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NOVEMBER 2014
FUNERAL HOME & CEMETERY NEWS
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CDC Releases Ebola Guidelines
for Mortuary Workers
The Centers for Disease Control and Prevention
(CDC) released Ebola guidelines for mortuary work-
ers on September 29, 2014. They are the most strin-
gent guidelines I’ve ever seen, easily outpacing HIV
and CJD guidelines released by the CDC and World
Health Organization (WHO).
There are good reasons for this. A person can carry
HIV or CJD for twenty years before it mutates. The
Ebola Virus becomes active in 21 days. It can then
kill within days. The Ebola Virus itself will survive
for around 24 hours on contaminated surfaces. The
limiting factor here is that the Ebola Virus is only
active at the end of the disease. By that time, the in-
fected individual is infirmed in a hospital or home.
You would never expect to find Ebola contamination
at a shopping mall.
While the CDC issues guidelines, OSHA considers
such recommendations as requirements under Arti-
cle 5 of the General Duty Clause. A funeral home
can and probably will be fined for not meeting or
putting the guidelines in place. My guess is that it
will trigger some infections. I strongly urge all funer-
al homes to include the guidelines in their 2015 an-
nual training. I would urge that they list the guide-
lines as a training guideline and have all potentially
exposed employees sign off on the training.
Here is the heart of the guidelines. I am assuming
that this is a hospital case and wrapping of the re-
mains has already taken place.
Do not perform embalming. The risks of occupa-
tional exposure to Ebola virus while embalming
outweighs its advantages; therefore, bodies in-
fected with Ebola virus should not be embalmed.
Do not open the body bags.
• Do not remove remains from the body bags.
Bagged bodies should be placed directly into a
hermetically sealed casket.
• Mortuary care personnel should wear PPE (sur-
gical scrub suit, surgical cap, impervious gown
with full sleeve coverage, eye protection (e.g., face
shield, goggles), facemask, shoe covers, and dou-
ble surgical gloves) when handling the bagged re-
mains.
• In the event of leakage of fluids from the body
bag, thoroughly clean and decontaminate areas
of the environment with EPA-registered disin-
fectants which can kill a broad range of viruses
in accordance with label instructions. Reusable
equipment should be cleaned and disinfected ac-
cording to standard procedures.
Ebola Virus Disease: Outbreak, Epidemic
or Catastrophe?
By Shun Newbern, MS, CFSP
Ebola Virus
In August 2014 I had the honor of addressing attendees in
an education session at the
National Funeral Directors and
Morticians Association
convention in Dallas, TX about the Eb-
ola Virus Disease. At that time there were two Americans be-
ing treated for the virus in Atlanta but no cases had been di-
If you were to handle a deceased that has contracted the Eb-
ola virus would you or your staff know what to do? It is im-
portant to note that this virus is nothing that modern West-
ern civilization has seen. It cannot be easily compared to the
Acquired Immune Deficiency Syndrome (AIDS/HIV). We
can’t help but reflect back on the high days (in the begin-
ning) of the AIDS and HIV epidemic when funeral homes
and embalmers charged extra to handle such decedents and
only offered cremation. Do you remember those days? Many
were unprepared, uneducated and lacked compassion. I can
recall working in San Francisco - fresh out of mortuary school
in 1992 - transporting twelve AIDS cases to mortuaries in a
24 hour period! This volume and the personal loss of relatives
and friends to this virus helped us to get to the needed level of
care through proper training, education, and understanding.
Here are a few of my recommendations for handling remains
with EbolaVirus Disease.The virus can be transmitted through
gnosed in the United States.
s I write this article today,
here is one case in Dallas and
ther possible persons being
hecked, cleared or possibly
reated for symptoms.
The Ebola Virus strain has
een around since the mid
70’s, limited to mostly West
frican villages. As villagers
ollow the custom of wash-
ng and bathing their own
ead, family members who
re not properly protected
ecome infected. In many
nstances, hundreds may die
lacerations, punctures, splash-
es of blood and body fluids, in-
struments and on equipment.
Persons handling these cases
should be properly trained in the
use of universal precautions and
personal protective equipment
(PPE), not limited to a biohaz-
ard contagious jump suit. De-
pending on the role of the person
– removal, transporting or prep-
aration - the PPE’s may be lim-
ited to shoe covers, gown, face
shield and gloves. Regarding the
gloves, using the double up rule
and puncture resistant gloves is
Ebola in West and Central Africa
as an entire family or infected village is wiped out.
This new strain began inWest Africa in December 2013. It
is horrific and a health worker’s and embalmer’s worst night-
mare. As of today the known case rate is nearly 7500 and the
known death rate is nearly 3400 (none in the United States).
What is different is that this strain has spread beyond Guin-
ea, Liberia and Sierra Leone to Nigeria and other countries.
The danger that this may become an epidemic or pandem-
ic is due to the fact that we have become a mobile society
and travel more. Embargos have been lifted and mankind
is traveling to and from various continents. Currently, in
their attempt to be politically correct, the United States has
no traveling restrictions for certain African countries. Sadly,
recommended. There should be very limited movement and
handling; including no autopsy. Transporting should be done
in a leak-proof, puncture resistant disaster pouch.
At death when the disease is advanced most cases will have
viral hemorrhagic fever (internal bleeding) causing blood
leakage from the eyes and mouth. In my opinion these cases
should not be embalmed. Place the deceased in refrigeration
until the time of disposition. We must limit how often this
type of case is moved and handled. This is not an airborne
virus, but a bloodborne virus and the occupational exposure
risks are very, very high as we are still learning about it. In
Africa, once the body is properly wrapped it is placed in a
hermetically sealed or gasketed casket.
If there is a sign of leakage from the body bag or pouch,
the area or vehicle should be thoroughly cleaned and dis-
infected. Cleaning after this type of case requires the use of
the highest standards. You may prefer to call in a certified li-
censed biohazard team to handle this.
The catastrophe with Ebola in the mind-set of many fu-
neral professionals is that Ebola is nothing to worry about.
Whether we see two or 200 deaths in the United States from
Ebola, if we approach this virus with a laissez-faire attitude
rather than a proactive attitude, it could indeed be a huge
catastrophe for funeral professionals and the families that we
serve. I must confess, that years ago I stood with many oth-
ers who acknowledged that the H1N1 (the swine flu) would
be the virus to remember.
I have embalmed and handled almost every type of con-
dition under the sun and this is one that I will choose not
to embalm due to the high risks that are involved. There are
many ways to memorialize a person without embalming.
I encourage everyone to
isease Con-
trol and Prevention websit
equent up-
dates, safe handling guida
la and any
other disease. I have recommended this website to embalmers
for many years as it addresses the occupational issues that we
see in the embalming room.
Shun Newbern, MS, CFSP is an embalmer, funeral director and
owner of Metropolitan Mortuary, Riverside, CA. In addition, he
is a national speaker, consultant and publisher on relatable issues.
He can be contacted by visitin
hunnewbern@aol.com
the vaccine that was used
on the two American
missionaries whom we
prayed for as they were
being treated in Atlanta
is gone – there isn’t any
more left to treat others.