Covid-19 – official advice

After today’s COBRA meeting, the prime minister warned that the spread of coronavirus Covid-19 is likely to become more significant, with government sources warning that it could be “months rather than weeks” before the outbreak peaks.

In the absence of any new information or guidance, and while we await the revealing of the government’s ‘major UK-wide action plan’  we have heard from many funeral directors who are concerned about their potential involvement with caring for people who have tested positive for the virus and subsequently died.

We thought it worth putting the official government advice for those handling the bodies of people who have died from Covid-19 here on the blog in an easy to find place – full details can be found here.

Here’s the official guidance:

20. Handling dead bodies

• the act of moving a recently deceased patient onto a hospital trolley for transportation to the mortuary might be sufficient to expel small amounts of air from the lungs and thereby present a minor risk
• a body bag should be used for transferring the body and those handling the body at this point should use full PPE
• the outer surface of the body bag should be decontaminated (see environmental decontamination) immediately before the body bag leaves the anteroom area. This may require at least 2 individuals wearing such protective clothing, in order to manage this process
• the trolley carrying the body must be disinfected prior to leaving the anteroom
• prior to leaving the anteroom, the staff members must remove their protective clothing
• once in the hospital mortuary, it would be acceptable to open the body bag for family viewing only (mortuary attendant to wear full PPE)
• washing or preparing the body is acceptable if those carrying out the task wear PPE. Mortuary staff and funeral directors must be advised of the biohazard risk. Embalming is not recommended
• if a post mortem is required safe working techniques (for example manual rather than power tools) should be used and full PPE worn, in the event that power tools are used. High security post mortem suites are available if needed and can be discussed with the PHE incident team
• after use, empty body bags should be disposed of as category B waste

21. Putting on and removing personal protective equipment

This PPE ensemble is more enhanced than pandemic flu requirements due to COVID-2019 being a novel coronavirus and the evidence base for transmission limited. Therefore, this is based on expert opinion to date and may be revised as the situation evolves.

Use safe work practices to protect yourself and limit the spread of infection:

• keep hands away from face and PPE being worn
• change gloves when torn or heavily contaminated
• limit surfaces touched in the patient environment
• regularly perform hand hygiene
• always clean hands after removing gloves

Pre-donning instructions:

• ensure healthcare worker hydrated
• tie hair back
• remove jewellery
• check PPE in the correct size is available

21.1 Putting on (donning) PPE

The order for putting on is gown, respirator, eye protection and gloves. This is undertaken outside the patient’s room.

Perform hand hygiene before putting on PPE

• put on the long-sleeved fluid repellent disposable gown, fasten neckties and waist ties
• respirator. Note: this must be the respirator that you have been fit tested to use. Where goggles or safety spectacles are to be worn with the respirator, these must be worn during the fit test to ensure compatibility. Position the upper straps on the crown of your head, above the ears and the lower strap at the nape of the neck. Ensure that the respirator is flat against your cheeks. With both hands mould the nose piece from the bridge of the nose firmly pressing down both sides of the nose with your fingers until you have a good facial fit.

If a good fit cannot be achieved, do not proceed.

Perform a fit check. The technique for this will differ between different makes of respirator. Instructions for the correct technique are provided by manufacturers and should be followed for fit checking.

Eye protection: place over face and eyes and adjust the headband to fit.

Gloves: select according to hand size. Ensure cuff of gown covered is covered by the cuff of the glove.

21.2 Removal of (doffing) PPE

PPE should be removed in an order that minimises the potential for cross contamination. Unless there is a dedicated isolation room with anteroom, PPE is to be removed in as systematic way before leaving the patient’s room i.e. gloves, then gown and then eye protection.

The respirator must always be outside the patient’s room.

Where possible (dedicated isolation room with anteroom) the process should be supervised by a buddy at a distance of 2 metres to reduce the risk of the healthcare worker removing PPE and inadvertently contaminating themselves while doffing.

The FFP3 respirator should be removed in the anteroom or lobby. In the absence of an anteroom or lobby, remove FFP3 respirator in a safe area (for example, outside the isolation room).

All PPE must be disposed of as healthcare (including clinical) waste.

The order of removal of PPE is as follows:

Gloves: the outsides of the gloves are contaminated

• grasp the outside of the glove with the opposite gloved hand; peel off
• hold the removed glove in gloved hand
• slide the fingers of the un-gloved hand under the remaining glove at the wrist
• peel the remaining glove off over the first glove and discard
• clean hands with alcohol hand rub

Gown: the front of the gown and sleeves will be contaminated

• unfasten neck then waist ties
• pull gown away from the neck and shoulders, touching the inside of the gown only using a peeling motion as the outside of the gown will be contaminated
• turn the gown inside out, fold or roll into a bundle and discard into a lined waste bin

Eye protection (preferably a full-face visor): the outside will be contaminated

• to remove, use both hands to handle the retraining straps by pulling away from behind and discard
• clean hands with alcohol hand rub

Respirator: in the absence of an anteroom/lobby remove FFP3 respirators in a safe area (such as outside the isolation room)

• do not touch the front of the respirator as it will be contaminated
• lean forward slightly
• reach to the back of the head with both hands to find the bottom retaining strap and bring it up to the top strap
• lift straps over the top of the head
• let the respirator fall away from your face and place in bin
• wash hands with soap and water

ENDS