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EDMUND G. BROWN JR.
Governor

State of California—Health and Human Services Agency
California Department of Public Health


AFL 20-24
March 16, 2020


TO:
All Facilities

SUBJECT:
Guidance for Procedures and Transfer of Deceased Persons with Confirmed or Suspected Coronavirus Disease 2019 (COVID-19)


All Facilities Letter (AFL) Summary

This AFL provides guidance for healthcare facilities for deceased persons with confirmed or suspected COVID-19, including transfer and postmortem procedures such as specimen collection and autopsy.

This AFL provides resources and guidance for healthcare facilities for deceased persons with confirmed or suspected COVID-19. COVID-19 is most often transmitted from a living person with close contact via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. This route of transmission is not a concern when handling human remains or performing postmortem procedures. Postmortem activities should be conducted with a focus on avoiding aerosol generating procedures.

Healthcare facilities should refer to the CDC Interim Guidance for Collection and Submission of Postmortem Specimens from Deceased Persons Under Investigation (PUI) for COVID-19, February 2020 for specific postmortem guidance.


General Guidelines

  • Provide workers with information and training on infectious disease risks, infection control practices, including use of personal protective equipment, respiratory protection, information about symptoms of COVID-19 illness, and how to report illness promptly.
  • Prevent unauthorized access to the morgue, autopsy room, and pathology laboratory.
  • Implement procedures for storage, disposal, and transportation of clinical and related waste, including sharps.
  • Provide adequate hand washing and drying facilities. Provide 60%-95% alcohol-based hand sanitizer tissues and no touch receptacles for disposal where hand washing facilities are not readily available.
  • Ensure workers avoid actions that may result in forceful expulsion of air from the body.
  • Decontaminate surfaces and equipment with appropriate disinfectants. Use any EPA-registered hospital disinfectant. Follow manufacturer's recommendations for use-dilution (i.e., concentration), contact time, and care in handling.


Postmortem Handling of Deceased Persons in Hospital Room

  • Follow standard precautions.
  • When lifting and moving the body, because of the possibility that air may be expelled from the body, the face of the deceased should be covered temporarily with a disposable surgical mask and placed in a body bag. Enclosing the deceased in a body bag also contains body fluids to prevent contact.


Guidance for Collection of Postmortem Specimens if an Autopsy is not Performed

If healthcare personnel (HCP) are not performing an autopsy or conducting aerosol generating procedures (AGPs), follow standard precautions. Individuals in the room during the procedure should be limited to HCP obtaining the specimen.

Personal Protective Equipment (PPE) Recommendations:

  • Wear nonsterile, nitrile gloves when handling potentially infectious materials.
  • Wear heavy-duty gloves over the nitrile gloves if there is a risk of cuts, puncture wounds, or other injuries that break the skin.
  • 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. If there is a risk of aerosol generation while handling human remains, use respiratory protection as specified in the OSHA general guidance.


Guidance for if an Autopsy is Performed

The CDC recommends standard precautions, contact precautions, and airborne precautions with eye protection (e.g., goggles or a face shield) be followed during autopsy of PUI for COVID-19.

PPE Recommendations:

  • Double surgical gloves interposed with a layer of cut-proof synthetic mesh gloves
  • Fluid-resistant or impermeable gown
  • Waterproof apron
  • Goggles or face shield
  • NIOSH-certified disposable N-95 respirator or higher
    • Powered, air-purifying respirators (PAPRs) with HEPA filters may provide increased worker comfort during extended autopsy procedures.
    • When respirators are necessary to protect workers, employers must implement a comprehensive respiratory protection program in accordance with the OSHA Respiratory Protection standard (29 CFR 1910.134) that includes medical exams, fit-testing, and training.


Guidance for the Transportation of Human Remains

The CDC recommends following standard routine procedures when transporting the body of a person with confirmed or suspected COVID-19.

After the body has been bagged:

  • Disinfect the outside of the bag with an Environmental Protection Agency (EPA) registered hospital disinfectant applied according to the manufacturer's recommendations.
  • Wear disposable nitrile gloves when handling the body bag.


Deathcare Workers

The United States Occupational Safety and Health Administration (OSHA), has issued COVID-19 guidance for deathcare workers, such as coroners, medical examiners, autopsy technicians, funeral directors, and other mortuary workers. Refer to the Deathcare Workers and Employers section of the OSHA COVID-19 Control and Prevention webpage for specific OSHA recommendations.


Reporting

When death or impending death from COVID-19 occurs, facilities must immediately call the local health department and local district office.

If you have any questions regarding the infection prevention and control of COVID-19, please contact the CDPH Healthcare-Associated Infections (HAI) Program at novelvirus@cdph.ca.gov.


Sincerely,

Original signed by Heidi W. Steinecker

Heidi W. Steinecker
Deputy Director

 

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