Assessment of occupational health and safety practices at government mortuaries in Gauteng Province: a cross-sectional study.

INTRODUCTION: hospital mortuaries are responsible for the receipt and storage of deceased people. This exposes mortuary workers to a variety of health and safety hazards, which include physical, chemical, ergonomics, biological and psychosocial hazards/stressors. The aim of this study was to assess occupational health and safety practices (OHS) among government mortuary workers in Gauteng province. METHODS: a cross-sectional descriptive study design was conducted between the year 2017 and 2018. A convenient sampling technique was used to sample 11 government hospitals in Gauteng Province. A total of 46 employees participated in the study. Data was collected using structured questionnaires and observational checklists. Ethical clearance and permission to conduct the study were obtained prior to the commencement of the study. Data was analyzed using Statistical Package for the Social Science (SPSS) version 25 software. RESULTS: thirty-one (67%) of the respondents did not know the concept of hazard. Observations indicated that 5 out of 11 (45%) facilities were well maintained with only 2 (18%) of the facilities had the participants wearing the required PPE on duty. There was no association between working experience and having a knowledge of the existing hazards. However, there was a high correlation (P<0.05) between training and adherence to safe practices. CONCLUSION: the OHS practices were poor amongst operational employees. The study highlights the significance of developing and implementing Occupational Health and Safety programmes. We recommend that these programmes should focus on occupational health and safety education, training, supervision, medical surveillance and monitoring strategies must be developed and implemented.

Autopsy Services and Emergency Preparedness of a Tertiary Academic Hospital Mortuary for the COVID-19 Public Health Emergency: The Yale Plan.

Pathology Autopsy and Mortuary Services have been front and center in the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) pandemic. The sheer number of fatalities from the pandemic have been unlike any other in recent memory and needed the rapid creation of new protocols and paradigms to manage the situation. This required rapidly escalating mortuary capacity to manage the increased fatalities from the pandemic with the establishment of lines of communication and networking with governmental entities, institution of new policies for patient flow, and implementation of worker infection control and well-being plans. Autopsies also assumed a crucial role, both to provide insight into the pathomechanisms of a novel disease and to allow tissue retrieval necessary to power research directed towards finding a vaccine. We here outline the plan adopted by the Yale Autopsy and Mortuary Services, in alignment with the institutional mission of high-quality patient care, education, research and health care worker safety and well-being, as the Corona Virus Disease of 2019 (COVID-19) pandemic surged in Connecticut. In the early response phase, ensuring sufficient mortuary capacity necessarily took center stage. As we enter the recovery and plateau phase of the pandemic, setting up a process for a rapid and safe autopsy, that will meet educational and research needs while ensuring the safety of our workforce is being implemented.

Review: The safe handling of a corpse (suspected) with COVID-19.

INTRODUCTION: Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. RESULTS: The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. CONCLUSION: In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a "business as usual" attitude and others a "code-red" attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse.

Nota Técnica 18/2020/SES/GASEC [Biossegurança para Manejo de cadáveres suspeitos ou confirmados por Covid-19] / Technical Note 18/2020 / SES / GASEC [Biosafety for Handling Suspected or Confirmed Corpses by Covid-19]

Traz orientações de Biossegurança para o manejo de cadáveres suspeitos ou confirmados por Covid-19 pelos serviços de somatoconservação, funerárias, cemitérios, crematórios, serviço de verificação de óbito, autópsia, transladação de cadáveres e velórios no Estado do Tocantins.

It provides Biosafety guidelines for the management of suspected or confirmed corpses by Covid-19 by somatoconservation, funeral services, cemeteries, crematoriums, death verification service, autopsy, transfer of corpses and funerals in the State of Tocantins.

Traz orientações de Biossegurança para o manejo de cadáveres suspeitos ou confirmados por Covid-19 pelos serviços de somatoconservação, funerárias, cemitérios, crematórios, serviço de verificação de óbito, autópsia, transladação de cadáveres e velórios en Estado do Tocantins.

COVID-19: Postmortem Diagnostic and Biosafety Considerations.

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.

Manejo de cadáveres por covid-19 y consideraciones éticas: síntesis rápida de evidencia / Corpse management by covid-19 and ethical considerations: rapid synthesis of evidence

INTRODUCCIÓN Wuhan, capital de la provincia de Hubei, en la región central de China, ha sido el epicentro desde diciembre del 2019 de infeción por SARS-Cov-2, agente causal de una enfermedad respiratoria aguda grave (COVID-19), que se ha expandido rápidamente por varios países y fue declarada como pandemia por la OMS el 11 de marzo del 2020. El primero de febrero del 2020, China, a través de sus autoridades en salud, indicó la cremación obligatoria de los cadáveres de fallecidos por COVID-19. Además de ello, el gobierno chino comenzó a reportar la data de fallecidos de COVID-19 a la OMS y a la opinión pública, sin embargo, reportes no oficiales de medios extrajeros indican que la cifra de fallecidos podría ser mayor a la de los reportes oficiales. Alrededor del 25 de enero del 2020, ya existía un incremento de carga laboral en los crematorios de Wuhan, que habitualmente trabajaban turnos de 4 horas al día, para esa fecha se estimaba la carga laboral en 24 horas, con 5 veces más cadáveres que lo habitual (1). Por la rapidez del desarrollo de esta pandemia, no existe data suficiente sobre el contagio a través de cadáveres de fallecidos por COVID-19, sin embargo, se vienen adaptando medidas ya establecidas para manejo de cadáveres por virus respiratorios, ya que el contacto con ellos podría suponer riesgo para las personas. Sin embargo, muchas de estas medidas emitidas, no incluyen recomendaciones que velen por los aspectos éticos y socioculturales del manejo de cadáveres, las costumbres, y las creencias de cada sociedad, aspectos que no se deben dejar de lado. Además, la pandemia actual del COVID-19 y sus profundas consecuencias materiales y emocionales, nos invitan a pensar en la importancia de la colectividad y de interdependencia para combatir a un virus que demuestra claramente la fragilidad de la vida. Pero, además, invita a reflexionar en la relevancia de entender esa colectividad e interdependencia como respeto, empatía y tolerancia hacia aquello que pudiese no estar alineado con prácticas, costumbres y creencias de un grupo hegemónico. En este sentido, cualquier estrategia de prevención y mitigación de enfermedades en general a implementarse, debería incluir en su planeamiento aspectos socioculturales de los distintos grupos comprometidos, con la finalidad de involucrar al mayor número de personas posibles en el mismo camino hacia el mejor manejo del problema de salud. En tal sentido, el objetivo de esta revisión es sistematizar la evidencia existente sobre experiencias y guías de manejo de cadáveres , y la importancia de la inclusión de aspectos socioculturales y éticos en planes de mitigación de la propagación de epidemias. MÉTODOS: Se realizó busquedas en Web Of Science y Scholar Google. Adicionalmente, se revisó manualmente los datos publicados por organismos internacionales (OMS ­ OPS - CDC) y las guías o reportes de experiencias de los países afectados por COVID-19. Para los aspectos socioculturales y éticos, se muestra la experiencia de manejo de cadáveres en el brote de ebola entre los años 2014-2015 en África occidental. RESULTADOS: La OMS/OPS establece sus recomendaciones para el manejo del cuerpo en las instalaciones de atención de salud, aclarando ser éstas preliminares y sujetas a modificaciones a medida que se disponga de nueva evidencia. Además, deja en claro que, al momento no se conoce a ciencia cierta la historia natural de la enfermedad, incluyendo los mecanismos de transmisión, pero resalta el rol fundamental de los procedimientos generadores de aerosoles (PGA) en la diseminación de la enfermedad, pide evaluar el riesgo durante el proceso de cuidado mortuorio y hace hincapié de explicar de manera adecuada a la familia, respetando el contexto cultural de la comunidad local. CONCLUSIONES: La pandemia del COVID-19 ha obligado a organismos internacionales y a los diferentes países a tomar medidas para la prevención, diagnóstico, tratamiento y recuperación de los afectados, así como establecer procedimientos para el manejo de los fallecidos en este contexto. Tanto la OMS, OPS y CDC, nos brindan recomendaciones para el manejo de cadáveres por COVID-19, ya sea por entierro o cremación, sin indicar preferencia por alguno de los dos métodos. Al igual que el Perú, a nivel internacional, en base a las recomendaciones de OMS ­ OPS y CDC, cada país ha generado sus propias directivas, recomendaciones, guías o documentos técnicos para el manejo de los fallecidos por COVID-19, cada uno con diversas particularidades que se han revisado en el presente documento. Se observa que los países afectados de América del Sur se adhieren a las recomendaciones dadas por la OMS/OPS. Sin embargo, las experiencias en otras realidades como Asia y Europa, nos indican que no existe un manejo estandarizado. Se evidencia la importancia del conocimiento sobre rituales y tradiciones de transiciones de la vida a la muerte en contextos de epidemia. Funerales y entierros cargados de dinámicas y simbolismos que cohesionan una sociedad pero que, a la vez, la ponen en riesgo dada la facilidad del contagio y propagación de la enfermedad a través de diversas interacciones humanas cotidianas y afectivas. Sin embargo, el rechazo y exterminio violento de estas prácticas en beneficio de la mitigación de epidemias podría ocasionar resultados adversos, generando barreras para el cumplimiento y desarrollo de los planes y estrategias para combatir la enfermedad. Guías, directivas sanitarias o cualquier tipo de documento oficial sobre el manejo de cadáveres, debe incluir aspectos socioculturales de la comunidad afectada y, el rol de los familiares y comunidad en dichos procesos. De lo contrario, la aceptación y uso de estas herramientas podrían no alcanzar los beneficios y resultados esperados. Por lo tanto, recoger y brindar información; entender y validar el conocimiento local y; dialogar con la comunidad debe ser un trabajo colectivo entre líderes locales y autoridades sanitarias con la finalidad de proponer alternativas y soluciones efectivas y sostenibles. Los hallazgos de esta revisión invitan a reflexionar sobre la necesidad de un enfoque holístico en contextos de epidemia y sus respuestas de mitigación con el objetivo fundamental de aliviar y no reforzar experiencias locales de inequidad económica, política y cultural.

Lineamientos técnicos para el manejo y disposición final de cadáveres de casos COVID-19 (Segunda Edición) / Technical guidelines for the management and final disposal of cadavers of COVID-19 cases (Second Edition)

Las directrices para el manejo y disposición final de cadáveres por COVID­2019, requieren de medidas de bioseguridad y precaución estándar encaminadas para este fin y lograr la prevención de esta infección en el personal responsable del manejo y disposición final de cadáveres. Los presentes lineamientos técnicos contienen las actividades que el personal de salud debe cumplir para el manejo y disposición final de cadáveres en los diferentes escenarios y durante el traslado en busca de atención. Asimismo se establecen las indicaciones para la inhumación ante el fallecimiento por caso confirmado o sospecho de COVID-19. Todo lo anterior con el objetivo de proteger la salud de la población en general fortaleciendo la prevención y evitando la transmisibilidad. Objetivo general: Establecer las disposiciones técnicas y de bioseguridad para la prevención de infecciones en el personal responsable del manejo y disposición final de cadáveres por COVID­19, familiares, comunidad en general y otros actores que intervengan en estos procesos por mandato legal. Objetivos específicos: a)Brindar las directrices sobre el manejo y disposición final del cadáver dentro y fuera de los establecimientos de salud. b)Orientar a las instituciones funerarias sobre el procedimiento a seguir durante la pandemia COVID-19. c)Disponer de un instrumento legal que garantice evitar la transmisibilidad de la enfermedad COVID-19 por la manipulación de cadáveres. Ámbito de aplicación: Están sujetos al cumplimiento de los presentes Lineamientos técnicos el personal del Sistema Nacional Integrado de Salud, municipalidades, personas naturales y jurídicas que estén vinculadas al manejo y disposición final de cadáveres por COVID-19

Manejo de corpos no contexto do novo Coronavírus COVID-19 / Body management in the context of the new Coronavírus COVID-19

Em dezembro de 2019, em Wuhan, China, um novo coronavírus (SARS-COV-2) foi identificado como causa de doença respiratória aguda grave (COVID-19). Em janeiro de 2020, a Organização Mundial da Saúde (OMS) declarou o surto como uma emergência de saúde pública de interesse internacional (ESPII) e, em março de 2020, com a disseminação do vírus em diferentes países, foi declarada a pandemia. As definições de caso suspeito e confirmado de COVID-19 adotadas pelo Ministério da Saúde estão disponíveis neste endereço eletrônico: https://coronavirus.saude.gov.br/sobre-a-doenca#casossuspeito. A transmissão da COVID-19 se dá pelo contato pessoa-a-pessoa e por meio de fômites. Salientamos que o vírus SARS-COV-2 pode permanecer viável em superfícies ambientais por 24 horas ou mais. A transmissão de doenças infecciosas também pode ocorrer por meio do manejo de corpos, sobretudo em equipamentos de saúde. Isso é agravado por uma situação de ausência ou uso inadequado dos equipamentos de proteção individual (EPI). Nesse contexto, os profissionais envolvidos com os cuidados com o corpo ficam expostos ao risco de infecção. Os velórios e funerais de pacientes confirmados/suspeitos da COVID-19 NÃO são recomendados devido à aglomeração de pessoas em ambientes fechados. Nesse caso, o risco de transmissão também está associado ao contato entre familiares e amigos. Essa recomendação deverá ser observada durante os períodos com indicação de isolamento social e quarentena. A autópsia NÃO deve ser realizada e é desnecessária em caso de confirmação ante-mortemda COVID-19. Devido ao risco aumentado de complicações de piores prognósticos da COVID-19, reco-menda-se que profissionais com idade igual ou acima de 60 anos, gestantes, lactantes, portadores de doenças crônicas, cardiopulmonares, oncológicas ou imunodeprimidos não sejam expostos às atividades relacionadas ao manejo de corpos de casos confirmados/suspeitos pela COVID-19. Considerando a possibilidade de monitoramento, recomenda-se que sejam registrados nomes, datas e atividades de todos os trabalhadores que participaram dos cuidados post-mortem,incluindo a limpeza do quarto/enfermaria. É necessário fornecer explicações adequadas aos familiares/responsáveis sobre os cuidados com o corpo do ente falecido.

Plano estadual de contingência para o manejo de óbitos por COVID-19 / State contingency plan for the management of deaths by COVID-19

Documento foi elaborado com base em informações, orientações e normas de órgãos federais, estaduais, municipais, tais como ANVISA, Conselho Federal de Medicina, Sociedade Brasileira de Patologia, Organização Mundial de Saúde (OMS), Regulamento Sanitário Internacional, entre outros.

Serious incidents after death: content analysis of incidents reported to a national database.

Objectives To describe serious incidents occurring in the management of patient remains after their death. Design Incidents occurring after patient deaths were analysed using content analysis to determine what happened, why it happened and the outcome. Setting The Strategic Executive Information System database of serious incidents requiring investigation occurring in the National Health Service in England. Participants All cases describing an incident that occurred following death, regardless of the age of the patient. Main outcome measures The nature of the incident, the underlying cause or causes of the incident and the outcome of the incident. Results One hundred and thirty-two incidents were analysed; these related to the storage, management or disposal of deceased patient remains. Fifty-four incidents concerned problems with the storage of bodies or body parts. Forty-three incidents concerned problems with the management of bodies, including 25 errors in postmortem examination, or postmortems on the wrong body. Thirty-one incidents related to the disposal of bodies, 25 bodies were released from the mortuary to undertakers in error; of these, nine were buried or cremated by the wrong family. The reported underlying causes were similar to those known to be associated with safety incidents occurring before death and included weaknesses in or failures to follow protocol and procedure, poor communication and informal working practices. Conclusions Serious incidents in the management of deceased patient remains have significant implications for families, hospitals and the health service more broadly. Safe mortuary care may be improved by applying lessons learned from existing patient safety work.

Effectiveness of Mortuaries in Turkey: A Questionnaire Study.

AIM: The autopsy is an important step in solutions of forensic cases. The design and effectiveness of mortuaries are of great importance in terms of proper conduction of death examinations and autopsies. In addition, the safety of evidence, protection of public and staff health, and the quality of service offered to relatives of dead people are closely related to the effectiveness of mortuaries. The aim of this study was to determine whether mortuaries in Turkey meet international criteria. MATERIALS AND METHODS: Nineteen mortuaries were included in the study. The forensic medicine experts working in these mortuaries were given a questionnaire composed of questions about standards developed by the National Association of Medical Examiners (NAME) through the website my.questbase.com. RESULTS: Most of the mortuaries outside big cities (80%) did not have their own facilities. All of them could not control the chain of evidence and did not have a separate well-ventilated autopsy room where they could keep putrefied corpses. CONCLUSIONS: Most of the mortuaries did not meet most of the NAME criteria. The mortuaries, especially those in places other than big cities, had some deficiencies and mishandlings. Autopsy facilities and accessory laboratories should be enabled to meet NAME accreditation standards.