Precautions in postmortem examinations in Covid-19 - Related deaths: Recommendations from Germany

Abstract

The Covid-19 pandemic is also a considerable risk for forensic workers, among other healthcare providers. The risk of contamination is serious in post-mortem procedures. SARS-CoV2 is a microorganism classified as Hazard Group 3. However, the lack of adequate scientific work on Covid-19 should prompt us to be even more cautious when handling potentially infected persons or materials. Before starting the post-mortem investigation a risk assessment should be carried out and the suitability of facilities, personnel and equipment should be evaluated. An autopsy room conforming to BSL 3 standards would be ideal but is not mandatory. For suspicious or approved cases however a number of procedural changes must be made concerning the body's removal, storage and inspection procedures. Facilities, equipment and training issues need to be revised against existing and potential risks of infection. In addition to proper ventilation and insulation, personal protective equipment, aerosol reduction measures and disinfection applications are required. As of yet it is still unclear how long this public health issue, which has grown to become a pandemic, will last. This article highlights preventive measures to be taken into consideration in post-mortem processes when a Covid-19 infection is suspected or confirmed. It should be noted that there is no standard guide yet in this regard. A guide should be created according to international standards and revised according to changing conditions.

Burden, risk assessment, surveillance and management of SARS-CoV-2 infection in health workers: a scoping review

“…As for other HWs, forensics workers are considered at risk of infection, especially during autopsies or managing specimens of COVID-19 patients [14][15][16][17][18]. Generally, PPE used in this setting are similar with some difference.…”

Biosafety Requirements for Autopsies of Patients with COVID-19: Example of a BSL-3 Autopsy Facility Designed for Highly Pathogenic Agents

“…Furthermore, guidelines on autopsies of COVID-19-deceased patients have been published by various medical societies, and several institutions have described their in-house procedures [8, 20-28] [for review and comparison of recommendations and guidelines, see 29].…”

Universal Precautions Provide Appropriate Protection during Autopsies of Patients with Infectious Diseases

“…The body should then be washed, sprayed with a 1/10 disinfectant-water solution, and placed in a corpse bag that is closed and sprayed with a washing solution of 1/10 disinfectant-water. 33 China and India have similar guidelines for the cleaning and disinfecting of bodies, and the United States also requires the use of body bags for transporting bodies to and from a morgue. 34 Per the current CDC guideline, the exterior surface of these body bag should be disinfected with a disinfectant approved by the US Environmental Protection Agency and that meets the criteria for use against SARS-CoV2.…”