Managing infection risks when handling the deceased

1 Managing infection risks when handling the deceased Health and Safety Executive Managing infection risks when handling the deceased Guidance for the mortuary, post-mortem room and funeral premises, and during exhumation This publication provides guidance on Managing the risks of infection from work activities which involve handling the deceased . It covers the safe handling , storage and examination of bodies and pathological specimens in hospitals, mortuaries and post-mortem rooms. It also provides guidance for those involved in funeral services (including embalmers) and exhumations of human remains. It updates and combines previous HSE guidance, Safe working and the prevention of infection in the mortuary and post-mortem room (2003) and Controlling the risks of infection at work from human remains (2005), based on a review of scientific knowledge, stakeholder feedback and experience of how the previous guidance was used in the workplace.

2 HSG283. Published by TSO (The Stationery Office), part of Williams Lea Tag, and available from: Online Mail, Telephone, Fax & E-mail TSO. PO Box 29, Norwich, NR3 1GN. Telephone orders/General enquiries: 0333 202 5070. Fax orders: 0333 202 5080. E-mail: Textphone 0333 202 5077. TSO@Blackwell and other Accredited Agents Published with the permission of the Health and Safety Executive on behalf of the Controller of Her Majesty's Stationery Office. Crown copyright 2018. First published 2018. ISBN 978 0 7176 66768. This information is licensed under the Open Government Licence To view this licence, visit Any enquiries regarding this publication should be sent to: Some images and illustrations in this publication may not be owned by the Crown and cannot be reproduced without permission of the copyright owner.

3 Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. Enquiries should be sent to Printed in the United Kingdom for The Stationery Office. J003462029 08/18. This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory, unless speci cally stated, and you are free to take other action. But if you do follow the guidance you will normally be doing enough to comply with the law. Health and safety inspectors seek to secure compliance with the law and may refer to this guidance. Managing infection risks when handling the deceased Contents Introduction 5. Risk assessment 9. Training and competence 14. infection control precautions 17. Collection, transport and transfer of information related to the deceased 23.

4 Managing the risks of infection in the post-mortem room and mortuary 27. Managing the risks of infection in funeral premises 37. Managing the risks of infection during exhumations 44. Appendix 1: Application of transmission-based precautions to key infections in the deceased 48. Appendix 2: Hazard notification sheet 51. Appendix 3: Cleaning and disinfection 53. Appendix 4: Health surveillance and immunisation 55. Appendix 5: Managing exposure and post-exposure prophylaxis 57. Appendix 6: Dealing with incidents and accidents 58. Glossary 59. References 61. Further reading 63. Acknowledgements 64. Further information 65. 3. Managing infection risks when handling the deceased 4. Managing infection risks when handling the deceased Introduction What is the purpose of the guidance and who is it aimed at?

5 1 This publication provides guidance on Managing the risks of infection when handling the deceased . It is aimed at those working in: the mortuary and post-mortem room anatomical pathology technologists (APTs) and pathologists;. funeral services funeral directors and their staff, including embalmers;. exhumations cemetery employees, environmental health officers;. archaeological researchers and redevelopment/construction companies. 2 Although this guidance focuses on Managing the risks of infection , other risks including manual handling (eg moving bodies), use of chemicals (eg disinfectants and embalming fluid), and radioactive seeds (eg prostate implants) will also need to be considered. 3 Additionally, deaths resulting from workplace accidents or other incidents involving exposure to chemicals or other harmful substances (eg crime scenes).

6 May present an increased chemical or radiological exposure risk to people performing post-mortem examinations and embalming, and this risk should also be considered. The College of Policing provides guidance on dealing with contaminated deaths on its website at content/civil-emergencies; this may be of interest to police officers attending chemical, biological, radiation or nuclear (CBRN) incidents. Although such circumstances are rare, they need to be assessed on a case-by-case basis. 4 This guidance may also be useful for people who come into contact with the deceased through their work activities, such as ambulance workers, the police, general practitioners, porters and domestic cleaners. 5 The guidance does not cover crime scene investigations, road traffic accidents, industrial accidents or infection control with regard to patient safety.

7 How to use the guidance 6 The guidance is structured to reflect the pathway of the deceased from death through to burial, cremation and, where required, exhumation. It considers the risks of infection that may be present along that pathway (see Figure 1). Each section of the guidance is intended to reflect one stage in the pathway, so some will be more relevant to you than others. 7 The pathway is colour-coded to help direct you through the guidance (see the key for details). This makes sure that focus is directed to the areas most relevant to a particular work activity. Some sections of the guidance are common to all aspects of Managing the risks of infection from the deceased , and will be relevant to all. 5. Managing infection risks when handling the deceased Collection and transport of the deceased Transfer of information Risk assessment Information, instruction and training, standard infection control precautions deceased in community deceased in mortuary Transfer of information Risk assessment Information, instruction and training, standard infection control precautions Post-mortem Transfer of information Risk assessment Information, instruction and training, standard infection control precautions Funeral directors Transfer of information Risk assessment Information, instruction and training.

8 Standard infection control precautions Body preparation Embalming Burial Cremation Exhumation Key to material Blue Applicable to all work activities Orange Applicable to mortuary and post-mortem rooms Purple Applicable to funeral services Red Applicable to exhumations Figure 1 Pathway of the deceased 6. Managing infection risks when handling the deceased Risk of infection from the deceased 8 Workers in a range of different occupations are required to handle the deceased at various stages of the pathway from death to burial or cremation. As such they may be exposed to a risk of infection , including during preparation of the deceased by funeral service staff, at post-mortem examination and, in restricted circumstances, during exhumation. 9 In the UK, a relatively small number of deaths each year (approximately 70,000).

9 Are linked to infectious diseases. However, some people may also present an infection risk where they were undiagnosed or asymptomatic with an infectious disease at the time of death. 10 This guidance advises on how to manage the risks of infection using the principles of standard infection control precautions (SICPs) and transmission-based precautions (TBPs). The term standard infection control precautions' is used to describe the minimum control measures that should be implemented to manage the risk of exposure from all work activities involving the deceased . For some activities that present an increased risk of infection , additional measures are required these are referred to as transmission-based precautions'. Further information about what is meant by these terms is provided in paragraphs 59 98.

10 11 Appendix 1 provides a non-exhaustive list of infections that may be found in the deceased . It advises on whether you may carry out certain activities and indicates where to apply specific TBPs. However, you must also do a risk assessment to find out whether the risk of infection can be adequately managed. It is important to consider the route of transmission, then identify and apply the appropriate TBPs. What are the legal duties? 12 Duties under the Health and Safety at Work etc Act 19741 apply to the risks of infection that may arise from work activities. If you are self-employed and employ others the law will apply to you. However, if you are self-employed and your work activity poses no potential risk to the health and safety of other workers or people, health and safety law does not apply to you.