Information for Funeral and Crematory Practitioners

Background

It is important to protect yourself and your staff as you transport and prepare the bodies of people who had CJD.

CJD is not spread between people by normal contact or through environmental contamination. It's not spread by airborne droplets, blood, or sexual contact as some other diseases are. CJD is caused by a prion, a type of infectious protein.

Prions are difficult to inactivate, so standard disinfection procedures and routine embalming solutions are ineffective. However, studies show that chemical solutions and physical processes involving bleach, sodium hydroxide, or autoclaving can inactivate prions.

Learn more about how to manage decedents with CJD safely, including transport, preparation, disinfection, and final disposition.

Transporting

To safely transport the decedent's body from the place they died to the funeral home, funeral service workers should use appropriate standard infection control measures, including wearing personal protective equipment (PPE).

The World Health Organization (WHO) recommends placing the body in a leak-proof bag before moving. The bag should be lined with absorbent material to prevent leakage of body fluids. If there is excess fluid, use a double bag. After transporting, disinfect all surfaces (i.e., stretchers, cots) with bleach.

Embalming and preparation

An autopsied or traumatized body of a suspected or confirmed CJD patient can be embalmed. Funeral workers should use the precautions outlined in the WHO CJD infection control guidelines, including personal protective equipment (PPE).

Autopsied bodies

Embalming

You can safely embalm bodies of suspect or confirmed CJD patients who have been autopsied.

• Adhere strictly to standard infection control measures.
• Place bodies of autopsied CJD patients on a waterproof sheet to collect all fluids.
• Use disposable instruments, masks, gowns, and puncture resistant gloves whenever possible.

Autopsies on these individuals are often restricted to removal of the brain. Therefore, take special precautions including placing a plastic sheet with absorbent wadding and raised edges underneath the head to ensure fluids are contained and prevent any spillage.

If sutures do not control leaking, pack the cranial cavity with absorbent material soaked with bleach, and tightly suture.

Dressing and family contact

• Wash the entire body with bleach, rinse, and sanitize before dressing.
• Take special care to limit fluid leakage when performing restorative work on a CJD patient. Collect all fluids in a suitable container.
• Advise family members to avoid contact with the decedent. This includes touching or kissing their loved one's face.

Bodies that weren't autopsied

Embalming

You can safely embalm bodies of CJD patients who have not been autopsied.

• Use standard infection control methods.
• Place the body on a waterproof sheet to collect body fluids and use disposable instruments.
• Collect body fluids in a suitable container.

Dressing and family contact

• Close incision sites with super glue, wipe down with bleach, and wash the body prior to dressing.
• You may undertake cosmetic restorative work.

You don't need to discourage family contact if the decedent has not been autopsied.

Casketing and viewing

Avoid unnecessary manipulation of the body that would force purging of body fluids and risk opening incision sites. If needed, the casket can be lined with a leakproof sheet.

You don’t need to prohibit an open casket viewing. However, if an autopsy has been performed, advise family members of the decedent to avoid contact with the body; this would include touching or kissing the patient’s face.

Terminal disinfection and waste disposal

CJD infection control guidelines advise disinfecting all collected fluids:

• Add 40 grams of sodium hydroxide pellets per liter of fluid.
• Stir the mixture after a few minutes. Avoid spilling the fluid as it will be hot.
• Leave it undisturbed for at least one hour.
• Dispose of it like other mortuary waste.

Further:

• Incinerate plastic sheets and other disposable items that have been exposed to body fluids.
• Flood mortuary working surfaces that have become contaminated with sodium hydroxide or bleach. Then, leave undisturbed for at least one hour.
• Don gloves and mop up the solution with absorbent disposable rags.
• Finally, swab the surface with water to remove any residual disinfectant solution.
• Use disposable instruments whenever possible.
• Reusable instruments and tools can be cleaned and disinfected using CDC's CJD sterilization protocols.

Waste disposal

• Dispose of all contaminated solid materials as hazardous waste.
• Dispose of body fluids/tissues and hazardous chemicals in accordance with funeral home policy and state and federal regulations.

Final disposition - cremation and burial

There are no special interment, entombment, inurnment, or cremation requirements for patients with CJD.

Interment of bodies in closed caskets does not present a significant risk of environmental contamination.

Cremated remains can be considered sterile as prions do not survive incineration-range temperatures.

Where to get more information

• World Health Organization infection control guidelines for transmissible spongiform encephalopathies. March 1999
• New York State Department of Health—Creutzfeldt-Jakob Disease Fact Sheet
• New York City Department of Health and Mental Hygiene—Information for Health Care Providers: Creutzfeldt-Jacob Disease (CJD)
• New York State Department of Health—Information on Creutzfeldt-Jakob Disease For Funeral Home, Cemetery, And Crematory Practitioners
• National Prion Disease Pathology Surveillance Center
  
• Creutzfeldt-Jakob Disease Foundation, Inc