As a Mortuary Services Company, we have been involved in the removal and treatment of many highly infectious cases over the years and are presently working with a number of funeral companies in the removal of positive Covid - 19 cases from their place of death. Although Embalming is discouraged on a deceased with Covid - 19, we are removing medical devices to accommodate cremation. We hope that our experience, so far, with this Corona Virus and the below information is both helpful and beneficial to your company.
First of all, let’s look at this statement from the World Health Organisation (WHO)
- COVID-19 is an acute respiratory illness caused by COVID-19 virus that predominantly affects the lungs;
Based on current evidence, the COVID-19 virus is transmitted between people through droplets, fomites and close contact, with possible spread through faeces.
- It is not airborne.
- As this is a new virus whose source and disease progression are not yet entirely clear, more precautions may be used until further information becomes available;
- Except in cases of hemorrhagic fevers (such as Ebola, Marburg) and cholera, dead bodies are generally not infectious. Only the lungs of patients with pandemic influenza, if handled improperly during an autopsy, can be infectious. Otherwise, cadavers do not transmit disease.
It is a common myth that persons who have died of a communicable disease should be cremated, but this is not true. Cremation is a matter of cultural choice and available resources.
Droplet infections are transmitted through the infected person expelling infected particles from their lungs by coughing or sneezing. These particles can then enter a nearby person through their mouth, nose eyes etc.
This is why full facial protection must be worn at all times when entering a premises where covid - 19 is or has been present. Obviously a deceased person will not be coughing or sneezing but by excessively moving the deceased, we may be putting pressure on their lungs, causing droplets to be expelled into the air. So how can we reduce this risk?
AVOIDING DROPLET INFECTION
Before placing a surgical mask over the deceased’s face, we can first place a disinfected barrier in the oral and nasal cavities. It is important to remember not to spray disinfectant into the mouth of the deceased as this may cause displacement of infected particles within the oral cavity. Instead, place some cotton wool within these cavities using a forceps, (dry cotton will catch and absorb any particles) then with a syringe filled with a suitable disinfectant, gently depress the plunger and saturate the cotton within the cavities.
- Place a surgical mask over the deceased head, making sure their nose and mouth are covered.
- Disinfect all deceased’s clothing using a spray bottle then wrap the deceased in a sheet and disinfect again. This may seem like overkill, but we are, at this stage, trying to contain and disinfect any secondary body fluids that may escape through movement.
- As gently as possible, through rolling movement, place the deceased into a body bag. If you are using double bags make sure to zip opposite ends of inner and outer bag. (eg. Inner zipped to the head, outer zipped to the feet).
- Disinfect outer bag thoroughly and place deceased into coffin.
- Close coffin lid and disinfect coffin.
The deceased is now within a sealed container and poses no health risk.
AVOIDING FOMITE INFECTION
Fomites are inanimate objects which may carry infectious materials or droplets.
Although viruses, by their nature, need an organic host to survive, there has been evidence in the past that many viruses can live outside the body for a certain amount of time, therefore if a person coughs onto a table top or even their T shirt, we must assume that the object (or fomite) is infected until properly disinfected or disposed of. It is for this reason we must spray down and disinfect each deceased’s clothing before removal.
It is also important to remember not to touch anything within premises or houses you are entering. Use your own pens when signing out deceased patients. Let common sense prevail in these cases and please… Wash your hands as often as possible and avoid touching your face.
Most hospital mortuary staff are now handling the removal of both Covid-19 positive and negative cases extremely well. You should be guided by their instructions and advice.
When this guidance is not available, for instance when entering a private home or a care facility, then the following guidelines may make the process a little easier.
- Communication is paramount. Always call to arrange a time for collection.
- Carry out risk assessment. To include:
- How many people will be on the premises.
- How close to the nearest exit is the deceased.
- Is there PPE available.
- Will residence be asked to remain in their rooms during the removal.
- Is Covid - 19 present within the premises.
- Is there an area to don PPE. Etc.
Working and communicating with staff and families can make these removals quite straightforward. Simply by letting them know that you will be entering the premises with full PPE will allow them to prepare better for your arrival and not “shock” family members that may have strayed into your path.
Make sure that you are the only one to touch the coffin and be very aware of your surroundings, avoiding objects that may be in your way.
Full Personal Protective Equipment should be worn by all persons involved with the removal of a deceased. Test results for Covid-19 on individuals are, at present, running at least 10 days late, therefore the results are effectively out of date. We can protect ourselves by using the following PPE:
- Shoe Covers
- Long Sleeved Gown
- Long Waterproof Apron
- Face Mask and Visor
- Hair Covering
- Surgical Gloves
Always arrange with the care home staff or family an area in which to don your PPE. Please bare in mind that this may be outside in the open.
Before leaving the premises, dispose of your PPE by standing in a rolled down refuse sack and taking off each part of your PPE, leaving your gloves till last.Please ensure that the refuse sack is disposed of through your clinical waste company.
The order should be:
- Shoe Covers (while stepping out of the bag)
- Hair cover
- Gloves (making sure you take them off inside out)
The issue of the HSE and Funeral Companies running out of PPE is a very serious one, but there are a number of alternatives with people demonstrating on YouTube. For example, bin liners can make very effective aprons.
PACE MAKERS / DIFIBRILLATORS
Even in these times of uncertainty, our loved ones wishes in death should be respected. There is no reason why a person who has died from Covid-19 cannot be cremated although they may have a pacemaker. If you need advice or some encouragement on this procedure then please do not hesitate in getting in touch with us. This procedure should only be carried out by a qualified embalmer.
Take care of yourselves & take care of each other,
Cyril Gantley MBIE Susan Moran MBIE