Covid-19: Guidelines for handling dead body

Coffins of two victims of Covid-19 are seen during a burial ceremony in the southern town of Cisternino, Italy, March 30, 2020. [Reuters]

Kenya recorded her first death as a result of the coronavirus on last Thursday, March 26, with the passing of a 66-year-old man. His death, not only brings home the dangers posed by the virus but will also force Kenyans to set aside some aspects of social life, such as burial as the numbers of those affected continue to rise.

One of them is our relationship with death and doing away with the intimacy provided by a funeral during the death of a loved one.

Here is a guide to burying a coronavirus victim. The guide aims to protect against the spread of COVID-19 at the site of death, during transport of human remains, at the mortuary, and during final disposal of remains.

PROCEDURE

PPE Recommendations: At every point of handling human remains of a COVID-19 patient, appropriate personal protective equipment (PPE) must be worn. The following PPE should be worn at a minimum:

• Wear nonsterile, nitrile gloves when handling potentially infectious materials.
• If there is a risk of cuts, puncture wounds, or other injuries that break the skin, wear heavy-duty gloves over the nitrile gloves.
• Wear a clean, long-sleeved fluid-resistant or impermeable gown to protect skin and clothing.
• Use a plastic face shield or a face mask and goggles to protect the face, eyes, nose, and mouth from splashes of potentially infectious bodily fluids.
• In case of a death in the ward or other bed, position pre-opened body bags next to hospital bed in a medical stretcher/Mortuary stretcher.

POST DEATH:

• Pull bed sheet(s) up and around body. Do not wash or clean body. Do not remove inserted medical equipment from body.
• Gently roll body wrapped in sheets while sliding the body bag under body.
• Complete transfer of body to body bag.
• Zip up body bag and ensure you minimize air in bag.
• Disinfect gloved hands using alcohol-based hand rub (ABHR).

CONTAMINATION:

• If any areas of PPE have visible contamination, disinfect with 0.5% Sodium hypochlorite (bleach).
• Disinfect outside of the body bag with 0.5% Sodium hypochlorite (bleach).
• Wheel the medical stretcher/Mortuary stretcher to decontamination area.
• Decontaminate surface of body bag with 0.5% Sodium hypochlorite.
• Begin by applying the 0.5% Sodium hypochlorite to top of bag and any exposed areas of Medical stretcher’s or Mortuary stretcher.
• Roll the body bag to one side to decontaminate half of bottom of body bag and newly exposed portion of Medical stretcher’s cot.
• Repeat with other side of bag and Medical stretcher.
• After cleaning all visible soiled areas, reapply 0.5% Sodium hypochlorite and allow sufficient contact time.
• Disinfect surfaces of medical stretcher’s or Mortuary stretcher from handles to wheels with disinfectant.
• Disinfect gloved hands using ABHR.

TAGGING:

• Place patient identification and any other documents that need to accompany the body. These can be put in a zip lock bag. Affix the following labels to the body bag before it is placed into the hearse or other vehicle used to transport the body: “infectious substance” label.
• Push Medical stretcher so only Medical stretcher and hand over the decontaminated body bag for burial.
• Proceed to PPE removal area.

KEY CONSIDERATIONS

• Strictly observe standard precautions.
• Appropriate personal protective equipment (PPE) must be worn Do not wash or clean the body.
• Do not remove any inserted medical equipment e.g. endotracheal or other tubing that would lead to generation of aerosols

TRANSPORTATION OF BODY

AIM: To protect workers involved in the transportation of human remains from the mortuary in the hospital to the place of final disposition. The disposal of human remains from COVID- 19 cases should be overseen by a public health official to avoid community practices that would result in more infections through contact.

KEY CONSIDERATIONS:

• The local health authorities should designate a team to oversee the process of human remains disposal in case of COVID-19 deaths.
• Minimize handling transportation of human remains to the extent possible.
• Ensure that anyone handling the body bag wears single-use (disposable) gloves with extended cuffs and a long-sleeved disposable gown.
• Coordinate all transportation of human remains of a COVID-19 patient with the local health officials
• As in the case of any other highly infectious disease, avoid transporting noncremated remains via aircraft.
• A plan should be in place to transport the body safely from the hospital to the hearse or vehicle used to transport the body.
• A public health official should be designated in advance to accompany the body from the hospital to the place of final disposition to ensure the safety of all those involved in the process.
• Follow government guidance on the conduct of funerals which includes minimizing the number of attendants to not more than fifteen and ensuring social distancing.
• There should be procedures in place so the designated official accompanying the body knows what to do if the body bag is compromised during transport and how to safely decontaminate it.
• The health official overseeing the body disposal should have a biohazard spill kit and recommended PPE with all of the equipment needed for any situation in which the body bag is compromised.