Once a body has been transferred from the cot to the preparation table, secondary disinfection procedures should be implemented. The body should be disinfected and washed. Special care should be applied to all orifices and lesions. Also, special care should be applied to the mouth. Spray and swab the mouth, remove and clean dentures, then re-spray and swab the mouth until clear of mucus and debris. Pour two or three ounces of disinfectant down the trachea to disinfect internal passages of the lungs.
Apply a liberal amount of Vaseline to the dentures, replace the dentures and proceed with the mouth closure. Vaseline creates a protective barrier over the disinfectant when it is applied within the oral cavities inner membrane to prevent dehydration of the mouth region.
If mouth closure is secured prior to disinfectant treatment of the bronchial tree of the lungs, disinfectant should be applied by way of the nose. At the time of death the nose has a pinched appearance due to facies hippocratica which denotes impending death.
In order to correct the pinched appearance, small pieces of cotton saturated with disinfectant, insecticide and Vaseline should be packed loosely in the nostrils to create natural form prior to injecting embalming fluid. This reinforces disinfection/deinfestation and provides a barrier against vermin like maggots. An earloop mask should be applied to control expulsion of air during manipulative movement of the body. During the embalming, a low suds disinfectant soap should be used concurrently with the massage process using disposable towels or sponges. This is essential to internal chemical distribution and disinfection and commonly known as concurrent disinfection. The sponge is one of the most dangerous reservoir mediums for microbial growth in the home (kitchen) and preparation room.
The nostrils of the nose should be sprayed with a disinfectant, cleaned and treated with Vaseline to prevent dehydration. The eyes should be closed and the eye lids should abut at the lower third of the eye socket and secured using Vaseline. Vaseline should be used to close the inner canthus to prevent dehydration. A small piece of cotton should be saturated with Vaseline and placed behind the earlobe to prevent curling of the lobe. If the earlobes are not properly positioned, earrings may not be observed due to the head positioning on the pillow.
When the embalming process has been completed, the body is rewashed, rinsed and disinfected. This is the final phase referred to as terminal disinfection. All orifices are packed with cotton saturated with disinfectant then followed with final packing of dry cotton. The body should then be sprayed and allowed to air dry creating a residual disinfectant barrier.
Terminal disinfection includes the cleaning and disinfection of instruments, the embalming machine, aspirator and embalming table. The floors should be swept of debris and disinfected. The walls and counters should be cleaned with a disinfectant and allowed to air dry leaving an invisible residual barrier against bacteria, fungi and viruses. For areas of the preparation room that may be inaccessible, steaming followed by fogging with disinfectant is recommended.
Instruments should be scrubbed with a hand brush, not a sponge, rinsed and dried prior to being placed in a cold chemical disinfectant. Scalpel blades should be removed from handles and discarded in a safe manner (special sharps container). Prior to placement of hinged sharps (scissors, hemostats) in a sterilant, instruments should be opened to allow chemical contact. Other instruments should be treated in the same manner after each embalming procedure to assure practitioner safety as well as to prevent possible cross contamination.
Self-protection has been lackadaisical and, in most cases, medical conditions have not been associated with individual health problems that can affect the practitioner. This attitude exists even now and will be a major concern in the future. Newly emerging diseases and mutating existing diseases (superbugs) are becoming plagues.
Education is essential to everyone who deals with our practices within the death industry. Sometimes only seminars provide information as to the potential hygienic hazards. A large segment of support personnel are part time and have had no formal introduction to the hygienic hazards. Part 8 will deal with infection control.