After death, the body and its immediate environment are _________________.
Generally, germs do _______ die with the host.
unsanitary
not
Hierarchy of hygiene control
sterilize
disinfect
antiseptic
sanitize
Aseptic
free from infection and from any form of life
Sterilization
this renders a substance free of all microbes (vegetative and spore bacterial forms) including viral
it is the most effective method of hygiene control
heat is the top of the list as this but not suitable to apply to a case prior to viewing (including cremation)
there is also a cold method of this
Disinfect
to destroy disease causing mibrobes (vegetative form of bacteria, but not spores)
i.e. washing with germicidal soap, injecting embalming chemicals
Antiseptic
to inhibit the growth of microbes
to interfere with microbal reproduction but does not kill
i.e. flush with a topical antiseptic
Sanitize
to reduce the number of microbes, some are still present
this is the lest effective method of hygiene control
i.e. washing with running water and common soap
Sanitizer
a chemical agent with disinfecting properties when applied to a precleaned object
Primary disinfection
the disinfecting and decontamination measures taken prior to embalming (arterial injection)
Concurrent disinfection
the disinfecting and decontamination measures taken during emblaming (arterial injection)
Terminal disinfection
the disinfecting and decontamination measures used after embalming (arterial injection and cavity treatment)
List the three types of disinfection
primary
concurrent
terminal
Instruments and equipment
Do not share instruments from one case to another without ______________ them beforehand
Doing this kills bacterial __________ to prevent the spread of tissue _______
sterilizing
spores, gas
Prep room
Use the __________ level of control you can employ
You will _____ be able to sterilize the entire prep room
highest
not
Embalmer
Destroy/dispose of gloves ________ each use
Keep finger nails ________ to avoid tears in the gloves
Thoroughly wash your hands ________ removing the gloves and check your skin for _______
after
short
after, cuts
If you have a cut in your skin...
_____________ the area immediately
_____________ bleeding
____________ a physician
disinfect
induce
consult
Purpose of environmental hygiene
Protect the ___________ health
Protect the __________________ (your health)
Create a clean, sanitary _______________
Protect the ______________
public
operator/embalmer
body
environment
Why should we create a clean, sanitary body as a purpose of environmental hygiene?
so the public can safely view the remains without the worry of contracting an infection or disease
How is hazardous waste disposed of after it is collected from the place of use?
it is incinerated
Why must biohazardous waste not go into regular common trash?
because it will go out to a public dumpster/landfill
biohazardous material should be incinerated
List the embalming procedures we should follow to ensure proper hygiene and create a clean, sanitary body
disinfection of all external orifices/body openings
bathe the body
use embalming chemicals to disinfect internally
Disinfection of all external orificies of the body is done with a ______________ disinfectanct spray
Cotton is then saturated with a disinfecting chemical to clean out __________ and nasal cavities
topical
oral
Body openings to worry about during primary disinfectionwhich should be cleaned as thoroughly as possible are
ears
nose
mouth
anus
groin area
Remove all materials from the mouth and throat (oral cavity) with clean cotton or if necessary, use a __________ __________ aspirator
nasal tube
The body is bathed with ____________ water and _______________ soap
running, germicidal
For safety purposes, when bathing the body in lab we must work as a _________
team
Use a ________________ prepared germicidal _________ intended for disinfecting ____________
commercially, soap, remains
Vascular fluids are designed to be ___________ with _________ in embalming machine tank
The embalmer mathematically computes the percent of ____________ being injected
diluted, water
formaldehyde (HCHO)
What is the range of solution strength for an average case?
- 1.0% - 2.5 %
- 3.0% - 4.0%
- 5.0% - 8.0%
1.0% - 2.5%
What is the range of solution strength for a difficult case?
- 1.0% - 2.5 %
- 3.0% - 4.0%
- 5.0% - 8.0%
3.0% - 4.0%
What is the range of solution strength for an advanced decomposition, high level case of edema case?
- 1.0% - 2.5 %
- 3.0% - 4.0%
- 5.0% - 8.0%
5.0% - 8.0%
Cavity fluids are used _____________ from the bottle. They are _________ diluted.
straight, not
Body should be placed on a table with the head ____________ above the rest of the body with the use of a __________ block
elevated, head
Generally, be sure the body is straight and in the _________ position on the table
Exception: _______________ cases. You do ______ cut or break tissues to straighten
straight
arthritic, not
The head and ________ should be placed on the headrest in such a way that it will not interfere with distribution of _______ or drainage
neck, fluid
The face may be tilted to the _________, about ________ degrees
This is the generally preferred "__________" viewing position
right, 15
casketed
Hands should be placed in a desirable position
Fingers together and slightly ________, hands folded across the _______________ or placed at sides until distribution is observed
cupped, abdomen
When positioning the hands on the body, which hand should be placed on top?
the left hand
Arms may need to be ____________ or otherwise posed for effective positioning or hands
Use _______ blocks to prevent elbows from interfering with the ____________ along the sides of the table
elevated
arm, drainage
Shoulders may need to be _________ to effect proper neck alignment, use body boards or __________ to help
elevated, bridges
The use of additional empermeable posing devices may be _____________ in special situations for proper body positioning
This will vary with the specific case
necessary
What is needed in order to remove facial hair?
From who?
permission
family/from the person who has authorization through Health and Safety Code Section 7100
What are the two recommendations we should do/use in order to achieve thorough diffusion (perfusion) to all tissues?
multi-site injection
adequate quantity of chemical
______ or more injection sites ensure ensure a more consistent _____________ of the disinfection and preservation chemical solutions (deep and superficial)
i.e. inject down the right common carotid artery while temporarily tying off the up side
then inject down starting at the left femoral artery, if needed
then inject either brachial artery, if needed
two, distribution
Adequate quantity of chemical...estimate _____ gallon of embalming solution for each _____ pounds of body weight
this is just an estimate
1, 50
During injection, allow any discharge to drain _________
When is closure of all external orifices performed?
freely
after injection
doing this in this particular order eliminates both pressure and discharged material from remains prior to suturing
Packing: the use of cotton helps prevent _______ or purge
odor
What is best to use when there is need to close the anal/vaginal openings?
Suture: as needed.
i.e. incisions, punctures, anal/vaginal openings
in extreme cases suturing lips closed
an AV plug
Use adhesives as needed
i.e. liquid cement for the line of closure on the ___________
mouth
Remove and record _______ clothing and personal effects
Examine for valuables
Do _____ destroy any personal items unless the family (NOK) instructs you to do so
all
not
__________ soiled clothing and return to the family
OR
__________ after proper authorization
launder
destroy
Where do we dispose of sharps?
in the red sharps container
When are items used during the embalming procedure considered contaminated?
Where are these items disposed of?
after contact with the dead human body
in the red bio-hazardous waste container
Use __________ amount (lots of) running water at ______ times while embalming.
Where do blood, body fluids and the running water we use during embalming flush into?
copious, all
into the regular sewer
Are bandages and cotton considered contaminated items?
yes, they should be disposed as bio-hazardous waste
Adhere to strict compliance to all ________, state, and ________ regulations
local, federal
When did the bloodborne pathogen standard (OSHA 20 CFR 1910.1030) become effective?
Who does it protect?
What type of occupations does it apply to?
December 6, 1991
Health care workers
it applies to occupations where there is exposure to blood, blood by-products, body fluids that might contain traces of blood, and other potentially infections materials
What does OPIM stand for?
other potentially infectious materials
Who is responsible for identifying the tasks and procedures in which occupational exposure may occur?
- employer
- employee
employer
List the type of immunization the employer must make available
What is required if the employee does not with to be immunized?
If the employee changes their mind, does the immunization still need to be provided by the employer?
HBV (hepatitis B virus)
written declination
yes, it must be
In the event of a needle stick or other accidental exposure by the employee what must be made available by the employer?
post-exposure evaluation and follow-up
The employer must list job descriptions that may be reasonably expected to involve skin, eye, mucous membrane, or parenteral (needle stick) contact with blood. This is known as communication of ______________
hazards
Employee's medical recordsare to be retained for the duration of employment plus ____ years
Employee's training records are to be retained for _____ years from the date of training
30
3
Tasks and procedures with potential exposure for each employee include all of the following:
____________ of bodies from the place of death
______________ bodies (think prep room)
____________ and casketing
Preparing ____________unembalmed bodies for disposition (think Jewish)
Housekeeping
removal
embalming
dressing
unembalmed
Exposure determination should be made with regard to universal precaution and not to use of PPE's
So, universal precaution says...
We are to ________ all human blood and body fluids as if known to be ___________ for HIV, HBV and other blood borne pathogens
treat, infectious
HIV: human immunodeficiency virus
HBV: hepatitis B virus
Epidemiology
The branch of medicine that deals with the incidence, distribution, and control of diseases
Epidemiology explanation
modes of ______________
symptoms of diseases that embalmers can contract (i.e. HIV, HBV and OPIM)
Reference any disease transmitted by air, droplet, and direct contact
transmission
All procedures involving blood and OPIM performed in such manner as to minimize
splashing
spraying
spattering
aerosolization (air borne)
Gather instruments and supplies ________ to working with contaminated gloves
prior
PPE is an acronym for:
personal protective equipment
The purpose of wearing personal protective equipment is to form a _________ and protect the handler of dead human remains and ________________ articles
barrier, contaminated
Formaldehyde rule:
employees to solutions of ______ (0.01 ppm) formaldehyde or greater are required to wear __________ and a face shield for protection of the eyes and skin
1%, goggles
For protection from entry of virus through mucous membranes of eyes, nose and lips, the embalmer is to wear mask, goggles or ___________ with the side shields or chin-length face ________
glasses, shield
Proper use of PPEs assures safeguard of your __________ thereby protecting the _________ health
health, public
PPEs are ____________ equipment so maintenance is not required
disposable
Closed drainage procedure during arterial injection
system of drainage tube or hose to take drainage directly to disposition receptacle
or
drainage from the right atrium (through the chest wall) with drainage aspirated from the thoracic cavity with the use of a trocar
Using the ____________ drainage system promotes minimal or no blood to flow over the body or table
closed
Laying a transparent, flexible or solid plastic material/shield between the embalmer and any open drainage site prevents splatter and ________________ (think air)
aerosolization
Avoid ________ water pressure when water is used during embalming or clean up to flush blood from the embalming table
Also, avoid splatter and _____________ (think air)
high
aerosolization
In order to avoid _____________ (term) entry (needle sticks or cuts) be conscious of where scalpels and other ___________ instruments are laid during embalming
parenteral, sharp
What is the purpose of covering broken or cut bones prior to the placement of an embalmer's hands or arms into the body cavity or any mutilated portion of the body
to prevent parenteral (needle sticks, cuts) entry
Do not place gloved hand to your mask or eye cover
Rinse gloved hands as needed during the embalming procedure
check for torn or sagging "water logged" gloves and replace immediately!!
Gloves wil "wick" water and pathogens through the pores
Avoid contamination of the environment
All contaminated items are to be cleaned and __________ at the conclusion of the embalming procedure or at the end of every ____________
sanitized, shift
The act of eating, drinking, smoking, applying personal cosmetics, lip balm or handling contact lenses is known as
farding
Is it allowed to eat, drink, smoke, apply personal cosmetics, lip balm or handling contact lenses in work areas?
eww, no!!
Follow housekeeping procedures and keep a written schedule.
Clean prep room at the completion of embalming or at the _____ of each work shift
Focus on cleaning and decontamination
Follow regulated waste handling and disposal
Waste products to be placed in sealed leak proof container or bag that is color coded or labeled
Use proper procedures for contaminated laundry handling, containment, and decontamination
be knowledgeable of Hepatitis B immunization which is required to be made available by employer
develop emergency procedures
report all accidents
perform post-exposure evaluation with a physician
use appropriate labels and signs for hazardous items
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Public Health Guidelines
perform a thorough cleansing of body surface with tuberculocidal germicidal _______
use _% formaldehyde or _% gluteraldehyde arterial solution
do cavity work
have sufficient ____ exhange
have annual physicals, HIV & __ skin testing, immunizations as needed
soap
3, 2
air
TB
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Personal HealthPrecautions
transfer remains with care, use ___ people
keep remains covered during transfer __/from cot
perform thorough terminal ___________
two
to
disinfection
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Minimum standards
Use _________ sites for injection/drainage
__-15 min/gal injection rate
3-_ gal of solution (1 gal per 50 lbs)
Supplemental chemicals
Strength of solution: min _% formaldehyde
multiple
12
4
2
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Administration
Establish and maintain procedures and practices which will protect employees
this includes:
training
use of PPE's
good equipment
documentation of activities
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Administration
Establish and maintain procedures and practices which will protect employees
this includes:
training
use of PPE's
good equipment
documentation of activities
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Training education
mode of ___________ transmissions
items of barrier attire
location of equipment
emergency procedures
disinfection protocols
infectious
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Work practices
NFDA recommended these need to be developed
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Work practices
NFDA recommended these need to be developed
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Personal protective equipment
SOP!
Establish a min. required barrier attire
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Medical
HBV & TB shots, monitoring immunization levels
According to the summary guidelines submitted to OSHA from the NFDA committee on infectious disease: Record keeping
Complete embalming case reports, including PPE's worn
Creutzfeldt-Jakob disease
rare (usually fatal) brain disease (usually in middle age) caused by an unidentified slow virus
mimics dementia and alzheimers
there is no diagnostic test for this disease in the living
the prion can remain latent up to 25 yrs. before surfacing in an infected person
there is no vaccine
there is no cure – and no treatment
it is infectious, fast acting and always fatal
no embalming chemicals can destroy it
common means of disinfection & sterilization won’t kill it
When was CJD discovered/first diagnosed?
in the 1920's
Sporadic CJD
mutation of protein gene into one that is abnormal
called a prion ("pry-on")
Familial CJD
genetic in origin
Iatrogenic CJD
infectious type
spread usually by means of hospital operation, contaminated instruments, transfusion fluids or transplant tissues
What percentage of reported cases does sporadic CJD cases account for?
- 1%
- 5% - 10%
- 80% - 85%
80% - 85%
What percentage of reported cases does familial CJD cases account for?
- 1%
- 5% - 10%
- 80% - 85%
5% - 10%
What percentage of reported cases does iatrogenic CJD cases account for?
- 1%
- 5% - 10%
- 80% - 85%
1%
Iatrogenic
induced unintentionally by the medical treatment of a physician
List the anatomy affected by CJD
brain (highly infectious)
cerebrospinal fluid (highly infectious)
corneas
blood
urine lymph nodes
liver
bones (possible)
lungs (possible)
Embalming procedure when dealing CJD cases: infectious control
wear _ pairs of gloves (never use vinyl)
full gear is a _____
3
must
Embalming procedure when dealing CJD cases: procedure details
avoid causing __________ (think air) distribution
watch out for contact with all tissues and body fluids
do ___ aspirate the cavity!!
aerosol
not
Embalming procedure when dealing CJD cases: cleaning
use bleach (sodium hypochlorite), let stand as long as possible on surgaces but avoid contact with _______________
soak instruments for _ hours or better yet dispose of instruments if budget allows for it
formaldehyde (HCHO)
2
Recommendations for prevention of HIV transmission in Health-Care Settings: introduction
Human immunodeficiency virus (HIV)
Acquired immunodeficiency syndrome (AIDS)
Transmission by sexual contact with infected person or physical contact with contaminated blood, body fluids, secretions, and perinatally from mom to baby
Recommendations for prevention of HIV transmission in Health-Care Settings: Definition of Health-Care workers
persons whose activities involved contact with patients, blood or body fluids
Recommendations for prevention of HIV transmission in Health-Care Settings: Risk to Health-Care workers
very real
Recommendations for prevention of HIV transmission in Health-Care Settings: Universal precautions
exercise these guidelines
routinely use appropriate barrier attire
Recommendations for prevention of HIV transmission in Health-Care Settings: Precautions for autopsies or morticians' services
be extra cautious of sharp edges
use double gloving
watch out for contact with body fluids
Recommendations for prevention of HIV transmission in Health-Care Settings: environmental considerations
use lots of running water to rinse table but watch for spills
standard disinfection/sterilization techniques prove effective, be sure to wash instruments before soaking
Recommendations for prevention of HIV transmission in Health-Care Settings: cleaning spills
use germicidal agents listed with EPA as tuberculocidal
bleach is effective
Recommendations for prevention of HIV transmission in Health-Care Settings: laundry and infective waste
use common sense, do not handle soiled inens with bare hands, wash with a good, strong detergent and bleach
What type of materials are used to diagnose and treat malignancies such as cancer?
radioactive materials
Chemotherapy
the treatment of disease with chemincal agents and drugs
all of these type of agents are toxic, even in small doses
Are radioactive isotopes dangerous/lethal to the embalmer?
Yes, if overexposure to them occurs
If a deceased has received a large internal therapeutic dose of a radioactive isotope, the handling of the body pay pose problems of ______________ exposure for the surgeon, the pathologist or the ____________
radiation, embalmer
It is important for members of the healthcare industry to realize the existence of ___________ exposure, the ______________ of this problem and how to meet it
radiation, magnitude
It is equally important for members of the healthcare industry not to ________________ the danger of _____________ exposure and not to be _______________ fearful when the hazard is minimal or nonexistent
exaggerate, radiation, unreasonably
Radioactive isotope
a chemical element that is similar in chemical properties to another element
BUT differs in atomic weight and electric charge
it emits radiation
it disintegrates over time as it emits electromagnetic radiation
aka radionuclide
Can embalmers protect themselves from radiation exposure when working on an exposed case?
YES! because radiation levels dimish over the square of the distance
the embalmer can stay away from the affected sites of the body if known
Isotope
atoms of the same element but with different atomic masses due to a variation in the number of nucleus within the nucleus of the atom of each element
unlike the isotopes used to treat cancer, most isotopes do not emit radiation
Radiation protection (safety) officer
a supervisor in an institution licensed to use radionuclides
has the responsibility to establish procedures and made recommendations in the use of all radioactive matter
T/F: An embalmer should not attempt to embalm a radiation-treated body unless a radiation safety officer has certified the body as safe
true
T/F: When embalming a radiation-treated body and the body has been certified as safe, the radiation safety officer will not give the embalmer any additonal precautions or recommendations for handling
false - they will
High levels of radiation can occur during treatment of _______________ diseases or through _______________ exposure
malignant, occupational
Millicurie
that amount of radioactive material in which 37 million atoms disintegrate each second
mCi
Patients receiving large doses of ___________ isotopes must be hospitalized until the isotope content is not more than __ mCi
radioactive, 30
30 mCi
that amount of radioactive material in which one billion, 110 million atoms disintegrate each second
With regard to bodies that die outside a hospital, the FD should ___ encounter more than __ mCi of radioactive isotope
If the person has higher levels, they would not be released when they were alive; they would be kept in isolation
If such a body is embalmed without an autopsy, use standard aspiration and injection methods. The hazard is minimal to the embalmer
not, 30
If the body's radioactivity is above the level of __ mCi and there is ___ to be an autopsy, the body should be embalmed in the hospital ________ under the direction of a ___________ protection officer
30, not, morgue, radiation
If a body contains appreciably more than __ mCi of any radioactive isotope and there is to be an autopsy with embalming following the autopsy, it should be done only under the advice of a __________ protection officer
5, radiation
Autopsied remains are not released until the level is at or below __ mCi
5
If the body is to be interred or cremated without embalming, there will be __ radiation hazard from external handling
no
When dealing with radiation exposure:
_ pairs of rubber gloves should be worn
with a very heavy rubber _______
and the standard __________ precautions with PPE attire underneath should be worn
throughout the entire embalming operation
2
apron
universal
When dealing with radiation exposure:
utilize large quantities of __________ water at all times during the embalming procedure to flush drainage matter
running
When dealing with radiation exposure:
minimize the time of close contact with the body.
Consider working in pairs: one embalmer can _________ vessels and the other embalmer can _____ features
raise, set
When dealing with radiation exposure:
When not actually performing a procedure, stand a distance from the body at least _ feet away
This will substantially reduce the amount of exposure
3
When dealing with radiation exposure:
special care should be taken to prevent the floor from being contaminated
care should be taken that all ______ fluids are properly discharged down the drain
In case of overflow or spillage, fluid should be taken up immediately using disposable good
body
When dealing with radiation exposure:
instruments should be soaked in a good soap or detergent, then rinsed well with ___________ water
running
When dealing with radiation exposure:
Gowns, towels, clothing, etc. should be monitored and stored for suitable decay (_______ decay) before being sent to the laundry
atomic
When dealing with radiation exposure:
disposable waste matter should be collected in a suitable biohazard garbage bag/can and disposed of by ______________
incineration
When dealing with radiation exposure:
Heavy, permanent-type rubber gloves should be thoroughly washed before being removed from the hands,
then placed in a container of soap and water and allowed to soak and then stored in a suitable place until the __________ has decayed to a safe level
radioactivity
When dealing with radiation exposure:
If the embalmer suffers any introduction of material from the body into lesions, the embalmer should wash the injured area copiously with _____________ water and thereafter consult with their physician or a ____________ safety officer
running, radiation
examples of substances used in diagnosis and treatment of malignancies:
common radioactive isotopes used which emit radiation
phosphorus (3_)
cobalt (6_)
strontium (8_)
iodine (13_)
gold (19_)
radium (22_)
common radioactive isotopes used which emit radiation
phosphorus (32)
cobalt (60)
strontium (89)
iodine (131)
gold (198)
radium (226)
Pediculosis
the state or condition of having lice
Characteristics of a "good disinfectant"
it has a wide range of activity: it works against ___________, bacteria and fungi
viruses
Characteristics of a "good disinfectant"
has sufficient strength: ______ microbes
kills
Characteristics of a "good disinfectant"
acts in the presence of __________ (think liquid)
water
Characteristics of a "good disinfectant"
is stable, had a reasonably long ________ life
shelf
Characteristics of a "good disinfectant"
is non-corrosive to ________ instruments
metal
Characteristics of a "good disinfectant"
is fast acting
:)
Characteristics of a "good disinfectant"
not highly toxic to living tissue and not injurious to the _____________ system
