A quote from the embalming text, The Principles and Practice of Embalming by Frederick and Strub concerning the attitude of embalmers is summed up in one paragraph. “A few operators attempt to display their “bravery” by refusing to take adequate precautions against infection. Such men are stupid rather than brave. Rubber gloves, an impervious apron, chemical disinfectants, an instrument sterilizer—all are the cheapest form of health insurance the embalmer can employ.” (1958-1982)

  If proper sanitation procedures are carried out in the preparation room, potential hazardous materials will not be tracked through the funeral establishment. This means clothing and shoes worn in the preparation or dressing of a body can be a source of cross contamination. This would not only affect the funeral home employees but the public whom we serve.

  Place the deceased in an airborne isolation room (preparation room). These preparation rooms should have instruments to monitor negative air pressure in relation to corridor, with 6 to 12 air changes per hour. These exhaust air directly outside or have air re-circulated by a high efficiency particulate air (HEPA) filter. A separate air ventilation system to control potential airborne threats is a basic consideration in design and the maintaining of the preparation room. Filters should be cleaned and sprayed with disinfectant. Restrooms need to be cleaned daily with lavatory cleaners and a disinfectant. A daily cleaning of anything the public uses such as; door knobs, telephones and passenger vehicles.

  When a family loses a loved one, they enter into a grief process. This is a form of stress which is different in every person. One result is the breakdown of the immune system which makes individuals more susceptible to opportunistic organisms. The immune system also has a direct influence on organic changes, which occur within the body, creating a chemical imbalance that brings about disease processes. What affects the mind affects the body and what affects the body affects the mind.

  All of the preceding would have a direct influence on handling traumatic deaths and/or those which have been autopsied. Accidents bring about many situations in addition to those associated with the average or communicable diseases related to death. Many can be highly infectious due to the release of opportunistic organisms not normally an external concern because of containment including: Trauma–a wound or injury, whether physical or psychic; Autopsy–post-mortem examination of a body to determine the cause of death. A Y-shaped incision, inverted Y incision and/or vertical incision are used for restricted thoracic or abdominal autopsy. A horizontal incision around the skull is used for a cranial autopsy. A vertical incision is used for a spinal autopsy (full or partial); Communicable Disease– capable of being transmitted from one person to another; Infectious Disease–invasion and multiplication of microorganisms in the body tissues. Infectious diseases are not always communicable, but communicable diseases are always infectious.

   The at risk hosts includes:

  Portal of Host Entry. Skin or mucous membrane, respiratory tract, alimentary tract, body openings, natural and/or artificial abrasions, cuts, lacerations or wounds. Infectious Agents: bacteria, fungi (mold and yeasts), viruses, rickettsiae and protozoa.

  Proper Disposable Barrier Attire. Proper barrier attire; Aseptic technique(s); scrubbing, barrier cream and gloves; disinfection, decontamination and disinfestations. Personal Health: Practices and policies.

  Modes of Transmitting the Infectious Agent(s): direct contact (touch, aerosol/droplet) and indirect contact (air, contaminated surfaces and objects (formites), body, fluids, exudates, insects etc.) Reservoirs of Infectious Agents in the Work Area: body (remains) equipment: hydro aspirators, electric aspirators, trocars, sharps, instruments, air contamination, solid and liquid wastes, surfaces, linen and bandages.

  Environmental controls include: steamers, sprayers, foggers, air conditioners, exhaust fans, disinjector, Biochem liquid waste, filtration system, and compactor or crusher.

  Proper Barrier Protection includes: hand washing (scrub); barrier cream; gloves, double gloving; paper goods (towels, sheets etc.); air purifying equipment; effective air handling system (minimum 12 times per hour); Disinjector;  effective fluid biochem waste system; practice – primary, concurrent and terminal disinfection; waste containers; visceral bags; body pouches, sharps container; compactors and crushers.

  Part 9 will continue with personnel barrier protection and chemical disinfection.