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syndrome (SARS) The virus responsible for severe acute respiratory syndrome, or SARS, is the coronavirus.74 This virus seems to spread quickly and can be very dangerous. While there have not been any known cases of SARS reported anywhere in the world since 2004,75 it is best if funeral service professionals know of the risk of airborne infectious agents and this is one to note. Another important infectious disease of concern to funeral service professionals is the prion transmitted Creutzfeldt-Jakob disease (CJD). Creutzfeldt-Jakob disease (CJD) The mode of transmission of prions is not completely understood, with 85% of patients showing no recognizable pattern of transmission, but it is known that iatrogenic CJD has been passed from cadavers to recipients of human growth hormone, dura mater, and corneal grafts as well as between living patients following use of contaminated neurosurgical equipment.76 Because prions are not destroyed by either formaldehyde or gluteraldehyde and because their concentration is highest in cerebrospinal fluid and nervous system tissue, embalming is not recommended for autopsied or traumatized bodies.77 If it must be done, the guidelines set forth by the World Health Organization should be utilized. It is strongly recommended that disposable instruments, masks, gowns, and puncture-resistant gloves be used whenever possible. Bodies of autopsied CJD patients should be placed on a waterproof sheet to collect all fluids.78 The entire body should be washed with bleach, rinsed, and sanitized before dressing.79 All collected fluids should be held in a suitable container and later treated (see below). All work surfaces and instruments should be disinfected after a suspected or confirmed CJD dead human body was treated. The surfaces can be disinfected by flooding with undiluted bleach. All collected fluids should be disinfected by adding 40 grams of sodium hydroxide pellets per liter of collected fluid, with the mixture being stirred after a few minutes and care taken to avoid spillage.80 It should be left undisturbed for at least one hour, and then disposed of like other mortuary waste.81 Embalming a body that has not been autopsied should be done in the usual way, with Universal Precautions utilized. Other Communicable Diseases of Current Concern There are some communicable diseases that have been of concern recently in the healthcare world, including the Zika virus and Ebola. For this reason, funeral service professionals should be aware of their existence and know a bit about their transmission and the disease process. Exam Question 6. Per a Johns Hopkins University study, funeral home employees who engaged in embalming were to have a positive tuberculin skin test when compared to the funeral home employees who did not embalm bodies. a. Five times as likely b. Just as likely c. Not as likely d. Twice as likely 68-70 Mayer, 50 71-73 CDC, Tuberculosis 74-75 CDC, Severe Acute Respiratory Syndrome 76-77 Davidson & Benjamin Jr., 656 78-81 CDC, Information for Funeral and Crematory Practitioners COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS Funeral Service Academy | 7 Zika Virus The Zika Virus has caused concern lately, specifically in the southeastern United States and among travelers coming back into the United States from Central and South American and the Caribbean. Zika is spread mostly by the bite of an infected Aedes species mosquito.82 Local mosquito-borne Zika virus transmission has been reported in the continental United States.83 Zika can also be passed from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects.84 Sexual transmission, and very likely blood transfusion transmission, is also possible with Zika.85 There is currently no vaccine available for Zika. Since Zika is not likely to cause death, except maybe in immunosuppressed individuals and the elderly, funeral service employees are not likely to encounter this virus much as an occupational hazard. Whether or not it is known if a dead human body is infected with Zika, it is best to use Universal Precautions. Ebola Ebola, although rare, has proved to be a relevant contagious disease with well-publicized recent cases here in the United States. The Ebola virus can be detected throughout the bodies of patients who die of the disease, and can be transmitted in postmortem care settings.86 Transmission of the virus is by laceration and puncture with contaminated instruments used during postmortem care, through direct handling of human remains without recommended PPE, and through splashes of blood or other body fluids such as urine, saliva, feces, or vomit to unprotected mucosa such as eyes, nose, or mouth during postmortem care.87 Aerosolization cannot be definitely excluded as a mode of transmission.88 The CDC recommends close collaboration with public health officials in the state or local jurisdiction to safely handle and care for these individuals.89 The CDC also advises that these dead human bodies should not be washed or cleaned, should not be embalmed, and medical devices or equipment (such as IVs) should not be removed.90 The body should be cremated or buried as soon as possible in a metal casket.91 Basically, the funeral service professional will be responsible for removal from the hospital, storage as needed at the funeral facility,
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