Care of the deceased patient

VHF viruses can be detected throughout the body after death. A such, VHF can be transmitted by laceration and puncture with contaminated instruments used during postmortem care, through direct handling of human remains without appropriate PPE, and from splashes of blood or other body fluids to unprotected mucosa which can occur during care of the deceased.

The following are important principles of care for people who have died due to VHF:

• Only personnel trained in handling infected human remains, and wearing PPE, should touch or move any VHF-infected remains or suspected VHF-infected remains.
• Handling of human remains should be kept to a minimum.
• Autopsies should not be performed on patients who die with VHF. An autopsy should only be done if directed by the coroner and following discussion with the department’s Communicable Disease section and the Victorian Institute of Forensic Medicine.
• When a deceased person has suspected VHF, but not confirmed, any post-mortem procedures should be delayed until testing for VHF is completed. Handle the body as if they have VHF, until confirmed otherwise.

Preparation of the deceased patient

In preparing the deceased patient, remember:

• Use Level 1 (Dry) PPE when handling the deceased.
• Do not remove intravascular devices or other invasive medical devices.
• Do not wash or clean the deceased.
• Place the body into a leak-proof body bag, zipper it closed, then place inside a second leak-proof body bag zippered closed.
• Once the body has been placed inside the first bag, the HCWs handling the body should change the outer layer of their gloves and apron. Disinfect the inner gloves before preplacing the second pair.
• If the zipper does not ‘seal’ the bag to make it leak-proof, consider using tape to seal the zipper.
• Take care that the bags are protected from punctures, either from the inside (for example, from medical devices left attached) or from external objects.
• Clearly label the outside bag with:
  • the name of the deceased
  • ‘Infectious Disease – Group A – Handle with Care’.
• Prior to transporting to the mortuary, use detergent/disinfectant to decontaminate the outer surface of the body bag.

Mortuary care

At the mortuary:

• do not open the body bags or remove the remains from the bag. Bagged remains should be placed directly into a casket or coffin, and sealed
• mortuary care personnel should wear Level 1 (Dry) PPE; single-use gloves (two pairs to be worn), a fluid-resistant or impermeable gown and surgical hood or a coverall, eye protection (goggles or face shield), and leg and shoe covers when handling the bagged remains
• in the event of leakage of fluids from the body bag, thoroughly clean and decontaminate areas of the environment (see Blood and body fluid spills on Environmental cleaning).

Handoff to funeral services

For funeral services, remember:

• Ensure a localised procedure is in place for transferring remains to funeral homes.
• Consideration could be given to transporting the body directly from the deceased’s room to a parked funeral vehicle, thereby avoiding the potential for contaminating another area in the facility.
• There should be no viewing of the deceased by family members. The body bags and casket/coffin should remain sealed.
• Funeral home staff must be trained and equipped with PPE.
• Avoid delays to minimise risk of decomposition and fluid leakage.
• Transportation of remains that contain VHF viruses should be minimised.