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North Glasgow Hospitals University NHS Trust NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 1 of 8 LAST OFFICES Replaces None AIM To prepare the deceased for the mortuary respecting their cultural beliefs. To comply with legislation in particular where the death of a patient requires the involvement of a Procurator Fiscal. To minimise any risk of cross-infection to relative, healthcare worker or persons who may need to handle the deceased. STATEMENT Patients may have one or more cultural beliefs or personal wishes relating to death and dying; these must be respected. Infection risks do not increase after death. Death in hospital may necessitate by law the involvement of the Procurator Fiscal. It is important that healthcare workers comply with legislation, the wishes of patients/relatives and continue to follow Standard Precautions and where necessary Transmission Based Precautions to minimise any risk of cross-infection. REQUIREMENTS Verification of death – by a doctor or approved person. Mortuary Pack Personal Protective Equipment: gloves and apron. Identify the following: If precautions in addition to STANDARD PRECAUTIONS are required; check notes if the patient has or is suspected of having an infection as listed in Table 1, then follow this procedure with any amendments as detailed from the table. If the patient has any cultural or religious beliefs which necessitate alternative procedures to nurses undertaking Last Offices. If this is the case then follow the instructions for the specific religion guidelines (Appendix 1). If the body of the deceased is likely to leak after death, a body bag will be required. If any special requests made before death, e.g. the keeping on of jewellery, clothes to be worn. If the eyes have been donated for corneal grafting. If there are any radiation precautions still in force. LOCATION At the bedside preserving privacy and dignity of the deceased. TIMING As soon as practical. The procedure may be delayed if relatives wish to visit the deceased on the ward. PROCEDURE Put on Personal Protective Equipment (PPE), i.e., gloves and plastic apron. If risk of splashing wear face protection. If a Fiscal case, cap off, but leave all invasive devices in situ, e.g. urinary NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 2 of 8 LAST OFFICES Replaces None catheter and venflon. If not a Fiscal case these may be removed or be left in situ. ¾ Jewellery removal should be witnessed by 2 persons and must be signed for. ¾ Remove all jewellery from the deceased unless advised otherwise by the deceased in life or by the relatives. If it proves difficult for nursing staff to remove jewellery, the relatives should be advised that this could be done later. ANY ATTACHED BODY PIERCING SHOULD BE REGARDED AS JEWELLERY. ¾ Record any jewellery left on the body in the nursing documentation. Depending on the religious beliefs, carry out the remainder of the procedure if indicated in Appendix 1 Wash the deceased and close the eyes. If relatives have consented to donating the eyes, gently tape close the eyelids using Transpore tape. If the deceased has dentures ensure they are in situ. Not for deceased of Jewish faith (Appendix 1). Attach identification bands to a wrist and the opposite ankle of the deceased. Both identification bands should contain the following information: Deceased’s Name, Hospital Number, date of birth, ward. If the lower jaw drops down significantly, consider putting on a chin support – currently North Division only. Place an adult incontinence pad/diaper under the deceased. Shroud the patient using a disposable gown. (If the family wish, the deceased may be dressed in their own nightwear or clothing). If the deceased is to be viewed by relatives on the ward ensure there is no blood or body fluid leakage about the face. Wrap the patient carefully in a sheet and fasten with tape. If there are problems with large bodies contact the mortuary/porters for advice. Out of hours, a mortuary technician can be contact via switchboard. If radiation restrictions are still in force, attach a sticker “RISK OF IONIZING RADIATION” to the outside of the shroud (and if a body bag NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 3 of 8 LAST OFFICES Replaces None is to be used to the outside of the body bag). Place the deceased in a body bag if the body is likely to leak, or if the patient has an infection / alert organism and it is indicated in table 1. Remove gloves and plastic apron and wash hands. (Use new gloves for any additional clearing procedures to prevent direct contact with blood or body fluids or equipment contaminated with blood or body fluid). Complete the MORTUARY NOTIFICATION CARD indicating if a body bag has been used because of Leakage or Infection and secure it to the outside of the sheet or body bag and/or the shroud. Section One of this card is to be completed by nurses, section Two by a doctor. (Failure to complete can delay funeral arrangements). Contact the porters and request they remove the deceased. Follow moving and handling guidance when transferring from bed to trolley. If there is a risk of leakage or infection the porters will use gloves regardless of whether the body is in a bag. The porters will wash their hands after handling a wrapped body. Complete nursing documentation. AFTER CARE Ensure all notes, laboratory reports and X rays are gathered together. Notes to be sent to medical records if not a Fiscal case. If the deceased is to undergo a post mortem the notes will accompany the patient to mortuary. If there is contamination of the trolley transporting the deceased follow the Spillages section of the Decontamination Policy. NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 4 of 8 LAST OFFICES Replaces None TABLE 1 Organisms or clinical conditions, which if the deceased has, or is suspected of having, necessitate precautions in addition to STANDARD PRECUATIONS. If in any doubt contact a member of the infection control team. RISK BAGGING VIEWING EMBALMING HYGIENIC CATEGORY PREPARATION Acute encephalitis Low No Yes Yes Yes Acute poliomyelitis Med No Yes Yes Yes Anthrax High Yes No No No C. difficile Low No Yes Yes Yes Chickenpox / shingles Low No Yes Yes Yes Cholera Med No Yes Yes Yes CJD all transmissible spongiform High No Yes No Yes encephalopathies Cryptosporidiosis Low No Yes Yes Yes Dermatphytosis Low No Yes Yes Yes Diphtheria Med Yes Yes Yes Yes Dysentery Med Yes Yes Yes Yes E. Coli 0157 Med Yes Yes Yes Yes Food poisoning Med No Yes Yes Yes Haemorrhagic Fever with Renal Med No Yes Yes Yes Syndrome Hepatitis A, E Med No Yes Yes Yes Hepatitis B, C and non-A and non- High Yes Yes No Yes B HIV, AIDS Med Yes Yes No Yes Legionellosis Low No Yes Yes Yes Leprosy Low No Yes Yes Yes Leptospirosis (Weil’s disease) Med No Yes Yes Yes Lyme disease Low No Yes Yes Yes Malaria Med No Yes Yes Yes Measles Low No Yes Yes Yes Meningitis – not meningococcal Low No Yes Yes Yes Meningococcal septicaemia (with Med Yes Yes Yes Yes or without meningitis) MRSA Low No Yes Yes Yes Mumps Low No Yes Yes Yes Opthalmia neonatorum Low No Yes Yes Yes Orf Low No Yes Yes Yes Paratyphoid fever Med Yes Yes Yes Yes Plague High Yes No No No Psittacosis Low No Yes Yes Yes Q fever Med No Yes Yes Yes NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 5 of 8 LAST OFFICES Replaces None RISK BAGGING VIEWING EMBALMING HYGIENIC CATEGORY PREPARATION Rabies High Yes No No No Relapsing fever Med Yes Yes Yes Yes Rubella Low No Yes Yes Yes SARS High Yes No No No Scarlet fever Med No Yes Yes Yes Smallpox High Yes No No No Streptococcal disease (invasive) Low No Yes Yes Yes Tetanus Low No Yes Yes Yes Tuberculosis Med Yes Yes No Yes Typhoid fever Med Yes Yes Yes Yes Typhus Med Yes No No No Viral Haemorrhagic Fever High Yes No No No Whooping cough Low No Yes Yes Yes Yellow Fever High Yes No No No Bagging: placing the body in a plastic body bag. Viewing: allowing the bereaved to see, touch and spend time with the body before removal to the deceased mortuary or undertakers. Embalming: injecting chemical preservatives into the body to slow the process of decay. Cosmetic work may be included. Hygienic preparation: cleaning and tidying the body so it presents a suitable appearance for viewing. NHS GREATER GLASGOW Effective from Oct 04 CONTROL OF INFECTION COMMITTEE STANDARD OPERATING PROCEDURE Review date Oct 07 Page Page 6 of 8 LAST OFFICES Replaces None Appendix 1 INFORMATION ON RELIGIOUS BELIEFS FOLLOWING A DEATH IN HOSPITAL The following is for guidance only; all deaths should be treated individually, and with equal respect. BUDDHISM 1. No objection to a post mortem. 2. Allow privacy for quietness and meditation/chanting. 3. The state of mind at death should be calm at time of preparation, as Buddhists believe that this will influence the character of rebirth. 4. Do not wash the body. 5. Wrap in plain sheet. 6. Advise not to remove body before Monk/Sister arrives. 7. Cremation common. CHRISTIANITY ANGLICAN/CHURCH OF ENGLAND/CHURCH OF WALES/EPISCOPAL CHURCH OF SCOTLAND: Contact Hospital Chaplain 1.
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