Management of Cadaver
Policy
Darren Stewart; Matron, Clevedon
Hospital, Clevedon
Author(s): Sue Hinchley, Locality Manager,
Community Services, District
Nurses, East End Court
Lead Clinician (if Matron, Clevedon Hospital,
appropriate): Clevedon
In consultation with: Control of Infection Committee
Health and Safety Committee
Control of Infection Policy
Incident Reporting Policy
To be read in Risk Management Policy
association with: Dignity in Care Policy
Waste Management Policy
Verification of Death Policy
Ratified by: Professional Executive Committee
Issue/Ratification date:
Review date:
If you require this document in a different format, please
telephone the Corporate Manager on 01275 546717
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Contents
1. Introduction page 5
2. Purpose page 6
3. Roles and Responsibilities page 6
4. Definition page 8
5. Legal Position page 8
6. Spread of Infection page 9
• Table 1 page 10 - 11
7. Communication page 12
8. Laying Out page 13
9. Body bags page 14
10. Mortuary page 14
11. Dignity in Care page 14
12. Audit page 15
13. Key Performance indicators page 15
14. Associated Policies page 15
15. References page 15
16. Appendix 1 page 16 - 17
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North Somerset PCT
Document status: Current
Version Date Comments/Consultation
2 17/09/2009
Date
Authors Name:
If you need further copies of this document please telephone …………on
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If you need this document in a different format please telephone ………………… on
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1. INTRODUCTION
1.1 The Health Act 2008 – Code of Practice for the Prevention and Control of Health
Care Associated Infection, places a duty upon NHS Trusts to have in place
appropriate management systems for infection prevention and control.
Appropriate procedures for the care of cadavers’ forms part of this process.
This policy must be implemented, audited, reviewed and updated as necessary
to ensure compliance with the Health Act.
North Somerset Primary Care Trust is also required to meet National Health
Care Standards (Safety Domain) including C4a, stating:
Healthcare organisations keep patients, staff and visitors safe by having systems
to ensure that the risk of healthcare acquired infection to patients is reduced …
1.3 There are approximately 600,000 deaths per year in the United Kingdom and
about two-thirds occur in hospital and less than 10% is associated with a known
or suspected infection. Final disposal of the body is usually 7 – 10 days after
death.
1.4 Opinion differs among healthcare workers on the management of bodies
associated with infection. The measures taken to control the perceived hazards
can occasionally be insensitively applied. The indiscriminate use of body bags
may cause needless anxiety for the bereaved family, friends and also among
staff.
1.5 Grieving is essential for the healing process and in some religions and cultures it
may require special rituals including washing the body and kissing. Not allowing
the last rites to be performed before placing the body in a plastic body bag may
cause deep resentment. Relatives must be asked about their wishes before
body preparation is commenced.
1.6 The safety of the persons who may come into contact with a body associated
with an infection must always be given high priority and this is covered by
Parliament Acts and by Regulations made under these Acts. There should be a
balance though between what is required for safety and the sensitivity and
dignity of the bereaved.
1.7 Not all cases of infection will have been identified before death and for this
reason, thus infection prevention standards must be adopted for the handling of
all bodies.
1.8 This policy is adapted from the Health Protection Agency North West Policy
(2004 – 2006) and the Health and Safety Executive document Controlling the
Risks of Infection at Work
1.9 This policy applies to all staff employed by North Somerset Primary Care Trust,
including students.
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2. PURPOSE
2.1 The purpose of this policy is to ensure safe management of Cadavers within
North Somerset Primary Care Trust. The policy must be used in conjunction
with other policies of North Somerset Primary Care Trust.
The Trust is committed to ensuring the health, safety and welfare of its
employees and contractors who are involved in the handling of cadavers. The
policy applies to all employees of the Trust. It is intended to enable the Trust to
safeguard employees and all other persons during the handling, transfer and
storage of cadavers. The Trust’s main objectives with regard to cadaver
management are to:
• Ensure that all cadavers are treated approximately within instruments of
statue such as the Health and Safety at Work Act 1974 and the
Environmental Protection Act 1990, and other such guidances that will reflect
statutory requirements, best price and Trust procedures.
• Ensure that all cadavers are correctly prepared, moved to the Hospital
Mortuary, if required, or taken directly by the undertakers of the relatives
choice, in accordance with the statutory and Trust procedural requirements.
• Where the patient has died in their home the relative will arrange to move the
cadaver directly to undertakers of their choice.
• Monitor contractor compliance with statutory requirements and Trust
standards for handling of cadavers.
• Ensure that records held in relation to cadaver management are kept in
accordance with statutory requirements.
• Monitor the arrangements for the collection, removal from hospital, storage
and final discharge from Trust facilities for all cadavers.
• Provide staff with suitable information, instruction and training to ensure that
the Trust’s cadaver management policy and procedures are understood and
following.
• Provide staff with appropriate personal protective clothing for handling
cadavers.
• Ensure that equipment used for moving and storage of cadavers complies
with statutory and Trust policy requirements.
3. ROLE AND RESPONSIBILITIES
3.1 Chief Executive
The Chief Executive has overall responsibility for the strategic and operational
management of the Primary Care Trust, including ensuring that Trust policies,
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such as the Cadaver policy, comply with all legal, statutory and good practice
guidance requirements.
3.2 Director of Infection Prevention and Control
The Director of Infection Prevention and Control, currently held by The Director
of Nursing, oversees North Somerset Primary Care Trusts development and
implementation of infection prevention and control policies in accordance with
the Infection Control Strategy. The Director of Infection Prevention and Control
chairs the Control of Infection Committee, which will formally review and approve
this policy and reports through the Governance Committee directly to the Chief
Executive, and ultimately to the Board.
3.3 Directors
All Directors are responsible for the implementation of this policy into practice
and taking appropriate action should any breach of this policy arise.
3.4 Hospital and Community Managers
Hospital and Community Managers, in conjunction with the Clinical Matrons and
Ward Managers are responsible for the operational implementation of this policy
and for ensuring that staff are aware of these responsibilities, including the
requirement to attendance Infection Control Training on an annual basis.
Managers are also responsible for taking appropriate action should any breach
of this policy arise.
3.5 The Employee
All staff employed by the Primary Care Trust are responsible for adhering to this
policy regardless of role, band, discipline or service area. Employees are also
responsible for ensuring that any breach of this policy is reported immediately to
their service manager in accordance with the Primary Care Trust incident
reporting procedure. Clinical staff have a responsibility towards the safer
working practices of colleagues or coworkers, such as students, trainees under
their supervision.
3.6 Infection Prevention and Control Team
It is the responsibility of the author to ensure this policy is updated. The Control
of Infection Committee will provide advice and training as required to assist with
the implementation of the policy. The team will periodically audit the policy and
monitor its effectiveness during routine clinical activities and planned audit
programmes as agreed by the Trust Infection Control Management Group and
the Provider Services Audit Programme.
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4. DEFINITION
Cadaver – A dead human body that may be used by physicians and other
scientists to identify disease sites or determine cause of death. It is imperative
we also recognise it is also a body of a loved ones relative.
5. LEGAL POSITION (LEGISLATION)
• Health & Safety At Work Act 1974
• Employees have a general duty under this Act to ensure, so far as is
reasonably practicable, the health, safety and welfare at work of their
employees.
• Employers and the self-employed also have a duty to conduct their activities
in such a way as to ensure, so far as is reasonable practicable, that persons
not in their employment are not exposed to risks to their health or safety.
• The Control of Substances Hazardous to Health Regulations 2002 (COSHH)
Page 8
• Employers must carry out an assessment of the risks created by work which
is liable to expose employees to any substances hazardous to health. This
includes any micro organism which creates a hazard to the health of any
person. Employers must also implement and maintain appropriate control
measures (see Appendix 1).
• The Management of Health & Safety at Work Regulations 1999 (Risk
Assessment).
• Employers and the self-employed are required to assess the risks to workers
and any others who may be affected by their undertaking. Employers with
five or more employees must record the significant findings of their
assessment.
• Employers and the self-employed also have a duty to provide comprehensive
information, to people who work in or visit their premises, regarding relevant
risks to their health and safety.
• Public Health (Control of Diseases) Act 1984 & Regulations of 1988.
• Section 10 defines those diseases to which section 43 – 45 of the Act applies
when dealing with dead bodies. This also applies to HIV/AIDS and viral
haemorrhagic fever which are not included in Section 10.
• Section 43 empowers a registered medical practitioner not to allow a body
having suffered from AIDS, anthrax, rabies and viral haemorrhagic fever to be
removed from hospital except for the purpose of being taken direct to a
mortuary or being forthwith buried or cremated.
• Section 44 of the act places a responsibility on the person in control of a
premises where a deceased who has died from a notifiable disease is held to
prevent any other persons coming unnecessarily into contact with, or
proximity to, the deceased. Section 44 requires appropriate steps to be taken
to physically separate and control access to such a dead person. The law
nevertheless recognises that the separation cannot be total.
• The body maybe be washed and dressed for hygienic or aesthetic reasons
and, if necessary, enclosed in a leak-proof bag.
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• Religious customs may dictate certain rites to be performed and relatives and
friends to touch and kiss the face to complete the grieving process; there is
no reason to discharge this in normal circumstances.
• Section 45 of the Act considers it unlawful to hold a wake over such a body.
The law thus requires us to balance the necessary with the unnecessary.
The Health Protection Agency can advise further.
6. SPREAD OF INFECTION
6.1 Organisms in a dead body are unlikely to infect healthy people with intact
skin, but there are other ways they may be spread.
• Needlestick injuries with a contaminated instrument or sharp fragment of
bone etc.
• Intestinal pathogens from anal and oral orifices.
• From Vaginal orifices.
• Through and from abrasions, wounds and sores on the skin.
• Contaminated aerosols from body openings or wounds e.g. tubercule bacilli
when condensensation could possibly be forced out through the mouth or
nose.
• Splashes or aerosols onto the eyes.
• From Aural discharge.
• The risks of infection are not high (no more than in life) and are usually
prevented by the use of standard principles of infection control which include
appropriate protective clothing and the observance of COSHH Regulations.
6.2 The risks from key specific infectious illness, either confirmed or suspected, are
outlined in Table 1, overleaf.
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TABLE 1
Infectious illness and Precautions to be taken
When Handling the Deceased
(Adapted from Health and Safety Executive Guidance 2005)
Follow this guidance for confirmed and suspected cases
Causative Risk Is a Body Can the Can Can
Infection Agent Category Bag Body be hygienic embalming
Needed? Viewed? preparation be carried
be carried out? out?
Intestinal infections: Transmitted by hand-to-mouth contact with faecal material or faecally contaminated
objects.
Dysentery Bacterium – C Advised Yes Yes Yes
(bacillary) Shigella Medium
dysenteriae Risk
Hepatitis A Hepatitis A C No Yes Yes Yes
Medium
Risk
Typhoid/ Bacterium C Advised Yes Yes Yes
paratyphoid Salmonella Medium
Fever typhi/paratyphi Risk
Blood-borne Infections: Transmitted by contact with blood (and other bodily fluids which may be
contaminated with blood) via a skin-penetrating injury or via broken skin. Through splashes of blood
(and other body fluids which may be contaminated with blood) to eyes, nose and mouth.
HIV Human B Yes Yes Yes No
Immuno- High Risk
deficiency
virus
Hepatitis B Hepatitis B B Yes Yes Yes No
and C and C High Risk
Viruses
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Causative Risk Is a Body Can the Can Can
Infection Agent Category Bag Body be hygienic embalming
Needed? Viewed? preparation be carried
be carried out? out?
Respiratory infections: Transmitted by breathing in infectious respiratory discharges.
Tuberculosis Mycobacterium C Advised Yes Yes Yes
Bacterium tuberculosis Medium
Risk
Meningococcal Bacterium C No Yes Yes Yes
Meningitis Neisseria Medium
(with Meningitides Risk
or
without
septicaemia)
Non- Various bacteria D No Yes Yes Yes
Meningococcal including Low Risk
Meningitis Haemophilus
Influenzae and
also viruses
Diphtheria Bacterium – C Advised Yes Yes Yes
Corynebacterium Medium
Diptheriae Risk
Contact: Transmitted by direct skin contact or contact with contaminated objects.
Invasive Bacterium – A Yes Yes No No
Streptococcal Streptococcus Very
pyogenes High Risk
(Group A)
MRSA Bacterium D No Yes Yes Yes
methicillin Low Risk
resistant
Staphylococcus
aureus
Other infections:
Viral Various viruses A Yes No No No
haemorrhagic e.g. Lassa fever Very
fevers virus, Ebola High Risk
(transmitted by virus
contact with
blood)
Transmissible Various prions B Yes Yes Yes No
spongiform e.g. Creutzfeld High Risk
encephalopathies Jacob disease/
(transmitted by variant CJD
puncture
wounds, ‘sharps’
injuries
or contaminated
or broken skin,
by splashing of
the mucous
membranes)
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7. SPREAD OF INFECTION
7.1 The Director of Public Health or the Consultant Microbiologist must always be
contacted for advice if there are any concerns about the infectivity of a deceased
person.
For the Director of Public Health, contact
Waverley House on 01275 546700
Consultant Microbiologist (available 24 hours), Weston General Hospital Tel:
01934 636363.
7.2 If a person has died with a known or suspected infection, it is essential and a
legal responsibility that all persons who may be involved in handling the body are
informed of the potential risk of infection by the doctor or nurse responsible for
verifying the death and the GP responsible for the patient. They should be
advised of the risk of infection, but the specific diagnosis remains confidential,
even after death. The persons who need to know include:
In-Patient – Nursing/care staff, morturary/portering staff, the bereaved relatives
and the undertakers.
At Home – The person(s) laying out bereaved relatives any visiting Doctor and
the undertakers.
Elsewhere – Emergency services staff. Also consideration should be given to
the Coroners Office and Pathologists.
7.3 The undertakers’ personnel and/or mortuary/portering staff should be informed in
writing of the potential risk of the infection and the degree of risk, and given the
names of the Consultant in Communicable Disease Control or Consultant
Microbiologist whom they can consult for further advice. This written information
is the responsibility of the person verifying the death.
Use form Appendix 1.
7.4 Where the patient has died at home and the death is being verified by a
community nurse the appropriate section of the verification form must be
completed to identify infection risk.
7.5 Health Services Advisory Committee publication “Safe Working & the
Prevention of Infection in the Mortuary and Post Mortem Room” (2003)
states that:
“All bodies must be identified and correctly labelled. Any that
cannot be property identified, and particularly those whom
there is no satisfactory medical record, must be labelled and
treated as ‘danger of infection’. All bodies so labelled
should be totally enclosed in a leak proof body bag and
marked in accordance with local rules”.
Page 13
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7.6 At Clevedon Community Hospital Labels indicating a danger of infection
(Biohazard labels) must be used for bodies which are suspected of containing
hazard group A, B or C pathogens, see Table 1, page 8/9. Warning labels
should be conspicuously placed on the body and the body bag but
accompanying clinical information should not be available to anyone other than
mortuary/undertakers staff.
For Community nursing staff verify death must inform the undertakers of any
risks of infections from hazard group A, B or C pathogens, see Table 1, page
8/9. Accompanying clinical information should not be available to anyone other
than mortuary/undertakers staff.
7.7 The undertakers must be willing to liaise with the relatives concerning any
potential risks.
7.8 It is important that good liaison and co-ordination is maintained between: clinical
staff including General Practitioner, microbiology and histopathology
laboratories, portering and mortuary departments, the undertaker, the bereaved
and the Director of Public Health (DPH) at all levels.
8. LAYING OUT
8.1 Hygienic preparation of bodies usually involves washing the face and hands,
closing the eyes and mouth, tidying the hair and possibly shaving the face. It
may also involve plugging orifices to prevent discharges. Any wounds should
also be covered. Once the death has been verified, If the death is not to be
referred to the Coroner, then all drains, catheters and intravenous lines
needs to be removed.
8.2 In some cultures and religious groups, relatives expect to carry out the ritual
preparation before burial and in most cases, this can be permitted but where a
risk of infection exists the hazard has to be assessed and appropriate advice
given see Table 1. This may mean only partial preparation and the use of gloves
and protective clothing, and should be supervised.
8.3 Staff performing the last offices should adopt the same standard routine
protective precautions as when the patient was alive, including disposable
examination gloves and a disposable practice apron when handling the
deceased. Any surface contamination should be removed by
washing/disinfection. Follow Primary Care Trust policy for:
• Decontamination of Medical Devices
• Control of Infection Policy
8.4 Orifices may be packed and any wounds or leaking openings should be covered
with occlusive dressings. Care must be taken to avoid contamination of any
wounds or skin lesions on the workers, skins and hands must be washed
thoroughly at the end of the procedure.
8.5 Where appropriate the nurse will inform the relatives on any restrictions,
emphasising that the body may be enclosed in a bag once it leaves the ward.
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8.6 Relatives may be ignorant of the true nature of infection and an individual’s
right to confidentially continues after death but, nevertheless, the bereaved
relatives must be advised on how to avoid risk of infection themselves. The
certifying doctor/nurse should discuss the precautions that are advised with the
relatives, carers, undertakers etc.
9. BODY BAGS
9.1 Body bags should only be reserved for cases where a risk of infection is
likely, see Table 1.
Plastic body bags are used for cadavers thought to be infective to handlers, or
likely to leak in transit, or otherwise offensive bodies. The bags are in many
cases used inappropriately for bodies that are of minimal or no risk, and this
causes problems to the staff of funeral parlours and unnecessary distress to
relatives.
Bodies cool more slowly inside a body bag, facilitating decomposition and
making hygienic preparation more difficult. It may be possible to only display the
head for viewing and this may cause additional distress to the bereaved.
Polyvinyl chloride body bags must be used if the body is to be cremated because
of the risk of dangerous emissions of dioxins (alternatives are available).
10. MORTUARY
10.1 The Mortuary is a standalone, facility or building converted to a purpose building,
contained within the rear enclosed courtyard of the hospital. Access is through a
locked door on the front elevation of the property.
10.2 Keys to the mortuary are controlled by reception staff in hours, Nursing staff out
of hours, with a key log of signing in access/return of key in process.
10.3 A log of all personnel accessing the fridge is maintained directly oh site.
The facility provides body fridge of recognised supply and design to
accommodate up to four bodies. Temperature is regulated and monitored, with
an alarm sounding in the main building.
It is the responsibility of the portering staff to make daily checks on the
temperature, registering this check on a daily log. This is audited on an annual
basis and collected monthly by the Clinical Matron.
Removal from hospital mortuary is arranged after ‘confirmation of Life Extinct’.
All deceased are moved via use of covered bespoke transfer trolley, using the
internal Hospital lift and exiting onto the courtyard via the rear lower ground floor
exit door.
After completion of all relevant paperwork, the Funeral Director officiating for the
deceased will arrange, by contacting the nurse in charge, appropriate removal to
their premises.
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11. Dignity
11.1 All deceased will be assured the same exacting care as they received when
alive.
11.2 When moving the deceased internally in the hospital, it is imperative that liaison
takes place between the nurse in charge of the hospital and the Funeral Director,
to allow a smooth delivery of procedure. Funeral Directors will ensure that the
gates to the courtyard are kept closed during the process of moving a body to the
mortuary, or for removal to the hearse, so as to reduce any stress to the general
public, who may, hitherto witness such events, even thought it may be an
accepted part of community life.
12. AUDIT
The Infection Prevention and Control Management Team will Audit compliance
with this policy, reporting to the Director of Infection Prevention and Control.
13. KEY PERFORMANCE INDICATORS
The Key performance indicators will be monitored by the Infection Control
Management Team by following:
• Uptake of mandatory infection control training
• Number of incidents related to management of cadaver
• Number of incidents related to management of cadaver associated with body
fluid spillage.
14. ASSOCIATED POLICIES/GUIDELINES
North Somerset Primary Care Trust – Waste Management Policy
North Somerset Primary Care Trust – Health Records Policy
North Somerset Primary Care Trust - Verification of Death Policy
North Somerset Primary Care Trust - Control of Infection Policy
North Somerset Primary Care Trust - Incident Reporting Policy
North Somerset Primary Care Trust - Risk Management Policy
North Somerset Primary Care Trust - Dignity in Care Policy
15. REFERENCE AND ASSOCIATED DOCUMENTS
Department of Health (2006). The Health Act (2006) – Code of Practice for the
Prevention and Control of Health Care Associated Infections.
Advisory Committee on Dangerous Pathogens. “Protection Against Blood Borne
Infections in the Workplace – HIV and Hepatitis”. 1995 Page 16
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CDR Review Vo.5, Review No. 5. “The Infection Hazards of Human Cadavers”.
Healing, Hoffman, Young. 29 May 1995
Control of Substances Hazardous to Health Regulations (2002)
Guidance from the Advisory Committee on Dangerous Pathogens and the
Spongiform Encephalopathy Advisory Committee. June 2003 “Transmissible
Spongiform Encephalophy Agents: Safe Working and the Prevention of
Infection”.
Health & Safety Executive (Draft) 2005. “Infection at work: Controlling the Risks
from Human Remains – A Guide for those in the Funeral Professional, including
Embalmers and those involved in Exhumation”.
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APPENDIX 1
INFECTION NOTIFICATION SHEET
TRANSFER OF DECEASED TO AN UNDERTAKER
OR MORTUARY FOR CLEVEDON HOSPITAL STAFF
To be completed by certifying Doctor or verify Nurse.
A. DETAILS OF DECEASED ( Complete
all sections)
NAME
DATE OF BIRTH
SEX
DATE OF DEATH
TIME OF DEATH
PLACE OF DEATH
NEXT OF KIN (N.O.K.)
B. STATUS OF DECEASED (Tick one box
only)
The deceased’s remains are a known If ticked, please complete Section C
potential source of infection
The deceased’s remains are not a known
or suspected source of infection
NEXT OF KIN (N.O.K.)
C. RISK OF INFECTION
The deceased’s remains are a potential source of infection by the following routes of
transmission. (Tick all that apply)
Inoculation (mucous membranes, broken skin, injuries that pierce the skin)
Inhalation (breaking in)
Ingestion (swallowing)
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D. SAFETY MEASURES
The following safety measures are
required:
MEASURE REQUIRED (complete all
sections)
Body Bag to be used YES/NO
Body may be removed from bag YES/NO
Embalming permitted YES/NO
Viewing of body by bereaved permitted YES/NO
Touching of the body by bereaved YES/NO
permitted
Signature
For further advice refer to the Cadavers
Policy or contact the Hospital Infection
Control Team on:
• 01275 872121 Clevedon Hospital
(24 hr number)
• Senior Infection Control Nurse on
01275 546884
Or the Director of Public Health on:
• 01275 546770
• 01934 636363 (Out of hours), ask
for the Consultant Microbiologist on call
ALWAYS follow Standard Principles of Infection Prevention
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