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>> This video guides healthcare or mortuary workers
in the safe handling of human remains
that may contain Ebola virus.
This video supplements procedural guidelines,
which can be found on the CDC website.
Make sure that all workers have read the guidelines,
and are familiar with the procedures before they handle
any infected human remains.
Ebola can be transmitted in postmortem care settings
by laceration and puncture
with contaminated instruments used during postmortem care,
through direct handling of human remains
without recommended personal protective equipment, PPE,
and through splashes of blood or other body fluids,
such as urine, saliva, feces, or vomit, to unprotected mucosa,
such as the eyes, nose, or mouth.
Only personnel trained in handling infected human remains
and wearing recommended PPE should touch or remove remains
that contain Ebola virus.
Do not wash or clean the body.
Do not embalm the body.
Do not perform an autopsy.
If an autopsy is necessary,
consult the state health department
and CDC regarding necessary precautions.
Do not remove any inserted medical equipment from the body,
such as intravenous, IV lines, endotracheal or other tubing,
or implanted electronic medical devices.
Cremate the body.
If cremation is not possible because of safety concerns,
the body should be buried in a standard metal casket
or other comparable burial method.
Contaminated area procedures -- the contaminated area is an area
that includes the patient treatment room.
Only workers wearing PPE that conform to CDC's guidance
on personal protective equipment
for healthcare workers are allowed to be in this area.
CDC's guidance on personal protective equipment, PPE,
for healthcare workers can be found on the CDC website.
You will need the following equipment --
a hospital gurney or mortuary stretcher,
three pre-opened cremation-compatible body bags
that meet the specifications described here.
The third bag serves as the bottom layer of the gurney,
and is made of laminated vinyl or other chlorine-free material,
with a minimum of 18 mil thickness.
The handles should be riveted handles,
reinforced with handle straps that run under the bag.
Handles should not be sewn on.
To keep fluids from leaking,
all seams should be factory heat-sealed or welded, not sewn,
and the zipper should be on top.
The second bag, or middle layer, should be designed specifically
for the containment and transport of infectious bodies.
The material should be pre-cut from the bulk roll
to provide sufficient material
to envelop the body and the next bag.
This bag is placed on top of the third bag.
It should be made
of chlorine-free material impervious to fluids
that can be heat-sealed around the body
to form a leak-proof body bag.
The first bag, or top layer, is the bag closest to the body.
It should be made of vinyl or other chlorine-free material,
and should be a minimum of 6 mil thickness.
To prevent leakage of fluids,
all seams should be factory heat-sealed or welded, not sewn.
The zippers should be on top.
A thermal sealer for sealing the second bag,
scissors for cutting excess material, a digital camera
or mobile phone capable of being decontaminated after use
and securely transmitting photographs electronically via
wi-fi or text message, a U.S. Environmental Protection Agency,
EPA, registered hospital disinfectant and wipes.
The label should state that the contents are appropriate for use
against non-enveloped viruses.
Alcohol-based hand rub, a biohazard bag, a zip-tie --
PPE is recommended by the CDC's guidance on PPE
for healthcare workers, and a large copy
of the Mortuary Guidance Job Aid.
A few more key points
to consider during postmortem preparation
of human remains containing Ebola virus are --
follow the cleaning
and disinfection recommendatios found in the CDC guidance
for environmental infection control
in hospitals for Ebola virus.
This guidance recommends immediate decontamination
of PPE surfaces, equipment, or patient care area surfaces
that become visibly soiled using the recommended wipes.
Place all waste produced during postmortem preparation
and decontamination into red biohazard bags
in the contaminated area, following the CDC guidelines
for Ebola-associated waste management.
Now we'll demonstrate the step-by-step guidelines
to protect workers
when conducting postmortem preparation
of human remains infected with Ebola in a hospital setting.
The number of workers needed
for this process should be determined by the size
and weight of the body being prepared, and the ability
of the workers to lift the body and assist
with managing the body bag.
Safe patient handling practices should be used as much
as possible, such as using a patient
or cadaver lifting device.
We recommend posting an enlarged copy
of the step-by-step guidelines in the contaminated area.
The workers should read the guidelines aloud
as they perform each step of the procedure.
Turn on the thermal sealer
to the manufacturer's recommended temperature setting.
This allows it to warm up during the initial preparation
of the body.
The thermal sealer will be used to seal the second body bag.
Use the camera or mobile phone to take a photograph
of the decedent's face.
This will be used for identification purposes later.
The photograph should be securely transmitted via wi-fi,
e-mail, or text message to the pre-identified site manager.
The camera or mobile phone must be decontaminated before being
removed from the contaminated area or reused.
If not decontaminated, the camera
or mobile phone should be discarded along
with the other medical waste.
Do not wash or clean the body,
and do not remove any inserted medical equipment,
such as IV lines, or endotracheal
or other tubing, from the body.
Position the gurney with the three pre-opened body bags next
to the hospital bed with the body.
Pull the bed sheets that are under the body
up around the front of the body.
Remove the first bag from the gurney.
Gently pull the body wrapped in sheets
as you slide the first bag under the body.
Complete the transfer of the sheet-wrapped body
to the first bag, and zip up the bag.
Reduce the amount of air trapped in the bag by pushing gently
as the bag is being zipped up.
Disinfect gloved hands using the alcohol-based hand rub.
If any areas of PPE have visible contamination, clean the area
with a disinfectant wipe.
Disinfect the outside
of the first bag using the recommended wipes according
to the manufacturer's recommendations.
Ensure the second bag on the gurney is folded open.
Transfer the first bag with the body in it to the gurney
by using safe patient lifting practices.
Place the first bag on top of the second bag material.
The body should fit inside the second bag.
Disinfect gloved hands again using alcohol-based hand rub.
Fold the second bag material around the first bag.
Heat seal the second bag approximately two inches
from the edges, while removing as much air
from the bag as possible.
Be careful not to damge your PPE with the hot sealer.
Heat seal the bag a second time approximately one inch below the
initial seal, and then heat seal diagonally across the corners.
Use scissors to trim off any excess material along the seam.
Turn off or unplug the thermal sealer to allow it to cool.
The thermal sealer must be decontaminated before it is
removed from the contaminated area or reused.
Disinfect the outside of the second bag
with the recommended wipes according
to the manufacturer's recommendations.
Disinfect gloved hands again using alcohol-based hand rub.
Work the third bag around the second bag,
and zip up the third bag.
Zip-tie the zipper shut.
Disinfect gloved hands again using alcohol-based hand rub.
Wheel the gurney to the decontamination area.
Decontaminate the surface
of the body bag using the recommended wipes.
Begin by applying the hospital disinfectant to the top
of the bag and any exposed areas of the gurney's cot.
Roll the bag to one side to decontaminate half of the bottom
of the bag, and the newly-exposed portion
of the gurney's cot.
Repeat with the other side of the bag and gurney.
While performing decontamination,
remove any visible soil on surfaces of the bag or gurney
with the disinfectant wipes.
After the visible soil has been removed,
reapply the hospital disinfectant,
and allow sufficient contact time as specified
by the manufacturer of the disinfectant.
Using the recommended wipes, disinfect the surfaces
of the gurney, from the handles to the wheels,
according to the manufacturer's recommendations.
Disinfect gloved hands using alcohol-based hand rub.
Clean area procedures --
the following equipment should be used in the clean area.
Hospital gurney or mortuary stretcher, adhesive backed pouch
that is applied to the decontaminated body bag,
single-use disposable gloves with extended cuffs,
and a long-sleeved disposable gown.
Biohazard spill kit, which should include recommended PPE,
absorbent material such as paper towels, kitty litter,
or a solidifier,
an EPA-registered hospital disinfectant,
and biohazard waste bags, infectious substance labels
to be applied to the decontaminated body bag.
These include the following --
black-and-white infectious substance label, United Nations,
UN, 2814 label, do not open label, name and phone number
of the hospital administrator.
Push the gurney gently so that only the gurney
and the decontaminated body bag enter the clean area.
The workers in the contaminated area should not enter the
clean area.
Another set of workers should receive the body
in the clean area, and transport the body
for disposition using safe patient handling practices.
The transportation of human remains guidelines listed
in the CDC guidance document should be used.
Remember, the number of workers needed
for this process will be determined by the size
and weight of the body being prepared, and the ability
of the workers to lift the body and assist
with managing the body bag.
Where feasible, a patient
or cadaver lifting device should also be used.
At this point, the body bag has been decontaminated.
As long as the body is handled carefully, the potential
for further contamination will have been eliminated.
Workers who handle the body bag from this point
until the body is cremated or placed
into a metal casket should wear single-use disposable gloves
with extended cuffs and long-sleeved disposable gowns.
Other PPE is optional.
If there is no evidence that the body bag has been compromised
by a tear or puncture, or liquid coming from the bag,
surfaces that contact the body bag should not be
considered contaminated.
Gloves and disposable gowns used
for transport can be disposed of as regular trash.
The contaminated area workers should proceed
to the PPE removal area and follow the procedures
in CDC's guidance on personal protective equipment
for healthcare workers.
You can find more information on the safe handling
of human remains with Ebola virus, including transportation
and disposition of remains, at these CDC and NIOSH websites.
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