Care of the Deceased Policy

Version Number 1.4 Version Date January 2016

Policy Owner Director of Infection Prevention and Control
Author Head of Operational Resilience
First approval or date May 2010
last reviewed
Staff/Groups Infection Control Consultant Nurse
Consulted Associate Directors of Nursing
Bereavement Team
Matrons
Pathology Lead Mortuary
Hospital Chaplaincy Service
Approved by PSSG February 2016
Next Annual Review January 2018
Equality Impact Assessment Completed Yes

1
Table of Contents

1. Rationale ................................................................................................................... 3
2. Aim ............................................................................................................................ 3
3. Definitions .................................................................................................................. 3
4. Roles and Responsibilities ......................................................................................... 4
4.1. Infection Prevention and Control Team ...................................................................... 4
4.2. Mortuary Staff ……. ................................................................................................... 4
4.3. Doctors or Nurses Certifying the Death...................................................................... 4
4.4. Ward/ Department Heads ………………………………………………………………….4
4.5. Ward Staff ……………………………………………………………………………………4
5. Confirmation of Death ................................................................................................ 4
6. Sudden Unexplained Death in Children (SUDIC) ....................................................... 4
7. Last Offices ………………………………………………………………………………… 5
8. Religious/ Faith/ Personal Considerations ................................................................. 6
9. Laying out Deceased Person ..................................................................................... 6
10. Identification and Wrapping……………………………………………………………….. 6
11. Obtaining Mementos of a Baby/ Child ………………………………………………… 7
12. Care of the Bariatric Deceased Patient ……………………………………………….. 7
13. Transportation from Wards to the Mortuary…………………………………………… 7
14. Body Storage ………………………………………………………………………………..8
15. Viewing ………………………………………………………………………………………8
16. Deceased Patients' Property ………………………………………………………………9
17. Post-Mortem Procedures …………………………………………………………………..9
18. Handover to Funeral Director……………………………………………………………. 10
19. Linked Policies …………………………………………………………………………….10
20. Training/ Audit and Compliance Monitoring …………………………………………… 10
21. Applicability ……………………………………………………………………………….. 10
22. Review …………………………………………………………………………………….. 10
23. References …………………………………………………………………………………10
Annex A Guidance for specific control measures: Risk of Infection from Human Remains 12
Annex B - High Risk and Group 3 Pathogens ………………………………………………..…13
Annex C - High Risk and Group 4 Pathogens …………………………………………………..14
Annex D – Equality Impact Assessment Tool ...................................................................... 15

2
Care of the Deceased Policy
1. RATIONALE

After death, the human body does not generally create a serious health hazard, and in most
cases universal/standard infection control procedures will suffice to reduce any possible risk.
However, certain infectious diseases may continue to be a risk to staff having contact with
cadavers, and extra control measures may be required. Not all infected patients display
typical symptoms; therefore some infections (including blood-borne viral infections) may not
have been identified at the time of death.

The need to maintain dignity and confidentiality after death must be respected, however,
there is also an obligation to inform personnel (who may be at risk from contact with the
deceased) so that appropriate precautions can be taken.

2. AIM

The aim of this policy is to provide guidance to healthcare workers involved in the care and
handling of the deceased person. This includes guidance regarding specific infections and
how potentially infected bodies should be managed after death to minimise infection risk.

This policy should be read in conjunction with other relevant Trust Infection Control Policies.

3. DEFINITIONS

Biological Agent – any micro-organism, parasite, microscopic infectious form of larger

parasite, cell culture, or human endoparasite, including any which may have been
genetically modified, which may cause infection, allergy, toxicity or otherwise create a
hazard to human life (HSE 2003)

Cadaver – deceased person, body, corpse

Standard Precautions – a series of actions and specific precautions developed to

minimise the risk of contamination or cross infection

Last Offices – preparation of the deceased person before removal to the hospital
mortuary

Hygienic Preparation – cleaning and tidying the deceased person to present a suitable
appearance for viewing (an alternative to embalming)

Embalming – injecting chemical preservatives into a body to slow the process of decay.
Cosmetic work may be included

Body Bag – strong plastic bag designed to be used to transport and store a deceased
person where there is a risk from certain infections or leakage of body fluids

Viewing – allowing the bereaved to see, touch and spend time with the deceased person

3
4. ROLES AND RESPONSIBILITIES

4.1 The Chief Executive

The Chief Executive is responsible for the standards of continuing care given to a patient
who dies whilst in Trust care or who is dead on arrival. This responsibility continues until the
deceased are removed from Trust premises.

4.2 The Director of Nursing and Clinical Governance

The Director of Nursing and Clinical Governance is responsible for Infection Control within
the Trust.

4.1. Infection Prevention and Control Team

The Infection Prevention and Control Team are responsible for advising and supporting staff
in the infection control management of a deceased person.

4.2. Mortuary Staff

The Mortuary Staff are responsible for informing funeral directors of any precautions
required, beyond standard precautions.

4.3. Doctors or Nurses Certifying Death

Doctors or Nurses Certifying Death are responsible for the completion of the Mortuary
Admission Form in consultation with the nurse in charge of the ward.

4.4. Ward/ Department Heads

Ward/ Department Heads are responsible for ensuring that all staff handling a deceased
person are aware of the actions of this policy

4.5. Ward Staff

Ward Staff involved in the care of a deceased person are responsible for carrying out last
offices and ensuring the actions of this policy are followed.

5. CONFIRMATION OF DEATH

Death must be certified by the patient’s doctor whenever possible. However when this is not
possible, or out of hours, the doctor covering the ward/dept where the patient has died must
be documented in the patients notes the time he/she certified the death and the process
followed. Between 22.00hrs -07.00hrs the Clinical Site Manager can verify death if the
patient’s death fits the verification criteria. (See Verification of Death policy)

6. SUDDEN UNEXPLAINED DEATH IN CHILDREN, (SUDIC)

See Somerset’s guidelines in SUDIC box in the accident and emergency department. The
box contents are to be checked monthly by a designated experienced paediatric nurse who
will also ‘top up’ as necessary, when informed from the A&E department that SUDIC has
occurred applicability.

4
7. LAST OFFICES

7.1. For children, once confirmation of death has occurred and Child Death Review
Protocol has been adhered to, last offices can be performed.

7.2. Nursing staff have the responsibility for performing last offices .When preparing the
deceased person prior to removal to the mortuary, universal/standard precautions
should be adhered to at all times. This includes the use of personal protective
equipment, i.e. wearing disposable aprons and gloves. If there is a risk of splashing
then protective eyewear (e.g. visor) is necessary. Attention should be paid to hand
hygiene, the handling of potentially infectious waste and linen, and the management
of sharps.

7.3. Tubes, Cannula and Leakage

All tubes, venous catheters etc below the head should always be left in situ. Spigot
where appropriate.

All Endo-tracheal (ET) tubes are to be left in, unless inserted as part of cardio-
pulmonary resuscitation or used as part of a planned withdrawal of treatment.

Neck lines, can be covered with gauze swabs and taped so that they are less visible
if the next of kin are going to view on the ward.

Naso-gastric tubes are to be left in and spigotted. If the deceased person is to be

viewed on the ward the tube can be cut and pushed up the nose. When the viewing
is complete the nose can be packed.

Leaks – all orifices that are likely to leak should be packed with gauze swabs. For
leaking oedematous limbs a plastic backed incontinence pad can be lightly secured
around affected limbs. Cover any wounds likely to continue to leak using waterproof
occlusive tape or dressings, if there is still likely to be leakage, the deceased person
should be placed in a body bag of the correct size zipping from feet to head. (Plastic
body bags are available on the wards and must be used for certain infections or if
leakage is likely to occur in transit. See Appendix A). For advice (in-hours) ring the
mortuary team.

Young children will have a nappy on. Older children may need to wear incontinence
protection if this was his/ her usual practice.

All jewellery should be left in situ and rings secured with tape. (Details must be
logged on the mortuary admission form by the nurse responsible for the care of the
patient). Funeral Directors will give any requested items to the family. If family
members are present at, or directly after the death and specifically request items of
jewellery, these should be given to them in the presence of another member of staff
and then clearly documented in the patient’s nursing notes and in patient’s property
book. The yellow page is to remain in the book, the green and white pages must go
with the patient’s property to the bereavement support office on a patient’s property
form.

5
8. RELIGIOUS/ FAITH/ PERSONAL CONSIDERATIONS

8.1. Some people may wish to assist with last offices and some religions/ faiths prefer
or require the family to perform last offices. This should be facilitated by ward staff
if at all possible, unless the death is suspicious, in which case the coroner’s
permissions will need to be obtained. For more information regarding different
religions/ faiths contact Chaplain or Clinical Site Manager for on call Chaplaincy
out of hours.

8.2. If family members do wish to assist with last offices they should be instructed to
take the same infection control precautions as staff.

9. LAYING OUT DECEASED PERSON

9.1. Lay out deceased person supine, closing his/ her eyelids. (It is helpful to do this as
soon as possible as the smaller muscles in the face develop rigor mortis very
quickly. If the eyes will not remain closed gently pull down the eye lid and place
some damp cotton wool on top. (This will need to be removed before viewing and/
or transportation to the mortuary). Leave at least one or two pillows in situ.
Straighten limbs.

9.2. Wash the deceased person, unless they have recently been washed, clean nails,
nostrils, ears and mouth, tidy hair.

9.3. Clean dentures and replace them in the mouth if possible. If not, place in a
labelled denture pot to accompany the deceased person to the Mortuary.
(Document on mortuary admission form). Replace other prostheses whenever
possible. If unable to do so, these also need to accompany the deceased person
to the mortuary.

9.4. The parents may wish to be involved in bathing a child.

10. IDENTIFICATION AND WRAPPING

10.1. Put shroud or personal clothing on deceased person, unless requested to do

otherwise. Secure ankles together with tape.

10.2. Ensure deceased person has an identification bracelet on wrist (primary identifier).

10.3. The deceased person should be wrapped in a sheet. The hand displaying the
wristband should be left outside the sheet allowing portering staff to check ID.
Whilst awaiting porters’ attendance, leave 2 pillows under deceased person’s
head. Once ID has been checked with portering staff the hand should be closed in
the sheet wrapping the deceased person completely. Sheet may be secured with
a small amount of tape. Do not wrap sheet too tightly, particularly around the face.

10.4. If the deceased person is likely to continue having leakage, in spite of precautions
in 7.3, place in body bag. Body bags are also to be used in case of certain
infections, see Annex A. For advice (in-hours) contact the mortuary team.

6
10.5. Infectious cases – If a deceased person is known to have suffered from a high risk
or hazard group 3 or 4 pathogen (see Annex A) this information must be entered
onto the mortuary admission form which will accompany them to the mortuary. For
reasons of confidentiality, neither labels nor form must state the diagnosis.

11. OBTAINING MEMENTOS OF A BABY/ CHILD/ ADULT

11.1. Parents permission must be obtained before photographs or other memento’s of a

child (for example: a lock of hair, foot or hand prints) are taken

11.2. If there are any special requests of this nature provide assistance with this as
appropriate. Photographs can be taken of the child with or without the family
according to the parents’ wishes. If the parents do not wish to keep any
photographs taken, label the photographs and store in the medical notes.

12. CARE OF THE BARIATRIC DECEASED PATIENT

All aspects of this policy apply equally to the bariatric patient however; the following
points need to be considered to ensure the dignity and safety of the bariatric
deceased.

12.1 Bariatric Body Bags are available from the mortuary and the equipment library on
level 2. They can be collected by a porter when required.

12.2 Movement and handling of the bariatric deceased will require risk assessment by
the ward / departmental lead to ensure safe removal from the ward to the
mortuary.

12.3 You may need to consider alternative methods of removal to the mortuary and this
should be co-ordinated by the CSM (out of hours) and the mortuary technician (in-
hours).

12.4 Always seek advice from the clinical site manager (out of hours) and the mortuary
technician (in-hours) if you require support when managing the laying out,
wrapping and transportation of the bariatric patient.

13. TRANSPORTATION FROM WARDS TO THE MORTUARY

13.1. Protective clothing is not required by staff during transportation if proper

containment is adhered to and the patient is not removed from an isolation room. If
body fluid leakage or improper containment is noted at the time of collection,
removal should be halted until the ward nursing staff have rectified the situation.

13.2. Hands must be washed before returning to subsequent duties.

13.3. Personal protective clothing (PPE) is available within the mortuary anteroom for
use when transferring the deceased to the refrigerator.

7
13.4. If the Next of Kin want to remove the deceased person from the ward contact
Bereavement Support Office in hours and Clinical Site Manager out of hours.

13.5. For baby / child it might be preferable for a member of the nursing team to
transport the baby. There is a pram or Moses basket available for this purpose.
For parents who do not want their child to be in the mortuary, arrangements can
be made with a funeral director to meet the porters at the mortuary, as long as the
medical certificate of cause of death, and cremation form, if needed, are
completed. The mortuary admission form will still have to be completed. Parents
can make their own personal arrangements and not use a funeral director.
Documentation will still have to be completed. We suggest the baby is home for
less than 12 hours due to the natural deterioration of the baby. Moses basket is
from available the Accident and Emergency Department .Bereavement Support,
mortuary, chaplaincy staff or funeral director can all be referred to for advice.

14. BODY STORAGE

14.1. A body cold store must have a capacity appropriate for the mortuary workload,
and be maintained at a temperature of about 4 oC.

14.2. In the event of a need for increased mortuary capacity this will be dealt with via the
mortuary contingency plan.

15. VIEWING

15.1. For specific guidance on viewing in the mortuary please refer to the mortuary
team. It is emphasised that as the hospital mortuary is not a Chapel of Rest it is
not ideal for viewing. (Where possible, when viewing is desired by family
members, ward staff should encourage this to take place on the ward or at the
funeral Directors). Generally the most appropriate places for viewing to occur are
on the ward or at the funeral director’s Chapel of Rest. However, where
immediacy is important for a family, viewing can be arranged via the Bereavement
Support Office during normal working hours.

15.2. Mortuary viewing is available Monday to Friday between 0900 and 1700. Outside
of these hours arrangements can be made via the Clinical Site Manager, but it
cannot be guaranteed that a viewing will be available.

15.3. If viewing involves physical contact with the deceased person the relative or visitor
should be encouraged to wash their hands thoroughly afterwards.

15.4. Viewing may not be possible in the case of certain high risk infections once the
body has been placed and sealed in a body bag.

15.5. If viewing is to take place on the ward the bed should be made with clean linen.

15.6. Parents may wish to have their baby or child in the room for several hours and
other members of the family may wish to come and view. Ensure the room is
appropriate.

8
16. DECEASED PATIENT’S PROPERTY

16.1. If parents wish a toy or special item accompany the child to the mortuary it must
be labelled.

16.2. The personal effects of the deceased person are to be listed in the ward property
book. Personal effects should be packed with thought and care for the person who
is going to unpack them. Soiled items of clothing should be packed separately in
wash – soluble property bags (available on the wards), and receiving relatives
advised. Any equipment, such as walking frames, wheelchairs etc, should be
cleaned as per Trust Decontamination of Equipment policy. Soiled equipment
must not be returned to relatives until appropriately cleaned. See Patient’s
Property Policy.

16.3. Do not pack perishable items such as fruit

16.4. All property must be labelled clearly with the deceased person’s name and
hospital number.

16.5. Relatives should be advised to wash their hands after handling soiled clothing.

16.6. Complete check list for bereavement office and attach to the front of the medical
notes.

17. POST – MORTEM PROCEDURES

17.1. Infection Control in the mortuary as elsewhere is based on universal/standard

precautions, i.e. the prevention of contamination of workers, irrespective of the
knowledge of the deceased persons’ infection status.

17.2. Standard operating procedures (SOP) in the mortuary should include documented
risk assessments and control measures for infection risks.

17.3. The main potential sources of infection to be considered when handling a

deceased person are:

Blood and other bodily fluids

Waste products such as faeces and urine

Aerosols of infectious materials, such as might be released when opening the

body

Direct contact with the skin and through abrasions, wounds and sores

Inoculation injury from a sharp object

Appendix A gives guidance regarding enhanced precautions required in the case of certain
infections

Where a deceased person is not properly identified i.e. police cases, road traffic collisions
(RTC), these should be treated as high-risk cases, unless additional information becomes
available.

9
18. HANDOVER TO FUNERAL DIRECTOR

18.1. Funeral Directors and ambulance staff must be informed if the body of the
deceased person is a known or suspected infection hazard. The information
should not include diagnosis or confirmation of the particular infectious agent but
rather the route of transmission.

18.2. Very occasionally there is a direct release of a deceased to an undertaker or very

rarely directly to a family member. This person will present with a body release
form to which the mortuary staff are obliged to respond to. In this instance advice
is to be given to this person on precautions in the event that the deceased is
infectious.

19. LINKED POLICIES/GUIDELINES

Infection Prevention Control Policy

Decontamination of Equipment
Brain stem testing policy
Tissue Donation Policy
Guidelines for Home Burial

20. TRAINING/ AUDIT AND COMPLIANCE MONITORING

20.1. Relevant information on Infection Control will be included in local induction and
mandatory programmes for nurses, healthcare assistants, porters and mortuary staff.
This will include hand hygiene and use of PPE.

20.2. All Trust staff have a duty to incident report any failure to comply with this policy.
Infection Prevention & Control related incidents are reviewed quarterly by the Infection
Control Committee (ICC) and action taken as required.

21. APPLICABILITY

This policy applies to all staff employed by the Trust whether on a permanent or
temporary basis.

22. REVIEW
This policy will be reviewed in 3 years or earlier if major changes are required.

23. REFERENCES
Advisory Committee on Dangerous Pathogens HMSO 2003

Control of Substances Hazardous to Health Regulations (COSHH) 2002 SI 2002/2677

The Stationery Office 2001 ISBN 0 11 042919 2

Communicable Disease Report (1995) The Infection Hazards of Human Cadavers

10
Department of Health (2006) The Health Act

Health Services Advisory Committee 2003 Safe Working and the prevention of
infection in the mortuary and post-mortem room (second edition), HSE books, 2003,
ISBN 0 7176 2293 2

The management of Health, Safety and Welfare Issues for NHS Staff, 2005: NHS
Confederation

11
 ANNEX A –

GUIDANCE FOR SPECIFIC CONTROL MEASURES REQUIRED FOR CERTAIN

DISEASES RE: RISK OF INFECTION FROM HUMAN REMAINS

Low Risk

Infection Body Bag Viewing Hygienic Embalming

Required Preparation

Acute encephalitis No Yes Yes Yes

Chicken pox/shingles No Yes Yes Yes

Cryptosporidiosis No Yes Yes Yes

Dermatophytosis No Yes Yes Yes

Legionellosis No Yes yes Yes

Leprosy No Yes Yes Yes

Lyme disease No Yes Yes Yes

Measles No Yes Yes Yes

Meticillin resistant staphylococcus No Yes Yes Yes

aureus (MRSA)

Meningitis (except meningococcal) No Yes Yes Yes

Mumps No Yes Yes Yes

Opthalmia neonatorum No Yes Yes Yes

Orf No Yes Yes Yes

Psittacosis No Yes Yes Yes

Rubella No Yes Yes Yes

Tetanus No Yes Yes Yes

Whooping cough No Yes Yes Yes

12
 ANNEX B –
High Risk and Group 3 Pathogens
Patients with the following infections/diseases are categorised as ‘high risk’

Infection Body Bag Viewing Hygienic Embalming

Preparation

Relapsing fever Adv Yes Yes Yes

Food poisoning Adv Yes Yes Yes

Salmonella Adv Yes Yes Yes

E. coli 0157 Adv Yes Yes Yes

Haemorrhagic fever with renal No Yes Yes Yes

syndrome

Hepatitis A No Yes Yes Yes

HIV/AIDS Adv Yes No No

Acute poliomyelitis No Yes Yes Yes

Diphtheria Adv Yes Yes Yes

Dysentery Adv Yes Yes Yes

Leptospirosis (Weil’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

Q fever No Yes Yes Yes

Cholera No Yes Yes Yes

Scarlet fever Yes Yes Yes Yes

Tuberculosis (Active) Yes No Yes Yes

Typhoid/paratyphoid fever Adv Yes Yes Yes

Typhus Adv No No No

Hepatitis B, C and non-A non-B Yes Yes No No

Invasive group A streptococcal Yes No No No

infection

13
 ANNEX C – HIGH RISK AND GROUP 4 PATHOGENS

Infection Body bag Viewing Hygienic Embalming

preparation

Anthrax Adv No No No

Brucellosis Yes No No No

Ebola Yes No No No

Lassa fever Yes No No No

Plague Yes No No No

Rabies Yes No No No

Smallpox Yes No No No

Transmissible spongiform Yes No No No

encephalopathies

Viral haemorrhagic fever Yes No No No

Yellow fever Yes No No No

Adv = Advisable and may be required by local health regulation

If the infection is not on the list and you are in any doubt, contact the Infection Prevention
and Control team.

Other conditions requiring a body bag and with restriction of contact are:

Death in a dialysis unit

Known intravenous drug user

Severe secondary infection

Gangrenous limbs and infected amputation sites

Large pressure sores

Leakage and discharge of body fluids likely

Post-mortem
Incipient decomposition

14
ANNEX D – EQUALITY IMPACT ASSESSMENT TOOL
To be completed and attached to any procedural document when submitted to the
appropriate committee for consideration and approval.

Yes / No /
Comments
N/A

1. Does the policy/guidance affect one group

less or more favourably than another on
the basis of:
Race No

Ethnic origins (including gypsies No

and travellers)
Nationality No

Gender No

Culture No

Religion or belief No

Sexual orientation including No

lesbian, gay and bisexual people
Age No

Disability No
2. Is there any evidence that some groups No
are affected differently?
3. If you have identified potential No
discrimination, are any exceptions valid,
legal and/or justifiable?
4. Is the impact of the policy/guidance likely No
to be negative?
5. If so can the impact be avoided? NA
6. What alternatives are there to achieving NA
the policy/guidance without the impact?
7. Can we reduce the impact by taking NA
different action?

If you have identified a potential discriminatory impact of this procedural document, please
refer it to the Trust’s lead for Equality & Diversity, together with any suggestions as to the
action required to avoid / reduce this impact.

For advice in respect of answering the above questions, please contact the Trust’s lead for
Equality & Diversity.

SIGNED – NAME: YVONNE THORNE DATE: 15/02/2016

15