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Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta, GA 30333
for Disease Control and Prevention (CDC) is working with local and state
health departments and public health laboratories to test specimens from
humans and animals with suspect monkeypox infection. These interim recommendations
provide guidance to autopsy personnel and morticians on the safe handling
of human remains that may contain monkeypox virus.
procedures require adherence to standard precautions with use of appropriate
personal protective equipment (PPE) and facilities with appropriate safety
features. Mechanical devices used during autopsies can efficiently generate
fine aerosols that may contain infectious organisms. Thus, PPE should
include both protective garments and respiratory protection as outlined
personnel with up-to-date smallpox vaccination (within 3 years) should
participate in autopsy or mortuary care. If unvaccinated personnel must
be utilized, persons
without contraindications to vaccination are preferred. (217
preparation and transportation of human remains
who perform post-mortem care of the remains should wear PPE as recommended
for Standard, Contact
and Airborne precautions. The body should be prepared following routine
healthcare facility procedures for cleaning and containing body fluids,
then wrapped in a plastic shroud. Wrapping should be done in a manner
that prevents contamination of the outside of the shroud; a change of
gown and gloves may be necessary. If an autopsy will be performed, the
shrouded body should be placed on a mortuary stretcher and covered with
a clean linen sheet for transportation to the morgue. If the remains will
go directly to a mortuary, it should be placed in a body bag prior to
removal. Persons transporting prepared and covered human remains should
wear gloves but other PPE is not required.
protective equipment for autopsy personnel
who transfer the remains from the mortuary stretcher onto the autopsy
table should wear gowns and gloves. Personnel who perform or assist with
the autopsy should wear the following PPE as required for Standard and
Airborne Precautions in the autopsy setting.
garments: surgical scrub suit, surgical cap, impervious gown
with full sleeve coverage, eye and face protection (e.g., face shield),
shoe covers and double surgical gloves with an interposed layer of cut-proof
synthetic mesh gloves.
protection: N-95 or N-100 respirators; or powered air-purifying
respirators (PAPR) equipped with a high efficiency particulate air (HEPA)
filter. PAPR is recommended for any procedures that result in mechanical
generation of aerosols, e.g., use of oscillating saws. Autopsy personnel
who cannot wear N-95 respirators because of facial hair or other fit-limitations
should wear PAPRs.
Handling of protective equipment:
protective outer garments must be removed when leaving the immediate
autopsy area and discarded in appropriate laundry or waste receptacles,
either in an antechamber to the autopsy suite or immediately inside
the entrance if an antechamber is not available. Hands should be washed
upon glove removal.
and postmortem assessment of monkeypox cases, safety procedures should
Prevention of percutaneous injury:
all sharps should be carefully handled, including never recapping, bending
or cutting needles, and ensuring that appropriate sharps containers
The number and extent of procedures should be minimized, both to decrease
opportunities for worker risk, and to decrease potential for environmental
contamination. Perform autopsies only to the extent required to obtain
needed information, omitting examinations that generate aerosols and
increase the risk of environmental contamination, e.g., the use of oscillating
saws to open the skull.
strategies and facility design
Air handling systems:
autopsy suites must have adequate air-exchanges per hour and correct
directionality and exhaust of airflow. Autopsy suites should have a
minimum of 12 air-exchanges per hour and should be at a negative pressure
relative to adjacent passageways and office spaces. Air should not be
returned to the building interior, but should be exhausted outdoors,
away from areas of human traffic or gathering spaces (e.g., off the
roof) and away from other air intake systems. For autopsies, local airflow
control (i.e., laminar flow systems), can be used to direct aerosols
away from personnel; however, this safety feature does not remove the
need for appropriate personal protective equipment.
Doors and windows:
During autopsy, keep doors and windows to autopsy suite closed.
biosafety cabinets should be available for handling and examination
of smaller specimens. Oscillating saws are available with vacuum shrouds
to reduce the amount of particulate and droplet aerosols generated.
These devices should be used whenever possible to decrease the risk
of occupational exposure.
environmental contamination during the post-mortem procedure. Following
the procedure, thoroughly clean and disinfect all surfaces with 0.5% sodium
hypochlorite or other EPA-approved high level disinfectant. All reusable
autopsy equipment should be cleaned and disinfected according to standard
organs should be sampled. Particular attention and extensive sampling
should include tissues demonstrating gross pathology or involvement as
suggested by clinical presentation. Autopsy specimens should include:
nodes and tonsils
tissues in 10% buffered formalin for immunohistochemical or histopathologic
evaluation and keep at room temperature.
fragments of tissues listed above should be collected using sterile technique
and placed in a sterile 1.5-2 mL screw-capped plastic vial with O-ring.
Do not add transport medium. Refrigerate if
shipment occurs within 24 hours; otherwise, freeze specimen.
should be labeled and packaged for transport as described in the Instructions
for Packaging and Transport of Diagnostic Specimens for Monkeypox Laboratory
collection, all non-reusable specimen collection and
barrier protection materials should be placed biohazard bags for handling
as medical waste
care should be limited to necessary procedures following standard mortuary
garments: Impervious gown with full sleeve coverage, eye and
face protection (e.g. surgical mask and face shield), shoe covers and
double surgical gloves should be worn. An interposed layer of cut-proof
synthetic mesh gloves should be considered for additional injury protection.
of percutaneous injury: Use care when handling sharps to prevent
blood or body fluid exposure. Needles should never be recapped, bent
or cut. Sharps containers should be available.
Equipment and environmental decontamination:
Minimize environmental contamination during embalming. Following the
procedure, thoroughly clean contaminated areas of the environment with
0.5% sodium hypochlorite or other EPA-approved high-level disinfectant.
Reusable equipment used during embalming and other procedures for preparation
of the body should be cleaned and disinfected.
and morticians may direct questions that related to this and other related
CDC documents to the local or state health department or the CDC NCID
Pathology Activity at 404-639-3133.