Purpose
Practitioners at funeral homes, cemeteries, and crematories must balance dealing with infectious diseases while still serving families whose loved one has died. Dealing with patients who died of Creutzfeldt-Jakob Disease (CJD) is no exception. Safety measures can help protect staff while taking care of the decedent and their family.
Background
CJD is not spread between people by normal contact or through environmental contamination. For example, it is not spread by airborne droplets or by blood or sexual contact as other diseases are.
Standard disinfection procedures and routine embalming solutions are ineffective against prions, infectious proteins that cause CJD. However, studies show that chemical solutions and physical processes involving bleach, sodium hydroxide, or autoclaving can inactivate prions.
It is important to protect yourself and your staff as you transport and prepare the bodies of people who had CJD.
If the bodies of CJD patients weren't autopsied, funeral preparation activities can be safely performed with strict adherence to standard precautions. These activities include transportation, preparation, disinfection, and final disposition.
Transporting
Funeral service workers can safely transport the CJD patient's body from the place they died to the funeral home. Workers should use appropriate standard infection control measures, including wearing personal protective gear.
The World Health Organization (WHO) recommends placing the body in a leak-proof pouch prior to moving. The bag should be lined with absorbent material to prevent leakage of body fluids. If there is excess fluid, a double bag can be utilized. After transporting, all surfaces (i.e. stretchers, cots) should be disinfected with bleach.
Preparation and dressing
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.
CJD patients who have not been autopsied or whose bodies have not been traumatized can be embalmed using standard precautions.
Family members should be advised to avoid contact with the CJD patient's body if they were autopsied. This includes touching or kissing their loved one's face. However, if the patient has not been autopsied, such contact does not need to be discouraged.
Embalming bodies not autopsied
Embalming bodies of CJD patients who have not been autopsied can be performed using standard precautions.
However, it may be prudent to place the body on a waterproof sheet to collect bodily fluids and use disposable instruments. The bodily fluids should be collected in a suitable container.
Incision sites should be closed with super glue, wiped down with bleach and the body washed prior to dressing. Cosmetic restorative work may also be undertaken.
Embalming bodies autopsied
Embalming bodies of CJD patients who have been autopsied can also be safely performed. Adherence to standard infection control measures is paramount when embalming an autopsied body of a suspected or clinically-diagnosed CJD patient.
Autopsies on these individuals are often restricted to removal of the brain. Therefore, special precautions should be taken including placing a plastic sheet with absorbent wadding and raised edges underneath the head. This will ensure containment of fluids and prevent any spillage.
If sutures do not control leaking, pack the cranial cavity with absorbent material soaked with bleach, and tightly suture.
Bodies of autopsied CJD patients
Bodies of autopsied CJD patients should be placed on a waterproof sheet to collect all fluids.
It is strongly recommended that disposable instruments, masks, gowns, and puncture resistant gloves be used whenever possible.
The entire body should be washed with bleach, rinsed, and sanitized before dressing.
Special care should be taken to limit fluid leakage when performing restorative work on a CJD patient. All fluids should be collected in a suitable container.
Casketing and viewing
Avoid unnecessary manipulation of the body that would force purging of body fluids and risk opening of incision sites. If warranted, the casket can be lined with a leak proof sheet.
An open casket for viewing should not be prohibited. However, if an autopsy has been performed, family members of CJD patients should be advised to avoid contact with the body. This would include touching or kissing the patient’s face.
Terminal disinfection and waste removal
According to WHO guidelines, disinfect all collected fluids by adding 40 grams of sodium hydroxide pellets per liter of fluid. Stir the mixture after a few minutes. Be careful to avoid spilling the fluid, as it will be hot. Leave it undisturbed for at least one hour. Then, dispose of it like other mortuary waste.
Plastic sheets and other disposable items that have been exposed to bodily fluids should be incinerated.
Mortuary working surfaces that have become contaminated should be flooded with sodium hydroxide or bleach. Then, leave undisturbed for at least one hour. Then don gloves and mop up with absorbent, disposable rags. Finally, swab the surface with water needed to remove any residual disinfectant solution.
Use of disposable instruments is preferred. However, reusable instruments and tools can be cleaned and disinfected by using CDC's CJD sterilization protocols.
All contaminated solid materials should be disposed of as hazardous waste. Dispose of body fluids/tissues and hazardous chemicals in accordance with funeral home policy, 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 the infectious agent does 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
- Brown P, Lamb G. CJD and the Mortuary Profession. The Director March 2000.
- Metropolitan Funeral Directors Association 1998. Creutzfeldt-Jakob disease: A Practical Guide for the Embalmer.
- Crain B. Creutzfeldt-Jakob disease: Safety tips for anatomic studies of possible CJD. College of American Pathologists Today, January 1996.