Coronavirus In India: Government Issues Guidelines On Dead Body Management

The Government has issues guidelines on dead body management. The guidelines come at a time when the family members of a 68-year-old woman in Delhi, who became the second casualty of novel coronavirus in India, alleged that authorities at the Nigambodh cremation ground refused to cremate the deceased.

Key Facts
  • The main driver of transmission of COVID-19 is through droplets. There is unlikely to be an increased risk of COVID infection from a dead body to health workers or family members who follow standard precautions while handling body.
  • Only the lungs of dead COVID patients, if handled during an autopsy, can be infectious.
Standard Precautions to be followed by health care workers while handling dead bodies of COVID

Standard infection prevention control practices should be followed at all times. These include:

  1. Hand hygiene
  2. Use of personal protective equipment (e.g., water resistant apron, gloves, masks, eyewear)
  3. Safe handling of sharps.
  4. Disinfect bag housing dead body; instruments and devices used on the patient. 5. Disinfect linen. Clean and disinfect environmental surfaces.
Training in infection and prevention control practices

All staff identified to handle dead bodies in the isolation area, mortuary, ambulance and those workers in the crematorium / burial ground should be trained in the infection prevention control practices.

Removal of the body from the isolation room or area
  • The health worker attending to the dead body should perform hand hygiene, ensure proper use of PPE (water resistant apron, goggles, N95 mask, gloves).  All tubes, drains and catheters on the dead body should be removed.
  • Any puncture holes or wounds (resulting from removal of catheter, drains, tubes, or otherwise) should be disinfected with 1% hypochlorite and dressed with impermeable material.
  • Apply caution while handling sharps such as intravenous catheters and other sharp devices. They should be disposed into a sharps container.
  • Plug Oral, nasal orifices of the dead body to prevent leakage of body fluids.  If the family of the patient wishes to view the body at the time of removal from the isolation room or area, they may be allowed to do so with the application of Standard Precautions.
  • Place the dead body in leak-proof plastic body bag. The exterior of the body bag can be decontaminated with 1% hypochlorite.
  • The body bag can be wrapped with a mortuary sheet or sheet provided by the family members.
  • The body will be either handed over to the relatives or taken to mortuary.
  • All used/ soiled linen should be handled with standard precautions, put in bio-hazard bag and the outer surface of the bag disinfected with hypochlorite solution.
  • Used equipment should be autoclaved or decontaminated with disinfectant solutions in accordance with established infection prevention control practices.
  • All medical waste must be handled and disposed of in accordance with Bio-medical waste management rules.
  • The health staff who handled the body will remove personal protective equipment and will perform hand hygiene.  Provide counseling to the family members and respect their sentiments.
Environmental cleaning and disinfection

Environmental cleaning and disinfection All surfaces of the isolation area (floors, bed, railings, side tables, IV stand, etc.) should be wiped with 1% Sodium Hypochlorite solution; allow a contact time of 30 minutes, and then allowed to air dry.
Handling of dead body in Mortuary  Mortuary staff handling COVID dead body should observe standard precautions.  Dead bodies should be stored in cold chambers maintained at approximately 4°C.  The mortuary must be kept clean. Environmental surfaces, instruments and transport trolleys should be properly disinfected with 1% Hypochlorite solution.  After removing the body, the chamber door, handles and floor should be cleaned with sodium hypochlorite 1% solution.

Embalming

Embalming of dead body should not be allowed.

Autopsies on COVID-19 dead bodies Autopsies should be avoided. If autopsy is to be performed for special reasons, the  infection prevention control practices should be adopted.

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