high-risk autopsy

high-risk autopsy

A term of art for a postmortem examination of a decedent who had, or is likely to have had, a serious infectious disease that can be transmitted to those present at the autopsy, thereby causing them serious illness and/or premature death. These include Hazard Group 3 pathogens. Autopsies on Hazard Group 4 pathogens (e.g., viral haemorrhagic fever agents) are prohibited in the UK as there are no HG 4-designated mortuaries.

Agents
Mycobacterium tuberculosis, blood-borne hetatitides (HBV, HCV, HIV), transmissible spongiform encephalopathy agents, including Creutzfeldt-Jakob agent; all retain their infectiousness after death.

Utility of performing
Teaching and learning tool, monitoring drug efficacy and toxicity, establishment and maintenance of tissue banks.

Special considerations for high-risk autopsies
• Opening of cranial cavity generates infective dusts—consider opening within a plastic bag.
• Minimise fluid spillage by performing autopsy within a body bag.
• Disposable instruments and equipment should be used when possible.
• Consider sampling tissues in situ.
• Decontamination of instrument may require special techniques.
• Maintain set of instruments for use only on high-risk autopsies.

Risk reduction, high risk autopsy
• Immunisation—tetanus, poliomyelitis, tuberculosis, HBV.
• Pre-autopsy testing, if decedent is suspected of having a Hazard Group 3 pathogen.
• Clothing—protective gear, including cap and hood that covers the hair, eye protection, face mask, microfilter mask for suspected TB, waterproof boots (ideally with steel toecaps), double or triple glove with a mesh-layer sandwich; however, overly cumbersome clothing may itself present a hazard.
• Aerosol formation—down draught ventilation; open intestines under water; the biggest concern is dust from bone saws.
• Equipment: pointed scissors and acutely angled blades should not be used; sharp instruments should not be passed hand to hand; disposable instruments should be used for spongiform encephalopathies.
• Circulators—the pathologist and technician eviscerating the body are considered contaminated, whereas the circulator (who labels the specimens, adjusts the lighting, takes phone calls, and monitors the pathologist and technician to ensure that they’re following health and safety guidelines) is “clean”.
• Safe sharps practice—open ribs with saw to reduce risk of jagged injuries; consider closing with staples as opposed to sutures.
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References in periodicals archive ?
The guidelines for digital protection during high-risk autopsy cases include wearing double latex, heavy latex, chain mail, fine mesh metallic, and Kevlar gloves.[3,8] None of these measures will protect against forceful needle punctures from retained needle fragments; therefore, even greater vigilance is required when presented with an autopsy on an HIV-positive decedent.[8] When faced with a patient in which retained needle fragments is suspected, we suggest preautopsy radiographic screening, a technique that has been effective in localizing needle fragments in these patients.[5,11] In addition, minimal manual tissue manipulation during autopsy and delay of autopsy may be advantageous as it has been reported that HIV viability may be time dependent.[12]