable gloves advisable by the producer of the cleaner or disinfectant whereas cleansing and when dealing with cleansing or disinfecting options.
    • Get rid of gloves in the event that they turn into broken or dirty and when cleansing is accomplished, as described under. By no means wash or reuse gloves.
  • Use eye safety, reminiscent of a face defend or goggles, if splashing of water, cleaner/disinfectant, or different fluids, is predicted.
  • Put on a clear, long-sleeved fluid-resistant robe to guard pores and skin and clothes.
  • Put on a NIOSH-approved disposable N95 or larger respirator  if you have to clear the room or space in lower than 24 hours or the advisable wait time can’t be met.
  • Extra PPE could also be required to guard staff in opposition to potential hazards related to the cleansing and disinfectant merchandise used and in accordance with the label directions.
  • If PPE is in low provide, and cleansing should happen earlier than the advisable wait time has handed, think about having staff who carried out autopsies conduct the cleansing and sanitizing of the world.
  • When respirators are vital to guard staff, employers should implement a complete respiratory safety program in accordance with the OSHA Respiratory Safety customary (29 CFR 1910.134exterior icon) that features medical exams, fit-testing, and coaching.
  • Guarantee staff are educated on OSHA’s Hazard Communication customary, 29 CFR 1910.1200exterior icon, to speak with staff concerning the hazardous chemical substances used within the office.
  • Use Environmental Safety Company (EPA)-approved disinfectantsexterior icon that meet the standards to be used in opposition to SARS-CoV-2, the virus that causes COVID-19. Comply with the producer’s directions for all cleansing and disinfection merchandise (e.g., focus, software technique, contact time).
    • Clear the floor first, after which apply the disinfectant as instructed on the disinfectant producer’s label. Guarantee satisfactory contact time for efficient disinfection.
    • Adhere to any security precautions or different label suggestions as directed (e.g., permitting satisfactory air flow in confined areas and correct disposal of unused product or used containers).
    • Keep away from utilizing product software strategies that trigger splashing or generate aerosols.
    • Cleansing actions must be supervised and inspected periodically to make sure appropriate procedures are adopted.
  • Don’t use compressed air and/or water underneath stress for cleansing, or some other strategies that may trigger splashing or may re-aerosolize infectious materials.
  • Gross contamination and liquids must be collected with absorbent supplies, reminiscent of towels, by employees conducting the post-mortem carrying designated PPE. Gross contamination and liquids ought to then be disposed of as described under:
    • Use of tongs and different utensils can decrease the necessity for private contact with dirty absorbent supplies.
    • Giant areas contaminated with physique fluids must be handled with disinfectant following elimination of the fluid with absorbent materials. The realm ought to then be cleaned and given a closing disinfection.
    • Small quantities of liquid waste (e.g., physique fluids) could be flushed or washed down atypical sanitary drains with out particular procedures.
    • Onerous, nonporous surfaces could then be cleaned and disinfected as described above.
  • Comply with customary working procedures for the containment and disposal of used PPE and controlled medical waste. State and native governments must be consulted for applicable disposal selections.
  • Get rid of human tissues in line with routine procedures for pathological waste.
  • Clear and disinfect or autoclave non-disposable devices utilizing routine procedures, taking applicable precautions with sharp objects.
  • Supplies or clothes that can be laundered could be faraway from the post-mortem suite (or anteroom, if relevant) in a sturdy, leak-proof biohazard bag that’s tied shut and never reopened. These supplies ought to then be despatched for laundering in line with routine procedures.
  • Wash reusable, non-launderable gadgets (e.g., aprons) with a detergent answer on the warmest setting potential, rinse with water, decontaminate utilizing disinfectant, and permit gadgets to dry utterly earlier than subsequent use.
  • Hold digital camera, telephones, laptop keyboards, and different gadgets that stay within the post-mortem suite (or anteroom, if relevant) as clear as potential, however deal with as if they’re contaminated and deal with with gloves. Wipe the gadgets after use with applicable Environmental Safety Company (EPA)-approved disinfectantsexterior icon that meet the standards to be used in opposition to SARS-CoV-2, the virus that causes COVID-19. If being faraway from the post-mortem suite, guarantee decontamination to the extent potential with applicable disinfectant in line with the producer’s suggestions previous to elimination and reuse.
  • When cleansing is full and PPE has been eliminated, wash arms instantly with cleaning soap and water for 20 seconds. If arms aren’t visibly soiled and cleaning soap and water aren’t obtainable, an alcohol-based hand sanitizer that accommodates at the least 60% alcohol could also be used. Nonetheless, if arms are visibly soiled, at all times wash arms with cleaning soap and water earlier than utilizing an alcohol-based hand sanitizer. Keep away from touching the face with gloved or unwashed arms. Be certain that hand hygiene amenities are available on the level of use (e.g., at or adjoining to the PPE doffing space).

Transportation of Human Stays

Whether it is essential to switch a physique to a bag, comply with Normal Precautions, together with further private protecting tools (PPE) if splashing of fluids is predicted. Normal physique bagging procedures must be adopted, in line with procedures used for deaths the place COVID-19 just isn’t suspected. Given the various weights of decedents and selection, development, and circumstances of physique bag supplies, postmortem care staff ought to use prudent judgement figuring out if dangers for puncture, tearing, or failure of physique luggage may happen and whether or not a second physique bag or a physique bag of thicker, stronger materials (e.g. minimal of 6 mil thickness) is important. Danger elements embody however aren’t restricted to:

  • Presence of sharp objects on the decedent that would trigger punctures or tears (e.g. jewellery, piercings, medical devices)
  • Weight of the decedent that would trigger the bag/bag deal with to fail throughout transport (if obtainable, confirm physique bag weight capacities as offered by the producer)
  • Bodily fluids posing publicity dangers to staff transporting the physique ought to a puncture, tear, or failure happen (e.g. SARS-CoV-2 has been detected within the feces of some sufferers recognized with COVID-19, although whether or not the virus in stool is infectious is unknown, Normal Precautions for bloodborne pathogens ought to at all times be taken.)
  • Injury or degradation to the physique bag that will have occurred in cargo or storage (e.g. the bag is damaged or brittle)

Comply with customary routine procedures when transporting the physique after specimens have been collected and the physique has been bagged. Disinfect the surface of the bag with Environmental Safety Company (EPA)-approved disinfectantsexterior icon that meet the standards to be used in opposition to SARS-CoV-2, the virus that causes COVID-19, utilized in line with the producer’s suggestions. Put on disposable nitrile gloves when dealing with the physique bag.

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