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and final disposition of cremation (preferred) or immediate burial. Many other communicable diseases are less serious and less common; however, the funeral service professional should be keenly aware of what is out there. Each of the following are generally found in a healthcare setting, which is where many dead human bodies are transported from before they arrive at the funeral home, and where many funeral service professionals spend a lot of time making removals of dead human bodies. • Clostridium difficile – a bacteria that causes a healthcare-associated infection, which people getting medical care can catch in the hospital or other facility. This bacteria was estimated to have caused almost half a million infections in the United States in 2011, with 29,000 of those dying within 30 days of initial diagnosis.92 Older adults receiving medical care are particularly vulnerable. • Klebsiella – a type of Gram-negative bacteria that can cause different types of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis.93 Klebsiella bacteria are normally found in the human intestines where they are natural flora (do not cause disease) and in human feces.94 Klebsiella bacteria have recently developed antimicrobial resistance, and commonly occur in healthcare settings among sick patients being treated for other conditions.95 Healthy people usually do not get Klebsiella infections, and the bacteria is spread through person-to-person contact.96 • Acinetorbacter baumannii – another bacteria that causes a healthcare-associated infection. These infections typically occur in intensive care units and healthcare settings housing very ill patients and rarely occur outside of healthcare settings.97 The bacteria is spread through person-to-person contact or contact with contaminated surfaces.98 • Vancomycin-resisitant Enterococci (VRE) – specific types of antimicrobial-resistant bacteria that are resistant to vancomycin, which is the drug most often used to treat infections cause by enterococci.99 Enterococci are bacteria that are Exam Question 7. The Centers for Disease Control and Prevention (CDC) advises that dead human bodies known to be infected with should not be washed or cleaned, should not be embalmed, and medical devices or equipment (such as IVs) should not be removed. The body should be cremated or buried as soon as possible in a metal casket. a. Ebola b. HIV/AIDS c. MRSA d. Zika 82-85 CDC, Zika Virus 86-87 CDC, Ebola 88 Davidson & Benjamin, 656 89-91 CDC, Ebola 92-99 CDC, Healthcare-associated Infections 8 | Funeral Service Academy COMMUNICABLE DISEASE AND FUNERAL PROFESSIONALS normally present in the human intestines and in the female genital tract and can sometimes cause infections.100 Most vancomycin-resistant enterococci infections occur in hospitals, making it a healthcare-associated infection.101 • Vancomycin-intermediate Staphylococcus aureus (VISA) and Vancomycin-resistant Staphylococcus aureus (VRSA) – another healthcare-associated infection, these Staphylococcus aureus bacteria are resistant to vancomycin.102 However, as of October, 2010, all VRSA isolates have been susceptible to other FDA-approved drugs.103 • Pseudomonas aeruginosa – these bacteria generally cause infections in people in the hospital and/or with weakened immune systems.104 Infections of the blood, pneumonia, and infections following surgery can lead to severe illness and death in these people.105 Sterilization Techniques in the Embalming and Preparation Room It is vital that instruments, equipment, and services be properly sterilized after each embalming, regardless of whether or not the decedent had a communicable disease or not. If a communicable disease was present, it is of particular importance. As will be discussed below as part of the OSHA Bloodborne Pathogens Standard, only products or chemicals that are listed by the EPA or FDA as registered disinfectants or sterilants may be used to decontaminate surfaces or instruments that have been contaminated with blood or other potentially infectious materials.106 Always check the label to be sure this is the case. The effectiveness of these products and chemicals is governed by strict adherence to the instructions on the label,107 so be sure to always follow all instructions on the label exactly as they are to ensure proper disinfecting or sterilizing. A mixture of 1 part sodium hypochlorite, also known as household bleach, to 10 to 100 parts water is considered adequate for surfaces.108 All surfaces in the embalming room should be disinfected in this way after an embalming or any preparation of a dead human body. This solution must be made up daily to be effective. Also, it should be noted that bleach is always dangerous in the embalming room if formaldehyde chemicals are present as the mixture produces a deadly gas. Use cautiously. All instruments MUST be disinfected with either EPA or FDA approved cold sterilants after each use.109 Approved cold sterilants might be something like Cidex® or Wavicide Disinfectant® (formerly known as DSD). Again, the label must indicate that it is registered with the EPA or FDA. Cleaning products such as soap and water, Lysol®, Mr. Clean®, Scrubbing Bubbles®, and similar products ARE NOT ACCEPTABLE for disinfecting
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