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• All disposable clothing and boots are removed by the pathologists at the post
mortem room door or decontamination dock and discarded as infectious waste. The technician then places the boots into the appropriate disinfectant to soak.
• After the appropriate time the body bag can be swilled off with water and then
placed into another clean body bag, which is sealed and over-sealed with bio- hazard tape.
• The name of the deceased is then written on the body bag in marker pen and
any jewellery, if present. •
The post mortem table is wiped down with the appropriate disinfectant there should be no fluid spillage onto the table if the autopsy was carried out in the
body bag and swilled with water. Boots are swilled in water and dried. •
The yellow bags are re-bagged into another yellow bag, and with the sharp bins, are sealed with bio-hazard tape and taken to the clinical waste collection point.
• Surgical tops and bottoms are placed into relevant contaminated laundry bags
and pathologist and technician shower before changing into outside clothes and leaving the mortuary.
• The undertakers who will carry out the funeral should be notified that the body is
infected and that when they come to collect the body the proper coffin should be brought not a stretcher or shell.
• When they come for the body, the body bag will not be opened but placed directly
into the coffin. •
The undertakers will be told of the potential risks of contamination and that: The body bag should not be opened
The body should not be embalmed; and Relatives should be discouraged from viewing the body. If the relatives insist
they may see the face only, and must not touch or kiss it. The undertakers should then sign for the body in the mortuary register through
the words ‘INFECTED BODY’, written in red ink so they aware that the body they have collected is infected.
The fridge that the body was on should then be wiped over with appropriate disinfectant, left for 1 hour and swilled with water.
3. Procedure for post-mortem examination of known or suspected CJD
Spongiform encephalopathy refer the document from mortuary •
The procedure for examination high risk cases including HIV, hepatitis and tuberculosis, can be used for examination of cases with known or suspected
spongiform encephalopathy which is also practiced by the Neurosciences Unit at the Queen Elizabeth Hospital in Birmingham.
• The only differences that will be required being:
o A dedicated set of equipment only for CJD cases must be used to avoid contaminating all other sets; and
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o Type I or II safety cabinet needs to be available for storage and handling of retained tissue specimens.
o Biosafety Level-3 autopsy room.
6.7.6 Specimen handling
1. Histology
• Tissue specimens for histology should be placed in appropriately sized containers
that will allow them to be totally submerged in at least 10 times their volume of fixative solution. Great care should be taken to ensure that the outside of these
containers is properly decontaminated before placing them into a plastic bag which is labeled with hazard warning labels, prior to transportation to the laboratory.
• Large specimens should be retained in the mortuary until fixation is considered
to be complete. •
Routine fixatives for histology, based on formaldehyde, rapidly inactivate tuberculosis, hepatitis and HIV organisms, and hence, once adequately fixed, no
hazard arises from trimming or cutting of paraffin embedded tissue block. 2.
CJDspongiform encephalopathies refer to mortuary documentSOP •
Brain should be fixed in 10 formal saline or equivalent without phenol or any other chemicals and dissected, if possible in Class 1 microbiological safety cabinet,
or on a disposable surface using hand, eye and face protection. Dissection in a shallow tray will limit dispersal of contaminated fluids onto work surfaces, which
must be decontaminated afterwards and any residual material incinerated. It is advisable to use disposable instruments wherever possible dissection.
• All tissues for histological examination should be fixed in formalin without the
addition of phenol which reacts deleteriously with formic acid. Unfixed frozen tissues should be clearly labeled ‘Risk of Infection’ and handled accordingly.
Exposure of brain tissue blocks to 96 formic acid for 1 hour after formalin fixation has been shown to be effective in substantially reducing CJD infectivity,
although it may make large blocks of tissue brittle and difficult to cut. If tissues are to be processed by machine, they should be washed again in formalin, since
formic acid may damage plastic containers.
• Tissue processing fluids, xylene and other laboratory waste should be disposed by
incineration after absorption with saw dust. Disposable microtome blades should be used to cut brain sections from CJD cases, and should be incinerated after use.
Histological sections are not regarded as being significant infectivity and can be additionally decontaminated after cover slipping by wiping with 96 formic acid.
• Remaining tissue unprocessed for histology should be placed into its container
which will be resealed and should remain inside the category 3 safety cabinet until its ultimate disposal by incineration.
3. Other laboratory samples
Fresh tissuebody fluids that are to be sent to laboratories i.e. for microbiological or toxicological analysis should be placed in a sealed leak proof container and then
placed inside a transport bag with biohazard or similar warning labels.
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6.7.7 Body cleaning and disposal
1. Routine autopsy cases after being sawn and clean with running water are given to
relatives for last rites. 2.
High risk cases are handled as for high risk autopsy. 3.
No relatives or undertakers are allowed to enter into the body storage areas. They are only allowed to come in at viewing area with supervision from mortuary staff.
4. When, for religious purposes, there is requirement to wash the body, those concerned
must be clearly warned of any risk that may exist. In such a case, the participants in the ceremony should be advised about the precautions they must take to help reduce
the possibility of contracting the infection or passing it on, and must be made to understand the possible consequences to themselves and others with whom they may subsequently
come in contact with. The activities should be supervise by the mortuary staff
6.7.8 Clinical waste
Most of the waste arising from post mortem examinations is defined as clinical waste and falls into two distinct groups and four subcategories which are:
1. Waste for incineration
• Disposable, generally single use items such as paper shrouds, swabs, dressings,
protective clothing and gloves. •
Human tissues and body fluids. •
Discarded syringes, needles and other disposable ‘sharps’, which must be placed in a ‘sharps’ bin immediately after use.
• Xylene, formalin and alcohol.
2. Disposal to drain
• Non-contaminated fluids which must be flushed with plentiful running tap water.
6.7.9 Visitors
1. Those visitors who decide to observe the autopsy may do so in the observation area
overlooking the autopsy tables. Access to the area should be via a direct route bypassing the dirty areas in mortuary.
2. No one may enter the autopsy room without first putting on the protective clothing
deemed necessary for the occasion. They must subsequently upon leaving the autopsy room required to wash their hands or may be required to shower before
putting on their own clothing. Protective clothing worn during autopsy must be removed and deposit in the bins provided.
6.7.10 Quality control
Mortuary facilities must undergo regular maintenance and the efficacy of such equipments i.e. fridge, ventilation systems, local exhaust systems, fume cabinets and PPEs are
regularly measured and monitored.
