Infection Control Practices for Mortuary Services in Hospitals

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The dead body, whether it is infected or not may be a source of infection for the staff in the mortuary and the postmortem staff. Bacteria may spread by air or by contact, but there are special hazards when a postmortem examination is being performed. contaminated aerosols or splashes may be released by means of squeezing sponges, cutting tissues such as lung or incising abscesses, and the sawing of bones may also release small contaminated chips in the air.
A common mode of infection is by cutting or pricking a finger with a contaminated instrument or a ragged bone edge. Usually, most of the organisms in the dead body are not likely to infect healthy individuals with intact skin, but still there are some special hazards.
  • Bodies shall be kept in refrigerated cabinets at 2-8 degree Celsius
  • Cleaning and disinfection of the body fluid spillages shall be undertaken as soon as the body is discharged
  • Hand hygiene shall be practice after every contact with the cadaver or any other article associated with it.
  • Mortuary staff shall wear disposable gloves & apron while handling bodies in a cadaver bag.
  • A body is no more infectious following death than during life. Few may pose an infection risk & must be placed in cadaver bag.
  • Diseases requiring the use of a cadaver bag:
         AIDS
         HBV
         Meningococcal meningitis
         Gangrenous limbs
         Burns
         Trauma
         Oozing body
  • Patients with MRSA & other routine organisms do not require use of a cadaver bag
 Prevention of Infection: If adequate precautions are taken, the risk of infection is not much.
  • Keep the mortuary room and refrigerator clean.
  • Good personal hygiene of members of the staff is also essential.
  • The room should be mechanically ventilated and designed, so that cleaning can be readily achieved.
  • There should be efficient fly proofing arrangements in the mortuary room
  • A shower with the soap and towels should be available for the mortuary room staff.
  • When performing postmortem, the staff should completely change their outer clothing, and wear a disposable gloves and rubber boots.
  • Visitors to the mortuary room, who are not going to be in contact with the body, should wear a gown and overshoes.
  • There should be a washbasin with disposable paper towels, soap and antiseptic hand washing preparations (Povidone iodine or Chlorhexidine detergent or 70% ethanol).
  • The staff members should wash their hands thoroughly after handling any contaminated surface or material, irrespective of whether gloves are worn and always on leaving the mortuary room. If the hands are contaminated, they should also be washed before handling case notes.
  • If the skin or eye is splashed, it should be thoroughly washed. An eyewash bottle containing sterile saline should be available.
Precautions for Preparation of Body:
  • Preparation of patient as per infection control Policy is already described
  • Lay the patient on his or her back and close the eyelids.
  • Remove all but need one pillow to support the jaw by placing a sandbag under the chin.
  • Remove any mechanical aids such as syringe drivers, etc.
  • Straighten the limbs.
  • Sponge cleans the patient, unless requested not to do so for religious or cultural reasons. Note: it may be important to the family to assist in sponge cleaning, to continue to provide the care given in the period before death.
  • Ensure that dentures are in situ (if available). If this is not possible dentures should accompany the body to the mortuary.
  • There must be details of a record of tubes or objects left on or in the body and jewellery unable to be removed. The faith of the deceased must also be recorded.
  • All incidents of exposure to blood or body fluids from the dead body, either parenteral or mucous membrane exposures, should be reported to supervisor. The injured person should immediately seek medical advice for proper wound care and post-exposure management.

Recommended procedures for ward staff:
  • Hepatitis B vaccination is recommended for all staff that is likely to come into contact with dead bodies.
  • The body will be classified by attending physician (Medical Officer) as category 1, 2 or 3. Tags for classification categories of dead bodies should be attached to dead body and case file.
  • Avoid direct contact with the dead body, blood or body fluids discharged from the dead body. Nursing and other personnel who handle dead bodies must wear protective clothing consisting of gown, apron, mask, caps and gloves; wear goggles if necessary. They should cover all cuts and abrasions with waterproof bandages or dressing.
  • Wound drainage and needle puncture holes of the dead body should be disinfected with 10000p.p.m. Hypochlorite and covered with impermeable material. Hypochlorite solution must be freshly prepared.
  • Extreme caution should be exercised when removing intravenous catheters and other devices which are sharp. They should be disposed into puncture resistant containers or sharp box immediately.
  • All body orifices should preferably be plugged with swabs soaked in 10000ppm hypochlorite.
  • The body should be cleaned and dried.
  • It is preferable for the ward staff to dress the deceased. The relatives should be informed beforehand so that they can bring the necessary clothing in advance. If the diseased own clothing is not available; the decease should be dressed with a hospital pyjama.
  • After identifying and attaching to the body, identify label and Cat. 1 tag, the body should be wrapped with double shroud before being placed on trolley and transported to the mortuary. All labels to be placed/stuck/pinned on the wrist/ankle.
  • After removing, the protective clothing, gloves and Bed sheet should be discarded as infectious wastes and hands should be washed thoroughly.
  • Equipment should be autoclaved or decontaminated with disinfectant in accordance with established disinfection policy.
  • All surfaces that may be contaminated should be disinfected with 1000ppm hypochlorite.
  • After removing protective clothing and gloves, hands should be washed thoroughly.   
Categorisation of bodies in wards:
Based on the mode of transmission and risk of infection of different diseases, the following categories of precautions for handling dead bodies are advised:

Cat. 1:
Signified by a Blue label. Universal precautions are recommended for all dead bodies other than those with infectious diseases as listed under Categories 2 & 3.

Cat. 2:
Signified by a yellow label. Additional precautions are recommended for dead bodies with known:
  • Human Immunodeficiency Virus infection (HIV)
  • Hepatitis B and C positive
  • Creutzfeldt-Jacob disease (CJD) without necropsy,
  • Severe Acute Respiratory Syndrome, and
  • Other infectious diseases as advised by the senior consultant
Cat. 3:
Signified by a Red label. Stringent infection precautions are recommended. For dead bodies with known:
  • Anthrax
  • Plague
  • Rabies
  • Viral hemorrhagic fevers
  • Creutzfeldt-Jacob disease (CJD) with necropsy, and
  • Other infectious diseases as advised by the senior consultant
Precautions:

Yellow
Embalming: Not allowed
Hygienic preparation at the Funeral (to be informed to the attendant)

Red
Embalming: Not allowed

Hygienic preparation at the Funeral (to be informed to the attendant)





Written by:

Dr. Praveen Bajpai

Director of Ingenious Healthcare Consultants Pvt. Ltd.
Founder of Skill Sathi


MBA in Hospital administration, PG Diploma in Quality Accreditation, PG Diploma in Medico Legal System, M. Phil in Hospital Mgmt. from BITS Pilani, P.hD in Management, Certified NABH Auditor, Certified NABL Auditor, Certified Auditor for Clinical Audits, Green Belt in Six Sigma, Certified in Hospital Infection Control Practices, Certified trainer for International Patient Safety Goals, Certified Auditor for JCI 7th Edition Standards 

www.skillsathi.in 



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