SH CP 23

Care of the Deceased Patient in

Relation to Infection Control Procedure
(Infection Prevention and Control Policy: Appendix 19)
This Appendix must be read in conjunction with the
Infection Prevention and Control Policy.
This policy may also be read with the Trust “Care of the service user after
their Death Policy (SH CP 145) and “Care of the service user after their Death
Procedure” (SH CP 146).

Version: 2

Summary: The Health Act (2008) stipulates that NHS bodies

Keywords (minimum of 5):
(To assist policy search engine)
Target Audience:
must, in relation to preventing and controlling the
risk of Health Care Associated Infections (HCAI),
have in place core policies, including care of the
deceased person. Implementation of this policy
will contribute to the achievement of compliance
with the Health Act(2008)
Last offices, body bag, cadaver, infection
notification sheet
All staff of all disciplines, Non-Executive
Directors, Volunteers, Governors and Contractors

Next Review Date: February 2018

Approved & Ratified by: IP&C Group Date of meeting:

06.02.14
Date issued: February 2014

Author: Mary Pilgrim

Infection Prevention & Control Nurse
Sponsor: Jude Diggins
Executive Director of Nursing, AHP & Quality and
Director of Infection Prevention and Control

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Version Control
Change Record

Date Author Version Page Reason for Change

15.10.13 Mary Pilgrim 2 4 2.2, Appendix numbering updated
2.4 and 2.6 Added for clarity of COSHH details
2.6
(added)
5 3.2, Appendix numbering updated
3.3 3.3 grammar changes in text
3.3 reminders to staff about family not touching
the body if infectious.
6 3.6 HPA changed to PH (England) April 2013
09.01.14 Mary Pilgrim 2 1, title Addition of This policy may also be read with the
box Trust “ Care of the service user after their Death
Policy
(SH CP 145) and “Care of the service user after
their Death Procedure” (SH CP 146).
4, 2.3 Reference to The Health Act and policies as
above.
5, 3.2 Definition of COSHH
5, 3.3 Updated text, new reference
6, 3.3 Addition of order codes
8. References updated
9 19.1 “Adapted from HSE 2005 and CDR 1995” added
to table
21.01.14 Mary Pilgrim 2 7 3.7 Added “refer to Appendix 19.1” and moved bullet
point 3 to section 3.3 at top of the same page

Reviewers/contributors

Name Position Version Reviewed &

Date

IP&C Committee members Version 1 April 2012

IP&C Team Version 1 April 2012
Trudi Archer Matron, ICS Version 1 April 2012
Sarah Garland Matron, OPMH Version 1 April 2012
Jill Angus Area Matron, Petersfield Version 1 April 2012
Mark Roberts Area Matron, Gosport & Fareham Version 1 April 2012
Angela Wilson Ward Manager, Sultan, Gosport Version 1 April 2012
Sue Adeyemo Matron, The Meadows Version 1 April 2012
Kath Clark Locality Manager, Childrens services Version 1 April 2012

IP&C Committee members Version 2 Jan 2014

IP&C Team Version 2 Jan 2014
Clinical Directors & Professional Version 2 Jan 2014
Leads
Bob Beeching Support Services Manager Version 2 Jan 2014
Tracy England Senior Contract & Business Manager Version 2 Jan 2014
Steve Webb Site Manager, Parklands Version 2 Jan 2014
Trish Bone Site Manager, PCH Version 2 Jan 2014
Jess Bundy FM Manager Version 2 Jan 2014
Alan Johnstone Head of Estates & Capital Version 2 Jan 2014
Mandy Weldon FM Manager Version 2 Jan 2014

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 CONTENTS

Page

1. Introduction 4

2. Definitions 4

3. Process 5
• Personal care after death
• Infection risk
• Use of Body Bags
• Vaccination of staff
• Notification of Diseases
• Public Health Act

4. Training 8

5. References 8

Appendices:

• 19.1 Guidance on care of the cadaver in relation to known 9

and/or suspected infection risk

• 19.2 Infection Notification Sheet 12

• 19.3 Action to be taken when a death occurs and a risk of 13

infection is known or suspected

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 Care of the Deceased Patient in Relation to Infection Control Procedure

1. Introduction

1.1 The care provided after a service user’s death and the support given to the
family at this difficult time are an integral part of the service user’s overall care
pathway and it is important to ensure that all health care professionals are able
to deliver this care to the standard required. This applies to all settings in the
Trust as well as the service user’s own home if attended by community staff.

1.2 There are approximately 600,000 deaths per year in the United Kingdom and
about two-thirds occur in hospital, of that less than one percent is associated
with a known or suspected infection. (CDR April 1995)

1.3 Opinion differs among health care workers on the management of a body
associated with an infection and measures taken or advised to control the
perceived hazards are often insensitively applied. For example the
indiscriminate use of body bags can cause needless anxiety for the bereaved
family, friends and staff.

1.4 This appendix advises staff of the actions they must take in order to prevent
cross infection when caring for the deceased service user and should be read
in conjunction with the policy on the care of the deceased service user including
Last Offices.

1.5 Good clear communication regarding the possibility of an infection risk must be
maintained between health care staff, mortuary attendants and funeral directors
at all times.

2. Definitions

2.1 Cadaver – is a term used by physicians and other scientists to describe a

deceased person or body

2.2 Hand hygiene – The process used to cleanse hands with soap and water,
alcohol gel or a detergent based wipe, (refer to Hand Hygiene Appendix 6
Infection Prevention and Control Policy).

2.3 Last offices – This term has been used to describe the care given to the
deceased person when this is focused on fulfilling religious and cultural beliefs
as well as health, safety and legal requirements The Health Act 2010 (DH) also
(Refer to Trust Care of the service user after their Death Policy (SH CP 145)
and “Care of the service user after their Death Procedure” (SH CP 146).

2.4 PPE – Personal protective equipment should be available to all staff

undertaking service user care (refer to Standard Precautions Appendix).

2.5 Body Bag – refer to 3.3

2.6 COSHH – (Control of substances hazardous to health) – Provides information

on the control of substances hazardous to health, using chemicals or other
hazardous substances at work that can put people’s health at risk.
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3. Process.

3.1 Personal care of the service user after death (formally known as last offices)
should honour the spiritual or cultural wishes of the deceased person. However
if the service user has been in contact or has been diagnosed as an infection
risk certain standard precautions are required to safeguard the health care
worker, mortuary attendant and funeral director. It is essential that the
management of deceased service users be handled with extreme sensitivity
and a sensible approach. An individualized approach assists with the
relationship between the families and carers at a time of probable distress.

3.2 Organisms in a dead body are unlikely to infect healthy people with intact skin,
but there are other ways they may be spread.

• Needle stick injuries from a contaminated instrument or sharp fragment of

bone (refer to Sharps and Inoculation Management Appendix10 Infection
and Prevention Policy).
• Intestinal pathogens from anal and oral orifices
• Through abrasions, wounds and sores on the skin
• Contaminated aerosols from body openings or wounds e.g. tubercule bacilli
when condensation could possibly be forced out of the mouth.
• Splashes and/or aerosols onto the eyes

The risks of infection are not high (and no more than in life) and are usually
prevented by the use of standard precautions and the observation of COSHH
regulations. The latter includes an assessment of risks of any micro organism
which creates a hazard to health of any person.

These standard precautions should be adhered to at all times and include:

• Hand Hygiene
• Appropriate use of protective clothing i.e. water repellent aprons and gloves
• Appropriate cleaning of the environment.
• Body Fluid Spillage management.
• Waste disposal as per Trust Waste Management Policy
• Sharps & Inoculation Management

3.3 Body bags should only be reserved for cases where a risk assessment makes
it necessary. 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, 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 (last offices) preparation more difficult. It
may only be possible to only display the head for viewing and this may cause
additional distress to the bereaved. (Essex Health Protection Unit, 2012
Infection Control guidelines for Funeral Directors).

Key Actions:

• Most deceased service users with a known or suspected infection would be

classed in categories, either A-D or 1-4 depending on the process adopted
locally. Categories 1 (D) or 2 (C) are low risk and DO NOT require a body
bag.
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 • There may still be occasions when a body bag is required because the
service user is leaking body fluids or exudates. If a body is likely to leak then
it must be placed in a body bag regardless of their infectivity status.
These bags are available from NHS Supplies; there are many types of body
bags available. But it is recommended that those made of polyvinyl
chloride should not be used if the body is to be cremated because of
the risk of dangerous emissions of dioxins (alternatives are available see
table below);

Order no Description Price

VMS002 Body bag PEVA Adult size 220 x Qty Price
Manufacturers 107cm white with 3 sided zip
product code 1+ 7.71
capacity 140kg=22stone
SL42
VMS011 Body bag PEVA Grab handled Qty Price
Manufacturers body bag with three sided zip size
product code 1+ 12.10
228cm x 109cm white capacity
SL57 178kg = 28stone

VMS015 Body bag PEVA Economy adult Qty Price

Manufacturers body bag with three sided zip
product code 1+ 6.34
213cm x 101cm white capacity
SL90 120kg = 19 stone

VMS021 Body bag PEVA Bariatric body Qty Price

Manufacturers bag with three sided zip size
product code 1+ 30.55
250cm x 132cm white capacity
SL75 280kg = 43stone

• If the deceased person had a known infectious disease that falls into
Category 3 (B) or 4 (A) they must be placed in a heavy duty body bag. A
reminder should be given that family, friends and staff must refrain from
handling the body.

• If the person had a known Category A or B (sometimes recorded

numerically as 3 or 4) disease you must inform anyone else coming into
contact with that service user e.g. Funeral Directors. (See appendix 19.1 of
this document)

• In some areas e.g. Lymington Hospital, all deceased service users are
placed in a lightweight (white) body bag prior to removal from the ward.

• Infection Notification sheet (Appendix 19.2) should be completed and

attached to all bodies prior to their removal from the ward. This must be
“outside” and visible for mortuary staff.

Those who directly handle the body should wear appropriate protective clothing
of disposable aprons and gloves. Mortuary staff should follow their own policies
and procedures regarding the use of protective clothing.
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3.4 All staff providing clinical care should have been appropriately immunised
against Hepatitis B per current Occupational Health Guidance. (HPA March
2009) and SHFT Staff Immunisation Policy.
Although vaccines can give good protection against Polio Virus, Diphtheria,
Tuberculosis and Hepatitis B, the protection is not 100% effective and there are
other infections against which there are no vaccines available e.g. HIV/AIDS
and Hepatitis C.
The use of standard precautions is therefore crucial in preventing cross
infection.

3.5 Under the Health and Safety at Work Act (1974) (section 6.1.1) all employers
have a responsibility for the safety of their employees. Those employees also
have a duty of care to inform others of potential risks. Care of a deceased
person who had a potentially infectious disease fall into this category (refer to
Appendices 19.1 of this document) for guidance on the care of a cadaver in
relation to known and/or suspected infection risk.

3.6 Notification Process for Infectious Diseases. The Health Protection Agency
(HPA) is responsible for protection the community (or any part of the
community) against infectious diseases and contamination.

In relation to the notification process it has two main roles:-

• Receiving and responding to notifications
• Surveillance reports and epidemiological studies

3.7 Public Health (Control of Diseases) Act 1984 & Regulations of 1988 –
Section 10 of the Act defines those diseases to which sections 43-45 of the Act
applies (see below and also refer to Appendix 19) when dealing with dead
bodies.

• Section 43 of the Act empowers a registered medical practitioner not to

allow a body having suffered from AIDS, anthrax, rabies or 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 person who has died from a Notifiable disease
is held to prevent any other persons coming unnecessarily into contact with,
or proximity to, the deceased person. - Section 44 thus places a specific
responsibility on hospital authorities, nursing and residential homes and
funeral directors. Section 44 requires appropriate steps to be taken to
physically separate and control access to such a dead person. The law
nevertheless recognizes that the separation can never be total.

• 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 discourage this in normal circumstances.

• Section 45 of the Act considers it unlawful to hold a wake over such a

body. The law therefore requires us to balance the necessary with the
unnecessary. Public Health (England) can advise further. (Bakhshi SS
2001).

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4. Training

Refer to TNA in IP&C Policy

5. References:

Bakhshi SS 2001: Code of Practice for funeral workers: managing infection risk
and body bagging. Communicable Disease and Public Health vol 4 no 4
Department of Health2010: Health Protection Legislation (England) Guidance
2010

Healing TD, Hoffman PN, Young SEJ, (1995), Communicable Disease Report,
CDR Report, The Infection Hazards of Human Cadavers, vol 5, R62-R68.

Health and Safety at work Act 1974

Health Protection Agency, (March 2009, Revised 2012) Essex Health

Protection Unit, Infection Control Guidelines for Funeral Directors

Health and Safety Executive (HSE 2005) Controlling the risks of infection at
work from human remains a guide for those involved in funeral services
(including Embalmers) and those involved in exhumation. HSE 06/2005

Public Health (Control of Diseases) Act 1984: Section 10

Sally Bestwick, (2008) Policy for the Management of the Cadaver. Western
Cheshire NHS Primary Care Trust.

The Health and Social Care Act 2008: Code of Practice on the prevention and
control of infections and related guidance (DH 2010).

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 Appendix 19.1: Guidance on care of the cadaver in relation to known and/or
suspected infection risk - Adapted from HSE 2005 and CDR 1995

Infection Degree Heavy Bereaved Embalming Hygiene

of Risk Duty permitted to Precautions
e.g. Body touch and (Last
4=A = Bag spend time Offices)
high with body
Acute Encephalitis (N) D (1) No Yes Yes Yes
Acute C (2) No* Yes Yes Yes
Poliomyelitis (N)
Anthrax (N) A (4) Yes No No No
Brucellosis (N) C (2) No* Yes Yes Yes
Chickenpox/Shingles D (1) No Yes Yes Yes
Cholera (N) C (2) No** Yes Yes Yes
with special
care
Cryptosporidiosis D (1) No** Yes Yes Yes
Dermatophtosis D (1) No Yes Yes Yes
Diphtheria (N) C (2) No* Yes Yes Yes
Dysentery C (2) No** Yes Yes Yes
(Amoebic or Bacillary)
Food Poisoning C (2) No** Yes Yes Yes
(or suspected) (N)
HIV/AIDS B (3) No** Yes Not advised Yes**
Influenza D (1) No Yes Yes Yes
Lassa Fever A (4) Yes No No No
Legionellosis (N) D (1) No Yes Yes Yes
Leprosy (N) D (1) No Yes Yes Yes
Leptospirosis C (2) No Yes Yes Yes
Lyme Disease D (1) No Yes Yes Yes
Malaria (N) C (2) No Yes Yes Yes
with special
care
Measles (N) D (1) No Yes Yes Yes

Meningitis (N) D (1) No Yes Yes Yes

(non-meningococcal)
Meningococcal C (2) No* Yes Yes Yes
Disease (N)

Mumps (N) D (1) No Yes Yes Yes

MRSA D (1) No Yes Yes Yes

Ophthalmia D (1) No Yes Yes Yes
Neonatorum
Orf virus disease D (1) No Yes Yes Yes
Paratyphoid C (2) No** Yes Yes Yes
Fever (N)
Plague (N) A (4) Yes No No No
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Infection Degree Heavy Bereaved Embalming Hygiene
of Risk Duty permitted to Precautions
e.g. Body touch and (Last
4=A = Bag spend time Offices)
high with body
Pneumonia/Bronchitis D (1) No Yes Yes Yes
Psittacosis D (1) No Yes Yes Yes
Q Fever D (1) No Yes Yes Yes
Rabies (N) A (4) Yes No No No
Relapsing C (2) No* Yes Yes Yes
Fever
Rubella (N) D (1) No Yes Yes Yes
SARS (N) A (4) Yes No –but No No
current
WHO
guidance
states that
relatives
may view
the body if
they wear
appropriate
PPE
Salmonellosis C (2) No** Yes Yes Yes

Scarlet Fever C (2) No* Yes Yes Yes

Smallpox (N) A (4) Yes No No No

Invasive Group A A (4) Yes No No No

Streptococcal Infection
Tetanus (N) D (1) No Yes Yes Yes
Tuberculosis C (2) No* Yes Yes Yes
Typhoid Fever C (2) No** Yes Yes Yes
Typhus B (3) Yes No No No
Viral A (4) Yes No No No
Haemorrhagic
Fever (N)
Transmissible B (3) Yes Yes No Yes
Spongiform
Encephalopathies
e.g. Creutzfeldt – Jakob
Disease
Tuberculosis (N) C (2) No* Yes Yes Yes
Viral Hepatitis A C (2) No* Yes Yes Yes
Viral Hepatitis B (3) No** Yes Not advised Yes***
B, C & Non A, non B
Hepatitis
Whooping Cough(N) D (1) No Yes Yes Yes
Yellow Fever (N) A (1) Yes No No No

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Key to Table

(N) = Notifiable Diseases = Diseases requiring notification (to Local Authority

Proper Officers) under the Health Protection (Notification) Regulations 2010.

No* The degree of (A, B, C &D) are absolute and, in most cases, are not specified in
law. The advice given in a specific case may be varied if the Clinician-in-
Charge/Hospital Infection Control Doctor or Consultant in Health Protection has
deemed it appropriate after assessing the risks.

No** Means no unless there is leakage of body fluids

Yes*** Means Last offices can be performed unless there is leakage of body fluids.
Standard precautions are always required and supervision of relatives.

Levels of Risk used in table above maybe referred to numerically or

alphabetically by different agencies e.g. A = 4 = very high risk, as below:-
A (4) – Very High
B (3) – High
C (2) – Medium
D (1) - Low
*Adapted from HSE 2005 and CDR 1995

Other conditions requiring a body bag

a. Known intravenous drug user
b. Severe secondary infection
c. Gangrenous limbs and infected amputation sites
d. Large pressure sores
e. Body fluid or exudate leakage (as above).
f. Death in a Dialysis Unit
g. Following a Post Mortem examination
h. Incipient decomposition

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Appendix 19.2: Infection Notification Sheet

Please place in an envelope marked for the attention of the undertaker to accompany
the deceased.
Name of the deceased
Address

DOB

GP & Surgery
Date and time of death

Hospital & ward

The deceased’s remains are a potential source of infection:

YES / NO / UNKNOWN (SEE NOTE 1 BELOW)

If YES (see note 2 below) the remains present a potential infectious hazard of
transmission by: (ring as appropriate)

Inoculation Aerosol Ingestion

Instructions for handling remains (if YES, tick as appropriate):

Can relatives view the body ( )

Body bag required ( )
Embalming ( )

Signed:

Print name:

NOTES:
Note 1: Not all service users display typical symptoms, therefore some infections
may not have been identified at the time of death.

Note 2: In accordance with the Health and Safety law and the information provided in
Health Services Advisory Committee Guidance

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 Appendix 19.3
Action to be taken when a death occurs and a risk of infection is known or
suspected

In hospital/community At home/community

Death

Risk of infection to
others

Assess by Clinician Assess by GP

May consult Infection Control Doctor (at May consult Consultant in Public Health
local Acute Trust)

Agree risk of infection

refer to Appendix
re: risk section 3.7

Infection control sheet to accompany body

Mortuary staff and Funeral Directors

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