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died in a health care facility or another setting.55 Funeral service professionals often must go into hospitals and nursing homes to remove the dead human body and take it to the nursing home; in doing so, removal technicians may come into contact with an infected wound. Likewise, once at the funeral home, the embalmer or crematory technician may come into contact with an infected wound. If a bacteria culture was performed on the deceased patient, the hospital or nursing home will generally let the funeral service professionals know that the deceased patient is infected with MRSA; nevertheless, funeral service professionals should be acutely aware of any infected wounds, regardless of whether it is known if the dead human body was infected with MRSA or not. Streptococcus pyogenes Group A Streptococcus, or Streptococcus pyogenes, can cause both noninvasive and invasive diseases such as strep throat, scarlet fever, and post-strep glomerulonepheritis.56 It is very common, and something that funeral service employees should be aware of as a bloodborne pathogen. Group A Streptococcus has been shown to survive in dead human bodies that were victims of invasive disease, presenting a serious infectious risk to the funeral professionals.57 It may be transmitted by direct contact and as a result of direct inoculation following even minor nicks to the skin during an autopsy or embalming.58 A gastrointestinal organism that funeral service professionals may come into contact with is nontyphoidal Salmonella. 59 Non-typhoidal Salmonella According to the World Health Organization, person-to-person transmission of the Salmonella bacteria occurs through the fecal-oral route.60 Upon manipulating dead human bodies, funeral service professionals, particularly embalmers, can come into direct contact with leaking fecal material.61 This could lead to transmission of the bacteria via the fecal-oral route.62 Airborne infectious agents that funeral service professionals should be aware of are Mycobacterium tuberculosis and the virus responsible for severe acute respiratory syndrome (SARS). 63 Mycobacterium tuberculosis Tuberculosis, often referred to as TB, is caused by the Mycobacterium tuberculosis bacteria spread through the air from one person to another. The tuberculosis bacteria are put into the air when a person with tuberculosis of the lungs or throat coughs, speaks, or sings.64 If people nearby breathe in the bacteria, they could potentially become infected. Once the bacteria is breathed into the lungs, it begins to grow.65 It can then move through the blood to other parts of the body, including the kidney, spine, and brain. The bacteria in the lungs and throat can be infectious, but the bacteria in other parts of the body, such as the kidney or the spine, is usually not infectious.66 A Centers for Disease Control and Prevention (CDC) report concluded that funeral service professionals, particularly those who engage in embalming, have an elevated risk of contracting tuberculosis as a result of their contact with dead human bodies.67 Likewise, a Johns Hopkins University Exam Question 5. Upon manipulating dead human bodies, funeral service professionals, particularly embalmers, can come into direct contact with leaking fecal material. This could lead to transmission of ________ via the fecal-oral route. a. Non-typhoidal Salmonella b. SARS c. Zika d. None of the above 49-54 CDC, MRSA 55 Davidson & Benjamin Jr., 656 56 CDC, Group A Streptococcus 57-59 Davidson & Benjamin Jr., 656 60 WHO, Salmonella 61-63 Davidson & Benjamin Jr., 656 64-66 CDC, Tuberculosis 67 Mayer, 50 6 | Funeral Service Academy COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS study concluded that funeral home employees who worked as embalmers had a greater exposure risk to tuberculosis than funeral home employees who did not embalm dead human bodies.68 This particular study found that 101 out of 864 (or 11.7%) funeral home employees who volunteered to be tested reacted to the tuberculin skin test.69 From here, it was determined that the funeral home employees who engaged in embalming were twice as likely to have a positive tuberculin skin test when compared to the funeral home employees who did not embalm bodies.70 While there is a vaccine available for tuberculosis, it is not widely used in the United States and does not always protect people from getting tuberculosis.71 The tuberculosis vaccine should be considered for only very select people who meet specific criteria and in consultation with a tuberculosis expert. Health care workers considering this option should be counseled regarding the risks and benefits associated with both the tuberculosis vaccination and the treatment of latent tuberculosis infection.72 Funeral service professionals are not generally advised to receive the tuberculosis vaccination. However, it is often recommended that a TB skin test be administered prior to beginning work in a health care setting, including in a funeral home. That way, if a person is suspected of being infected with bacteria while on the job, the time period can be narrowed down should the individual test positive for being infected with the bacteria. This skin test does not indicate the progression of the tuberculosis disease, only the presence of the Myobacterium tuberculosis bacteria.73 Severe acute respiratory
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