Contamination of personal protective equipment during COVID-19 autopsies

Abstract

Confronted with an emerging infectious disease at the beginning of the COVID-19 pandemic, the medical community faced concerns regarding the safety of autopsies on those who died of the disease. This attitude has changed, and autopsies are now recognized as indispensable tools for understanding COVID-19, but the true risk of infection to autopsy staff is nevertheless still debated. To clarify the rate of SARS-CoV-2 contamination in personal protective equipment (PPE), swabs were taken at nine points in the PPE of one physician and one assistant after each of 11 full autopsies performed at four centers. Swabs were also obtained from three minimally invasive autopsies (MIAs) conducted at a fifth center. Lung/bronchus swabs of the deceased served as positive controls, and SARS-CoV-2 RNA was detected by real-time RT-PCR. In 9 of 11 full autopsies, PPE samples tested RNA positive through PCR, accounting for 41 of the 198 PPE samples taken (21%). The main contaminated items of the PPE were gloves (64% positive), aprons (50% positive), and the tops of shoes (36% positive) while the fronts of safety goggles, for example, were positive in only 4.5% of the samples, and all the face masks were negative. In MIAs, viral RNA was observed in one sample from a glove but not in other swabs. Infectious virus isolation in cell culture was performed on RNA-positive swabs from the full autopsies. Of all the RNA-positive PPE samples, 21% of the glove samples, taken in 3 of 11 full autopsies, tested positive for infectious virus. In conclusion, PPE was contaminated with viral RNA in 82% of autopsies. In 27% of autopsies, PPE was found to be contaminated even with infectious virus, representing a potential risk of infection to autopsy staff. Adequate PPE and hygiene measures, including appropriate waste deposition, are therefore essential to ensure a safe work environment.

Postmortem Minimally Invasive Autopsy in Critically Ill COVID-19 Patients at the Bedside: A Proof-of-Concept Study at the ICU

“…The safety of the procedure for viral contamination was tested by using multiple swabs at the end of each US-MIA. Except for one positive swab from the ultrasound transducer that had been in direct contact with the deceased patient's puncture sites, all other swabs were virus-negative, which is in accordance with a previous study on the risk of SARS-CoV-2 contamination during autopsies of COVID-19 patients [32]. The diagnostic output of our bedside US-MIA revealed COVID-19-specific and non-specific organ pathologies similar to those detected by conventional autopsies.…”

Prevention of COVID-19 transmission from deceased subject: A critical point of view

“…COVID-19 is the most important health challenge today and the adherence to control strategies to contain the spread of the virus is a global priority. Even if there is no consensus on the spread of the virus from the deceased person, the careful management of the bodies is mandatory, considering that the rate of contamination of personal protective equipment after full autopsies varies between 15% and 65% [4,5]. Nevertheless, this viewpoint underlines that there is no consensus on the practices and techniques for the autopsy and for the management of the body for the funeral services.…”

“…Despite the vaccination campaign progressing successfully, our battle is not yet won, and avoiding exposure to this virus is crucial to preventing COVID-19. Person-to-person transmission occurs primarily via direct contact or through droplets spread by the infected individual coughing or sneezing [3][4][5]. Although the infection rate from dead bodies is unclear [4], managing them is of great importance in reducing viral transmission, especially because mortuary staff and pathologists will be exposed to potentially infective materials from cadavers, transmitted through airways, body bags, autopsy tables, and autopsy room walls [4,6].…”

Occupational hazards for pregnant and breastfeeding female physicians and dissection assistants working in forensic medicine

“…Fälle einer postmortalen Übertragung von Sars-CoV-2 oder Influenzaviren auf Obduktionspersonal sind bislang nicht bekannt geworden, allerdings wurden infektiöse SARS-CoV-2-Partikel an der persönlichen Schutzausrüstung von Obduzentinnen nachgewiesen [9], sodass die Möglichkeit einer Ansteckung unbedingt berücksichtigt werden muss. Präventiv sind das effektive Lüften, das Tragen von Schutzmasken (mindestens FFP2) und -brillen sowie die Händehygiene wirksam.…”