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COVID-19 Update

Posted By: Michele Hood News ,

COVID-19 Resource Page 

We have linked many of the resources that we and other organizations have created to help funeral directors and their communities.  Click on the title above to be brought directly to the resource page.

UPDATE 9/25/2020

This afternoon, Governor DeSantis issued an Order to implement Phase 3 reopening of Florida IMMEDIATELY. Please click on the button below for more information on the Governor's Order. If you have any questions about the impact of the order on your business, please contact your county and local governments for any mandates.

Click here to read Governor DeSantis Executive Order #20-244 Phase 3 Reopening 2020-09-25

Click here for more information on Governor DeSantis's 9/25/2020 Order to begin Phase 3 IMMEDIATELY

UPDATE 7/10/2020

The CDC recommends the use of cloth face coverings for all individuals over the age of 2, and maintaining social distancing of 6 feet apart. This is particularly important indoors where there is less air movement and the re-circulation of air in this setting. For out of doors services, face masks and physical distancing of 6' is still recommended,

CDC Guidance for funeral services

UPDATE 6/05/2020

Governor DeSantis's Phase 2 Reopening Plan

Funeral Homes were not specifically listed as either retail establishments or large venues. All persons in Florida are encouraged to avoid congregating in groups larger than 50 people and continue to use appropriate physical distancing, protocols and sanitation, and use of masks are recommended. 

UPDATE 5/15/2020

Governor DeSantis's Full Phase 1 Infographic Presentation on 5-15-2020

UPDATE 4/30/2020

As a follow-up to the 4/28/2020 update, the Division of Funeral, Cemetery, and Consumer Services has finalized the PPE distribution process by the Division of Emergency Management. Funeral establishments, direct disposal establishments, cinerator facilities, centralized embalming facilities, cemeteries, refrigeration facilities, and removal facilities which are licensed under Chapter 497 of the Florida Statutes, may request personal protective equipment from Florida's Division of Emergency Management. The Division of Funeral, Cemetery, and Consumer Services will review and assist in coordinating licensees' PPE requests with the Division of Emergency Management. 

Instructions for requesting PPE from the Division of Emergency Management

Licensees will need to use the COVID-19 Emergency Requisition Form created specifically for Chapter 497 Licensees. Please submit this form electronically to the Division of Funeral, Cemetery, and Consumer Services at Mary.Schwantes@myfloridacfo.com. At this time, only emailed submissions can be accepted and reviewed.

COVID-19 Emergency Requisition Request Form for Personal Protective Equipment (PPE) For use by Chapter 497 Licensees

UPDATE 4/29/2020

On April 29, 2020, Governor DeSantis issued Executive Order #20-112 to begin the process of reopening Florida amid the pandemic. You can view Executive Order #20-112 here.

The Florida Government issued a fact sheet on the order, and you can view it here: Executive Order #20-112 FAQs

View the Governor's Safe. Smart. Step-by-Step: Plan for Florida's Recovery

UPDATE 04/28/2020

The IFDF has been working together with the Division of Funeral, Cemetery & Consumer Services (FCCS); the Department of Emergency Management (DEM); the Department of Health (DOH); and the other state associations, FCCFA, FMA, FMBA to obtain PPE for funeral, cemetery & cremation personnel.
We will be meeting again this afternoon to finalize the process. You will be required exhaust efforts to obtain PPE in the marketplace, however when your normal providers supplies are exhausted, you will be able to submit a request called a "mission" to the Division, on a prescribed form.
The PPE will be distributed to the DEM Region closest to you. A designated contact in each region will be notified when there is an mission to be fulfilled and arrange for you to pick up your PPE from a designated funeral related contact. In some regions, deliveries or group pick ups may be arranged. As soon as these details are complete, we will email them out to our mailing list. If you would like to be included, and do not already have a user profile, please create one here.

UPDATE 04/22/2020

CFO Issues Exective Order Effective Immediately
  • Allows cremating any dead human body prior to the expiration of 48 hours after the death of such human body during the state emergency. The medical examiner must approve, however you may cremate immediately upon receiving that approval.
  • Allows the use of a cremation, refrigeration, embalming, or removal services, that exceeds the 75 mile distance requirement so long as the cremation, refrigeration, embalming or removal service is licensed pursuant to Chapter 497, Florida Statutes.
  • Allows the Division of Funeral, Cemetery, and Consumer Services to issue limited licensure to retired professionals who were once licensed, in any state, as a funeral director, embalmer, combined funeral director and embalmer, or direct disposer during this time of critical need, as provided in s. 497.143, Florida Statutes. Provided, such retired professionals held such licensure in any state for a period of five years or more.
This order goes into effect immediately and shall expire upon the expiration of Executive Order 20-52, including any extensions thereof.
Read the order here

UPDATE 04/09/2020

We have updated the EOC Contacts list from our 04/06/2020 list below.

 The Department of Financial Services, Division of Funeral, Cemetery & Consumer Services has been working to assist funeral licensees thorugh the coronavirus pandemic. Following is an update from Division Director Mary Schwantes:

  • Yesterday, DCFO Jay Etheridge, Ellen Simon and I shared with DFS representatives assigned to the State Emergency Operations Center (SEOC) the industry’s concerns regarding PPE, including a list of the six counties which have been denying PPE requests to funeral service personnel.  Please continue to let me know of any counties which are denying PPE requests so that I can continue to share that information.  Even though these involve issues outside the Division’s authority, I have also provided them with a copy of the attached and asked for their possible assistance on the multi-jurisdictional issues identified on pages 3-4.  I will let you know if/when I receive feedback on these matters from our SEOC representatives.

 

  • The Department provided the Governor’s office with a proposed Executive Order for his consideration regarding deathcare issues.  If entered, at a minimum, the order is expected to address issues involving the 48-hour waiting period for cremation, PPE prioritization, the use of retired funeral professionals, and the 75-mile restrictions on the distance between funeral, refrigeration, and cinerator establishments.  Again, I will let you know if/when we receive information regarding any order.

 

As to other items which are potentially within the authority of this Division and/or the Board of Funeral, Cemetery, and Consumer Services:

 

Inspections required for new establishments, change of ownership, or physical changes at a facility (renovation changes, etc.):

  • The Division will continue to recommend that the Board consider a ruling similar to the following for each matter for which an inspection is required as a condition for licensure or similar approval:

Taking into consideration the March 9, 2020, Executive Order Number 20-52 which was issued by Ron DeSantis, as Governor of Florida, and pursuant to Section 497.103(8), Florida Statutes, the usual satisfactory on-site inspection requirement for this application is temporarily waived throughout the length and duration of Executive Order Number 20-52 or any extensions thereof, or any other executive order by the Governor of the State of Florida declaring a State of Emergency regarding the COVID-19 pandemic.  At the Division’s discretion, an on-site inspection will be held prior to or within a reasonable time following the expiration of the Emergency Order. The applicant will have 30 days following the initial inspection to correct deficiencies, if any, which are noted during the inspection.  If the applicant is not able to correct any deficiencies within that timeframe,  the license is automatically suspended.

 

Internship extensions:

  • At the recommendation of the Division and Board Counsel, the Board ruled that:

All internship licenses granted licensure pursuant to sections 497.370, 497.375, and 497.377, Florida Statutes, which are valid as of March 9, 2020, are extended throughout the length and duration of the Executive Order Number 20-52.  As has always been the case, the continued employment of the intern is at the discretion of the licensed training facility.

 

Utilization of retired funeral directors:

  • This is one of the issues we hope will be addressed in an Executive Order from the Governor as above indicated.  If it is not addressed in that fashion, we will review the issue again to determine other available options for shortening the amount of time it would take for these professionals to obtain temporary licensure.

 

Timely approval of licensure applications, particularly those of professionals seeking licensure by endorsement

  • To my knowledge, licensing applications continue to be timely processed by FCCS staff, even during this COVID-19 pandemic.  If any of you have specific problems or concerns regarding these issues, please contact me directly – and as soon as possible - so that I can look into the situation further.  Of course, licensing remains subject to Board approval.  If it becomes necessary for the Board to meet more frequently than once a month to address such matters during this pandemic, we can consider that option.  However, we would need more information or specific examples of problems in order to better address that possibility.

UPDATE 04/06/2020

DOH Emergency Operations ESF#8

The Florida Department of Health, Emergency Operations Center, Emergency Support Function 8 pertains to Public Health and Medical. Funeral Service falls within the scope of this emergency Support Function. The requisition form linked here can be used by licensed funeral providers to request PPE. It should be returned to your local county Emergency Operations Center Contacts The linked excel spreadsheet includes all of the information we have been able to gather thus far. If you have questions about specific requests, please contact them directly.

UPDATE 04/01/2020

Projections for course of COVID-19 Cases

Executive Order from Governor Ron Desantis

What Executive Order Means

 

UPDATE 03/24/2020

 

We have posted the call with the Surgeon General's Office here

UPDATE 03/21/2020

IFDF has secured a call with the Florida Surgeon General's office for Monday, March 23 at 10:45 am. the call will focus on COVID-19 considerations relating to funeral and cemetery providers. Dial in instructions were emailed out and are available in your member compass. If you need assistance logging in, please email here before Monday. Participation is limited to the first 300 callers and will be first come, first served. We will also be live streaming the event on our Facebook page.

UPDATE 03/20/2020

Division of Funeral, Cemetery & Consumer Services Updates

UPDATE 03/19/2020

National Funeral Directors Free Event, Friday March 20, 2020 at 10:00 am EDT

Guidance for Operations During COVID-19 Pandemic

UPDATE 03/17/2020

Governor Ron DeSantis activated the Florida Small Business Emergency Bridge Loan Program to support small businesses impacted by COVID-19. The bridge loan program, managed by the Florida Department of Economic Opportunity (DEO), will provide short-term, interest-free loans to small businesses that experienced economic injury from COVID-19. The application period opens tomorrow, March 17, 2020 and runs through May 8, 2020.

Governor DeSantis Activates Emergency Bridge Loans for Small Businesses

UPDATE 03/16/2020

CDC Officials took part in a Facebook Live webinar posted by NFDA. You can review that recording here

IFDF has created a statement that members may wish to customize and post to their funeral home website to let their families know they are taking precautions. Please login to your Member Compass for a copy of this text.

Frequently Asked Questions about COVID-19 and Funerals, as provided by CDC

Large Event Recommendations

Funeral Home COVID-19 Policy Samples

 

Published 03/10/2020

The CDC has advised that funeral directors should follow the same protocols as Autopsy for handling decedents who are infected with COVID-19. We are currently working with Florida's Surgeon General on a meeting to discuss additional concerns about making removals, especially from home environments where COVID-19 is suspected as a cause of death. Family members exposed to COVID-19 may be infectious for 9-14 days after contact. 

The IFDF has asked the Florida Surgeon General’s Office to brief all associations in the funeral/cemetery profession on COVID-19 virus. Unlike the HIV virus, this virus lives on surfaces, and is contagious to those who may have come in contact with surfaces and family members for up to 14 days. This has immediate impact on removals, bodies, clothing, health equipment, etc., of those handling deaths from the virus. We will keep you informed about the pending meeting and the recommendations.   
Interim Guidance for Collection and Submission of Postmortem Specimens from Deceased Persons Under Investigation (PUI) for COVID-19, February 2020 (CDC)

State and local health departments who have identified a Persons Under Investigation (PUI) should immediately notify CDC’s Emergency Operations Center (EOC) at 770-488-7100 to report a deceased PUI and determine whether testing for SARS-CoV-2, the virus that causes COVID-19, at CDC is indicated. The EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays.

CDC is available for urgent consultation in the event that an autopsy on a COVID-19 PUI is being considered. CDC can be reached for urgent consultation by calling the EOC at 770-488-7100.

This interim guidance is based on what is currently known about COVID-19. The Centers for Disease Control and Prevention (CDC) will update this interim guidance as needed and as additional information becomes available.

The CDC is closely monitoring an outbreak of respiratory illness caused by a novel (new) coronavirus (named SARS-CoV-2); this illness is now called coronavirus disease 2019 or COVID-19. This virus was first identified in Wuhan, Hubei Province, China and it continues to spread. CDC is working across the Department of Health and Human Services and other parts of the U.S. government in the public health response to COVID-19.

Much is unknown about COVID-19. Current knowledge is largely based on what is known about similar coronaviruses. Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Rarely, animal coronaviruses can infect people and then spread between people such as with MERS-CoV, SARS-CoV, and now with SARS-CoV-2, the virus that causes COVID-19. Most often, spread from a living person happens with close contact (i.e., within about 6 feet) 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, and ensuring that if aerosol generation is likely (e.g., when using an oscillating saw) that appropriate engineering controls and personal protective equipment (PPE) are used. These precautions and the use of Standard Precautions should ensure that appropriate work practices are used to prevent direct contact with infectious material, percutaneous injury, and hazards related to moving heavy remains and handling embalming chemicals.

This document provides specific guidance for the collection and submission of postmortem specimens from deceased persons under investigation (PUI) for COVID-19. This document also provides recommendations for biosafety and infection control practices during specimen collection and handling, including during autopsy procedures. The guidance can be utilized by medical examiners, coroners, pathologists, other workers involved in the postmortem care of deceased PUI, and local and state health departments.

The following factors should be considered when determining if an autopsy will be performed for a deceased PUI: medicolegal jurisdiction, facility environmental controls, availability of recommended personal protective equipment (PPE), and family and cultural wishes.

If an autopsy is performed, collection of the following postmortem specimens is recommended:

  • Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19:
    • Upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
    • Lower respiratory tract swab: Lung swab from each lung
  • Separate clinical specimens for testing of other respiratory pathogens and other postmortem testing as indicated
  • Formalin-fixed autopsy tissues from lung, upper airway, and other major organs

If an autopsy is NOT performed, collection of the following postmortem specimens is recommended:

  • Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19, to include only upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
  • Separate NP swab and OP swab specimens for testing of other respiratory pathogens

Detailed guidance for postmortem specimen collection can be found in the section:  Collection of Postmortem Clinical and Pathologic Specimens.

In addition to postmortem specimens, submission of any remaining clinical specimens (e.g., NP swab, OP swab, sputum, serum, stool) that may have been collected prior to death is recommended. Please refer to Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 (COVID-19) for more information.

Recommended Biosafety and Infection Control Practices

Collection of Postmortem Upper Respiratory Tract Swab Specimens

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

Engineering Control Recommendations:

Since collection of nasopharyngeal and oropharyngeal swab specimens from deceased persons will not induce coughing or sneezing, a negative pressure room is not required. Personnel should adhere to Standard Precautions as described above.

PPE Recommendations:

The following PPE should be worn at a minimum:

  • Wear nonsterile, nitrile gloves when handling potentially infectious materials.
  • If there is a risk of cuts, puncture wounds, or other injuries that break the skin, wear heavy-duty gloves over the nitrile gloves.
  • 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.

Autopsy Procedures

Standard Precautions, Contact Precautions, and Airborne Precautions with eye protection (e.g., goggles or a face shield) should be followed during autopsy. Many of the following procedures are consistent with existing guidelines for safe work practices in the autopsy setting; see Guidelines for Safe Work Practices in Human and Animal Medical Diagnostic Laboratories.

  • AGPs such as use of an oscillating bone saw should be avoided for confirmed or suspected cases of COVID-19. Consider using hand shears as an alternative cutting tool. If an oscillating saw is used, attach a vacuum shroud to contain aerosols.
  • Allow only one person to cut at a given time.
  • Limit the number of personnel working in the autopsy suite at any given time to the minimum number of people necessary to safely conduct the autopsy.
  • Limit the number of personnel working on the human body at any given time.
  • Use a biosafety cabinet for the handling and examination of smaller specimens and other containment equipment whenever possible.
  • Use caution when handling needles or other sharps, and dispose of contaminated sharps in puncture-proof, labeled, closable sharps containers.
  • A logbook including names, dates, and activities of all workers participating in the postmortem and cleaning of the autopsy suite should be kept to assist in future follow up, if necessary. Include custodian staff entering after hours or during the day.

Engineering Control Recommendations

Autopsies on decedents with known or suspected COVID-19 should be conducted in Airborne Infection Isolation Rooms (AIIRs). These rooms are at negative pressure to surrounding areas, have a minimum of 6 air changes per hour (ACH) for existing structures and 12 ACH for renovated or new structures, and have air exhausted directly outside or through a HEPA filter. Doors to the room should be kept closed except during entry and egress. If an AIIR is not available, ensure the room is negative pressure with no air recirculation to adjacent spaces. A portable HEPA recirculation unit could be placed in the room to provide further reduction in aerosols. Local airflow control (i.e., laminar flow systems) can be used to direct aerosols away from personnel. If use of an AIIR or HEPA unit is not possible, the procedure should be performed in the most protective environment possible. Air should never be returned to the building interior, but should be exhausted outdoors, away from areas of human traffic or gathering spaces and away from other air intake systems.

PPE Recommendations:

The following PPE should be worn during autopsy procedures:

  • 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 1910.134external icon) that includes medical exams, fit-testing, and training.

Surgical scrubs, shoe covers, and surgical cap should be used per routine protocols. Doff (take off) PPE carefully to avoid contaminating yourself and before leaving the autopsy suite or adjacent anteroom (https://www.cdc.gov/hai/pdfs/ppe/ppe-sequence.pdfpdf icon).

After removing PPE, discard the PPE in the appropriate laundry or waste receptacle. Reusable PPE (e.g., goggles, face shields, and PAPRs) must be cleaned and disinfected according to the manufacturer’s recommendations before reuse. Immediately after doffing PPE, wash hands with soap and water for 20 seconds. If hands are not visibly dirty and soap and water are not available, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water before using alcohol-based hand sanitizer. Avoid touching the face with gloved or unwashed hands. Ensure that hand hygiene facilities are readily available at the point of use (e.g., at or adjacent to the PPE doffing area).

Additional safety and health guidance is available for workers handling deceased persons under investigation (PUI) for COVID-19 at the Occupational Safety and Health Administration (OSHA), COVID-19 websiteexternal icon.

Collection of Postmortem Clinical and Pathologic Specimens

Implementing proper biosafety and infection control practices is critical when collecting specimens. Please refer to Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus Disease 2019 (COVID-19) for additional information.

Collection of Postmortem Clinical Specimens for SARS-CoV-2 Testing

CDC recommends collecting and testing postmortem upper respiratory specimens (nasopharyngeal and oropharyngeal swabs) and, if an autopsy is performed, lower respiratory specimens (lung swabs).

Use only synthetic fiber swabs with plastic shafts. Do not use calcium alginate swabs or swabs with wooden shafts, as they may contain substances that inactivate some viruses and inhibit PCR testing. Place swabs immediately into sterile tubes containing 2-3 ml of viral transport media. NP, OP, and lung swab specimens should be kept in separate vials. Refrigerate specimen at 2-8°C and ship overnight to CDC on ice pack.

Upper Respiratory Tract Specimen Collection: Nasopharyngeal Swab AND Oropharyngeal Swabs (NP swab, OP swab)

  • Nasopharyngeal swab: Insert a swab into the nostril parallel to the palate. Leave the swab in place for a few seconds to absorb secretions. Swab both nasopharyngeal areas with the same swab.
  • Oropharyngeal swab (e.g., throat swab): Swab the posterior pharynx, avoiding the tongue.

Lower respiratory tract: Lung swabs

  • Collect one swab from each lung.

Collection of Postmortem Clinical Specimens for Other Routine Diagnostic Testing

Separate clinical specimens (e.g., NP swab, OP swab, lung swabs) should be collected for routine testing of respiratory pathogens at either clinical or public health labs. Note that clinical laboratories should NOT attempt viral isolation from specimens collected from COVID-19 PUIs.

Other postmortem specimen collection and evaluations should be directed by the decedent’s clinical and exposure history, scene investigation, and gross autopsy findings, and may include routine bacterial cultures, toxicology, and other studies as indicated.

Collection of Fixed Autopsy Tissue Specimens

The preferred specimens would be a minimum of eight blocks and fixed tissue specimens representing samples from the respiratory sites listed below in addition to specimens from major organs (including liver, spleen, kidney, heart, GI tract) and any other tissues showing significant gross pathology.

The recommended respiratory sites include:

  1. Trachea (proximal and distal)
  2. Central (hilar) lung with segmental bronchi, right and left primary bronchi
  3. Representative pulmonary parenchyma from right and left lung

Viral antigens and nucleic acid may be focal or sparsely distributed in patients with respiratory viral infections and are most frequently detected in respiratory epithelium of large airways. For example, larger airways (particularly primary and segmental bronchi) have the highest yield for detection of respiratory viruses by molecular testing and immunohistochemistry (IHC) staining. Performance of specific immunohistochemical, molecular, or other assays will be determined using clinical and epidemiologic information provided by the submitter and the histopathologic features identified in the submitted tissue specimens.

Collection of tissue samples roughly 4-5 mm in thickness (i.e., sample would fit in a tissue cassette) is recommended for optimal fixation. The volume of formalin used to fix tissues should be 10x the volume of tissue. Place tissue in 10% buffered formalin for three days (72 hours) for optimal fixation.

Safely Preparing the Specimens for Shipment

After collecting and properly securing and labeling specimens in primary containers with the appropriate media/solution, they must be transferred from the autopsy suite in a safe manner to laboratory staff who can process them for shipping.

  1. Within the autopsy suite, primary containers should be placed into a larger secondary container.
  2. If possible, the secondary container should then be placed into a resealable plastic bag that was not in the autopsy suite when the specimens were collected.
  3. The resealable plastic bag should then be placed into a biological specimen bag with absorbent material; and then can be transferred outside of the autopsy suite.
    1. Workers receiving the biological specimen bag outside the autopsy suite or anteroom should wear disposable nitrile gloves.

Submission of Specimens to CDC

State and local health departments who have identified a PUI should immediately notify CDC’s Emergency Operations Center (EOC) at 770-488-7100 to report a deceased PUI and determine whether SARS-CoV-2, the virus that causes COVID-19, testing at CDC is indicated. The EOC will assist local/state health departments to collect, store, and ship specimens appropriately to CDC, including during afterhours or on weekends/holidays.

Submission of Postmortem Clinical Specimens for SARS-CoV-2 Testing

This section applies to submission of postmortem NP swab, OP swab, and lung swabs

  • Store specimens at 2-8°C and ship overnight to CDC on ice pack.
  • Label each specimen container with the patient’s ID number (e.g., medical record number), unique specimen ID (e.g., laboratory requisition number), specimen type (e.g., tissue), and the date the sample was collected.
  • Complete a CDC Form 50.34 for each specimen submitted.
  • In the upper left box of the form provide the following: (1) for test requested select “Respiratory virus molecular detection (non-influenza) CDC-10401” and (2) for At CDC, bring to the attention of enter “Stephen Lindstrom: 2019-nCoV PUI – Autopsy specimens”.

Clinical specimens from COVD-19 PUIs must be packaged, shipped, and transported according to the current edition of the International Air Transport Association (IATA) Dangerous Goods Regulationsexternal icon. Store specimens at 2-8°C and ship overnight to CDC on ice pack. If a specimen is frozen at -70°C ship overnight to CDC on dry ice. Additional useful and detailed information on packing, shipping, and transporting specimens can be found at Interim Laboratory Biosafety Guidelines for Handling and Processing Specimens Associated with Coronavirus 2019 (COVID-19).

Submission of Fixed Autopsy Tissue Specimens

CDC’s Infectious Diseases Pathology Branch will perform histopathologic evaluation; testing for SARS-CoV-2, as well as other respiratory viral pathogens (e.g., influenza); and bacterial and other infections, as indicated.

Paraffin-embedded tissue blocks

In general, this is the preferred specimen and is especially important to submit in cases where tissues have been in formalin for a significant time. Prolonged fixation (>2 weeks) may interfere with some immunohistochemical and molecular diagnostic assays.

Wet tissue

If available, we highly recommend that unprocessed tissues in 10% neutral buffered formalin be submitted in addition to paraffin blocks.

Requirements for submitting fixed tissues to CDC

  1. Contact CDC’s Infectious Diseases Pathology Branch at pathology@cdc.gov who will provide a pre-populated CDC Form 50.34 for your convenience. Include in the email:
    1. A brief clinical history
    2. A description of gross or histopathologic findings in the tissues to be submitted
  2. After you receive email approval from pathology@cdc.gov:
    1. Electronically fill, save, and print both pages of the CDC Form 50.34.
    2. In the upper left box of the form, Select Test Order Code CDC-10365 (“Pathologic Evaluation of Tissues for Possible Infectious Etiologies”)
    3. Enter “COVID-19 PUI” and provide any applicable CDC and State Case ID numbers in the Comments section on Page 2 of the CDC 50.34 form.
    4. In addition to the CDC 50.34 form, enclose the following in the specimen submission package:
      1. Surgical pathology, autopsy report (preliminary is acceptable), or both
      2. Relevant clinical notes, including admission History and Physical (H&P), discharge summary, if applicable
  3. Mailing/Contact Info:
    1. Formalin-fixed wet tissues and/or formalin-fixed paraffin-embedded tissue blocks should be shipped in suitable packaging at ambient temperatureDo not freeze fixed tissues.
    2. Ship to: Dr. Sherif Zaki, CDC, IDPB, 1600 Clifton Rd NE, MS: H18-SB, Atlanta, GA 30329-4027
    3. Send tracking number to pathology@cdc.gov
    4. Tel: 404-639-3132, Fax: 404-639-3043, Email: pathology@cdc.gov

Cleaning and Waste Disposal Recommendations

The following are general guidelines for cleaning and waste disposal following an autopsy of a decedent with confirmed or suspected COVID-19. The surface persistence of SARS-CoV-2 is uncertain at this time. Other coronaviruses such as those that cause MERS and SARS can persist on nonporous surfaces for 24 hours or more.

Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an Environmental Protection Agency (EPA)-registered, hospital-grade disinfectant for appropriate contact times as indicated on the product’s label) are appropriate for COVID-19 in these settings.

After an autopsy of a decedent with confirmed or suspected COVID-19 , the following recommendations apply for the autopsy room (and anteroom if applicable):

  • Keep ventilation systems active while cleaning is conducted.
  • Wear disposable gloves recommended by the manufacturer of the cleaner or disinfectant while cleaning and when handling cleaning or disinfecting solutions.
    • Dispose of gloves if they become damaged or soiled and when cleaning is completed, as described below. Never wash or reuse gloves.
  • Use eye protection, such as a faceshield or goggles, if splashing of water, cleaner/disinfectant, or other fluids, is expected.
  • Use respiratory protection if required on cleaner or disinfectant label.
  • Ensure workers are trained on OSHA’s Hazard Communication standard, 29 CFR 1910.1200external icon, to communicate with workers about the hazardous chemicals used in the workplace.
  • Wear a clean, long-sleeved fluid-resistant gown to protect skin and clothing.
  • Use disinfectants with EPA-approved products with label claims against human coronaviruses. All products should be used according to label instructions.
    • Clean the surface first, and then apply the disinfectant as instructed on the disinfectant manufacturer’s label. Ensure adequate contact time for effective disinfection.
    • Adhere to any safety precautions or other label recommendations as directed (e.g., allowing adequate ventilation in confined areas and proper disposal of unused product or used containers).
    • Avoid using product application methods that cause splashing or generate aerosols.
    • Cleaning activities should be supervised and inspected periodically to ensure correct procedures are followed.
  • Do not use compressed air and/or water under pressure for cleaning, or any other methods that can cause splashing or might re-aerosolize infectious material.
  • Gross contamination and liquids should be collected with absorbent materials, such as towels, by staff conducting the autopsy wearing designated PPE. Gross contamination and liquids should then be disposed of as described below:
    • Use of tongs and other utensils can minimize the need for personal contact with soiled absorbent materials.
    • Large areas contaminated with body fluids should be treated with disinfectant following removal of the fluid with absorbent material. The area should then be cleaned and given a final disinfection.
    • Small amounts of liquid waste (e.g., body fluids) can be flushed or washed down ordinary sanitary drains without special procedures.
    • Hard, nonporous surfaces may then be cleaned and disinfected as described above.
  • Follow standard operating procedures for the containment and disposal of used PPE and regulated medical waste. SARS-CoV-2 is not considered a Category A infectious substance. State and local governments should be consulted for appropriate disposal decisions.
  • Dispose of human tissues according to routine procedures for pathological waste.
  • Clean and disinfect or autoclave non-disposable instruments using routine procedures, taking appropriate precautions with sharp objects.
  • Materials or clothing that will be laundered can be removed from the autopsy suite (or anteroom, if applicable) in a sturdy, leak-proof biohazard bag that is tied shut and not reopened. These materials should then be sent for laundering according to routine procedures.
  • Wash reusable, non-launderable items (e.g., aprons) with detergent solution, decontaminate using disinfectant, rinse with water, and allow items to dry before next use.
  • Keep camera, telephones, computer keyboards, and other items that remain in the autopsy suite (or anteroom, if applicable) as clean as possible, but treat as if they are contaminated and handle with gloves. Wipe the items with appropriate disinfectant after use. If being removed from the autopsy suite, ensure complete decontamination with appropriate disinfectant according to the manufacturer’s recommendations prior to removal and reuse.
  • When cleaning is complete and PPE has been removed, wash hands immediately with soap and water for 20 seconds. If hands are not visibly dirty and soap and water are not available, an alcohol-based hand sanitizer that contains 60%-95% alcohol may be used. However, if hands are visibly dirty, always wash hands with soap and water before using alcohol-based hand sanitizer. Avoid touching the face with gloved or unwashed hands. Ensure that hand hygiene facilities are readily available at the point of use (e.g., at or adjacent to the PPE doffing area).

Transportation of Human Remains

Follow standard routine procedures when transporting the body after specimens have been collected and the body has been bagged. Disinfect the outside of the bag with an EPA-registered hospital disinfectant applied according to the manufacturer’s recommendations. Wear disposable nitrile gloves when handling the body bag.

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