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 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.

2 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.

3 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.

4 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.
Taunton and Somerset NHS Trust
Infection Control Policy for Care of the deceased
COI/Dec 2002
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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.

5 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.

6 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.

7 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.

8 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:
Taunton and Somerset NHS Trust
Infection Control Policy for Care of the deceased
COI/Dec 2002
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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 blood-
borne 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

Taunton and Somerset NHS Trust

Infection Control Policy for Care of the deceased
COI/Dec 2002
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TABLE 1
Guidelines for handling cadavers with infections noticeable in England and Wales
Degree of Infection Bagging Viewing Embalming Hygienic
risk preparation
Low Acute encephalitis No Yes Yes Yes
Leprosy No Yes Yes Yes
Measles No Yes Yes Yes
Meningitis(except Menningococcal) No Yes Yes Yes
Mumps No Yes Yes Yes
Ophthalmia neonatorum No Yes Yes Yes
Rubella No Yes Yes Yes
Tetanus No Yes Yes Yes
Whooping Cough No Yes Yes Yes
Medium Relapsing fever Adv Yes Yes Yes
Food poisoning No/Adv Yes Yes Yes
Hepatitis A No Yes Yes Yes
Acute poliomyelitis No Yes Yes* Yes
Diphtheria Adv Yes Yes Yes
Dysentery Adv Yes Yes Yes
Leptospirosis (Well’s Disease) No Yes Yes* Yes
Malaria No Yes Yes Yes
Meningococcal septicaemia (with or
Adv Yes Yes Yes
without meningitis
Paratyphoid fever Adv Yes Yes Yes
Cholera No Yes Yes* Yes
Scarlet fever Adv Yes Yes Yes
Tuberculosis Adv Yes Yes Yes
Typhoid fever Adv Yes Yes Yes
Typhus Adv No No No
High Hepatitis B,C, and non-A, non-B Yes Yes No No
High(rare) Anthrax Adv No No No
Plague Yes No No No
Rabies Yes No No No
Smallpox Yes No No No
Viral haemorrhagic fever Yes No No No
Yellow Fever Yes 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 Chickenpox / shingles No Yes Yes Yes
Cryptosporidiosis No Yes Yes Yes
Dermatophytosis No Yes Yes Yes
Legionellosis No Yes Yes Yes
Lymes disease No Yes Yes Yes
Orf No Yes Yes Yes
Psittacosis No Yes Yes Yes
Methicillin resistant staphylococcus aureus No Yes Yes Yes
Tetanus No Yes Yes Yes
Medium HIV / AIDS Adv Yes No No
Haemorrhagic fever with renal syndrome No Yes Yes Yes
Q fever No Yes Yes Yes
High Transmissible spongiform
encephalopathies( i.e. CJD, invasive group Yes No No No
A Strep infection)

Taunton and Somerset NHS Trust

Infection Control Policy for Care of the deceased
COI/Dec 2002
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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

Taunton and Somerset NHS Trust

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COI/Dec 2002
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