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Safety and Health Administration (OSHA)’s Bloodborne Pathogen Rule, all funeral home employees whose job description requires them to come in contact with body fluids or items soiled with body fluids are to be given the Hepatitis B vaccine at no cost to the employee.33 The employee may choose not to receive the vaccination. If so, he or she must sign a declination form.34 However, the employee must first go through appropriate training regarding Hepatitis B and the efficacy, safety, method of administration, and benefits of the Hepatitis B vaccination, and must indicate that they understand that the vaccine is provide free of charge.35 If any employee that initially signed the declination form decides at any point while still employed at the funeral home and while still exposed to body fluids or items soiled with body fluids that they want the vaccine, they can request it and the employer must provide it at no cost to the employee.36 Hepatitis C Hepatitis C is an inflammatory disease of the liver caused by the Hepatitis C virus.37 It is spread through direct contact with blood or other body fluids.38 Most cases of Hepatitis C are transmitted through the use of illegal injected drugs.39 There is no vaccine for Hepatitis C. There are, however, current drugs that promise to “cure” those with Hepatitis C, or clear the virus from the body.40 The risk for Hepatitis C infection after a needlestick or sharps injury is thought to be only about 3%. HIV The human immunodeficiency virus (HIV) weakens a person’s immune system by destroying important cells that fight disease and infection.41 It is the virus that causes AIDS (acquired immunodeficiency syndrome). There is no effective cure for HIV. In the United States, HIV is commonly transmitted from person to person through sexual intercourse and sharing needles or syringes.42 HIV can also be transmitted from mother to child during pregnancy, birth, or breastfeeding, as well as by being stuck with an HIV-contaminated needle or other sharp object.43 This is how funeral service professionals can be contaminated in the workplace: According to the Centers for Disease Control and Prevention (CDC), HIV can live in a used needle up to 42 days depending on temperature and other factors.44 Scientists estimate that the risk of HIV infection from being stuck with a needle used on an HIVinfected person is less than 1%.45 However, HIV can potentially also be dangerous to funeral service professionals because of its ability to survive after the death of the infected body. Infectious HIV has been reported in the pleural fluid, pericardial fluid, and blood of infected dead human remains after storage at 2 degrees Celsius for up to 16.5 days post mortem.46 Viable HIV was also recovered from bone fragments, brain, bone marrow, spleen, and lymph nodes from an infected dead human body with AIDS at autopsy six days after death.47 To keep the risk of infection low, funeral service professionals handing infected dead human remains should use Universal Precautions. Appropriate personal protective equipment should be utilized, and instruments and surfaces should be properly sterilized and disinfected post-embalming or preparation. (For more information on Universal Precautions and sterilization methods, please see the appropriate sections later in the course.) Two common bacterial pathogens that may be potentially contracted by funeral service professionals through mucocutaneous contamination (contact or droplet transmission) are Methicillin-Resistant Staphylococcus aureus (MRSA) and Streptococcus pyogenes. 48 Exam Questions 3. Infectious HIV has been reported in the pleural fluid, pericardial fluid, and blood of infected dead human remains after storage at 2 degrees Celsius for up to ________ post mortem. a. 24 hours b. 48 hours c. 16.5 days d. 3 weeks 4. Two common bacterial pathogens that may be potentially contracted by funeral service professionals through are Methicillin-Resistant Staphylococcus aureus (MRSA) and Streptococcus pyogenes. a. Airborne vectors b. Gastrointestinal contamination c. Mucocutaneous contamination d. Prion transmission 32 Hart & Loeffler, 221 33-36 OSHA 3128 37-39 Mullins, 399 40 Liver Foundation, Can Hepatitis C Be Cured? 41-45 CDC, HIV/AIDS 46 Douceron, Deforges, Gherandi, Sobel & Patriot 47 Nyberg, Suni & Haltia 48 Davisdson & Benjamin Jr., 655 COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS Funeral Service Academy | 5 Methicillin-Resistant Staphylococcus aureus (MRSA) Methicillin-resistant Staphylococcus aureus, or MRSA, has established itself as a community-acquired infectious agent with increasing frequency. MRSA is a type of staph bacteria that is resistant to many antibiotics.49 In a healthcare setting, such as a hospital or a nursing home, MRSA can cause severe problems. These problems include bloodstream infections, pneumonia, and surgical site infections.50 If MRSA is not treated quickly, these infections can cause sepsis and death.51 MRSA is usually spread by direct contact with an infected wound.52 To know if MRSA is the cause of an infection, laboratory cultures of the bacteria must be performed.53 Because of the prevalence of MRSA in the population – studies show that two in 100 people carry MRSA54 – the funeral professional has a potential risk of exposure from the remains of individuals who
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