While the Centers for Disease Control and Prevention (CDC) is doing its best to reassure the North American public that they know how to stop the further spread of Ebola in the continental United States (and, I'm assuming Canada and Mexico as well), the organization did have an interesting set of recommendations that was released in September 2014 for the safe handling of human remains of Ebola patients in United States hospitals and mortuaries. Here are some of the highlights.
Anyone who is in contact with a person that died of Ebola must wear personal protective equipment (PPE) which consists of a surgical scrub suit, surgical cap, impervious gown with full sleeves, eye protection, face mask, shoe covers and double surgical gloves. Leg coverings and aprons may be required where there are copious amounts of blood, vomit or faeces that have contaminated the environment. PPE should be in place before there is contact with the body and should be removed and discarded as regulated medical waste after procedures are complete. Caution is required when removing PPE to prevent contamination.
Patients who die of Ebola have the virus present throughout their bodies. As such, the Ebola virus can be transmitted in post-mortem care settings by lacerations and punctures with contaminated instruments used during a routine autopsy. Contamination can occur if the bodies are handled without the necessary personal protective equipment (PPE) and through splashes of blood, urine, saliva and faeces into unprotected eyes, nose or mouth. As such, the CDC recommends the following:
• Autopsies on patients who die of Ebola should be avoided. If an autopsy is necessary, the state health department and CDC should be consulted regarding additional precautions.
For onsite post-mortem preparation, the body should be wrapped with a plastic shroud to prevent bodily fluids from escaping. All intravenous and endotracheal tubes should be left in place and the body should not be washed. The body should be placed in a leak-proof plastic bag not the than 150 microns thick and zippered closed. The bagged and shrouded body should then be sealed in a second body bag not less than 150 microns thick. Prior to transporting the body bag to the morgue, the exterior of the body bag should be cleaned using a disinfectant. PPE is not required for individuals driving a vehicle containing the human remains unless they are going to handle the body. Transportation of remains that contain the Ebola virus should be minimized as much as possible. All transportation must be co-ordinated with local and state authorities in advance.
At the mortuary, the CDC recommends the following:
• Do not perform embalming. The risks of occupational exposure to Ebola virus while embalming outweighs its advantages; therefore, bodies infected with Ebola virus should not be embalmed.
• Do not open the body bags.
• Do not remove remains from the body bags. Bagged bodies should be placed directly into a hermetically sealed casket.
• Mortuary care personnel should wear PPE listed above (surgical scrub suit, surgical cap, impervious gown with full sleeve coverage, eye protection (e.g., face shield, goggles), facemask, shoe covers, and double surgical gloves) when handling the bagged remains.
• In the event of leakage of fluids from the body bag, thoroughly clean and decontaminate areas of the environment with EPA-registered disinfectants which can kill a broad range of viruses in accordance with label instructions. Reusable equipment should be cleaned and disinfected according to standard procedures.
Remains should be cremated or buried promptly the previously mentioned hermetically sealed casket.
Given that the CDC feels that the situation is well under control, I found it rather interesting that they had such detailed instructions for the handling and burial of a victim of the Ebola virus on their website. Perhaps one can never be too certain of what may transpire on this side of the Atlantic Ocean.
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