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BMW Rules, 2016
BMW Rules, 2016
Version: 2
Reviewers/contributors
Page
1. Introduction 4
2. Definitions 4
3. Process 5
• Personal care after death
• Infection risk
• Use of Body Bags
• Vaccination of staff
• Notification of Diseases
• Public Health Act
4. Training 8
5. References 8
Appendices:
1. Introduction
1.1 The care provided after a service user’s death and the support given to the
family at this difficult time are an integral part of the service user’s overall care
pathway and it is important to ensure that all health care professionals are able
to deliver this care to the standard required. This applies to all settings in the
Trust as well as the service user’s own home if attended by community staff.
1.2 There are approximately 600,000 deaths per year in the United Kingdom and
about two-thirds occur in hospital, of that less than one percent is associated
with a known or suspected infection. (CDR April 1995)
1.3 Opinion differs among health care workers on the management of a body
associated with an infection and measures taken or advised to control the
perceived hazards are often insensitively applied. For example the
indiscriminate use of body bags can cause needless anxiety for the bereaved
family, friends and staff.
1.4 This appendix advises staff of the actions they must take in order to prevent
cross infection when caring for the deceased service user and should be read
in conjunction with the policy on the care of the deceased service user including
Last Offices.
1.5 Good clear communication regarding the possibility of an infection risk must be
maintained between health care staff, mortuary attendants and funeral directors
at all times.
2. Definitions
2.2 Hand hygiene – The process used to cleanse hands with soap and water,
alcohol gel or a detergent based wipe, (refer to Hand Hygiene Appendix 6
Infection Prevention and Control Policy).
2.3 Last offices – This term has been used to describe the care given to the
deceased person when this is focused on fulfilling religious and cultural beliefs
as well as health, safety and legal requirements The Health Act 2010 (DH) also
(Refer to Trust Care of the service user after their Death Policy (SH CP 145)
and “Care of the service user after their Death Procedure” (SH CP 146).
3.1 Personal care of the service user after death (formally known as last offices)
should honour the spiritual or cultural wishes of the deceased person. However
if the service user has been in contact or has been diagnosed as an infection
risk certain standard precautions are required to safeguard the health care
worker, mortuary attendant and funeral director. It is essential that the
management of deceased service users be handled with extreme sensitivity
and a sensible approach. An individualized approach assists with the
relationship between the families and carers at a time of probable distress.
3.2 Organisms in a dead body are unlikely to infect healthy people with intact skin,
but there are other ways they may be spread.
The risks of infection are not high (and no more than in life) and are usually
prevented by the use of standard precautions and the observation of COSHH
regulations. The latter includes an assessment of risks of any micro organism
which creates a hazard to health of any person.
3.3 Body bags should only be reserved for cases where a risk assessment makes
it necessary. Plastic body bags are used for cadavers thought to be infective to
handlers, or likely to leak in transit, or otherwise offensive bodies. The bags are
in many cases used inappropriately for bodies, are of minimal or no risk and
this causes problems to the staff of funeral parlours and unnecessary distress
to relatives. Bodies cool more slowly inside a body bag, facilitating
decomposition and making hygienic (last offices) preparation more difficult. It
may only be possible to only display the head for viewing and this may cause
additional distress to the bereaved. (Essex Health Protection Unit, 2012
Infection Control guidelines for Funeral Directors).
Key Actions:
• If the deceased person had a known infectious disease that falls into
Category 3 (B) or 4 (A) they must be placed in a heavy duty body bag. A
reminder should be given that family, friends and staff must refrain from
handling the body.
• In some areas e.g. Lymington Hospital, all deceased service users are
placed in a lightweight (white) body bag prior to removal from the ward.
Those who directly handle the body should wear appropriate protective clothing
of disposable aprons and gloves. Mortuary staff should follow their own policies
and procedures regarding the use of protective clothing.
Care of the Deceased Patient in Relation to Infection Control Procedure 6
Infection Prevention and Control Nurse
Version 2
February 2014
3.4 All staff providing clinical care should have been appropriately immunised
against Hepatitis B per current Occupational Health Guidance. (HPA March
2009) and SHFT Staff Immunisation Policy.
Although vaccines can give good protection against Polio Virus, Diphtheria,
Tuberculosis and Hepatitis B, the protection is not 100% effective and there are
other infections against which there are no vaccines available e.g. HIV/AIDS
and Hepatitis C.
The use of standard precautions is therefore crucial in preventing cross
infection.
3.5 Under the Health and Safety at Work Act (1974) (section 6.1.1) all employers
have a responsibility for the safety of their employees. Those employees also
have a duty of care to inform others of potential risks. Care of a deceased
person who had a potentially infectious disease fall into this category (refer to
Appendices 19.1 of this document) for guidance on the care of a cadaver in
relation to known and/or suspected infection risk.
3.6 Notification Process for Infectious Diseases. The Health Protection Agency
(HPA) is responsible for protection the community (or any part of the
community) against infectious diseases and contamination.
3.7 Public Health (Control of Diseases) Act 1984 & Regulations of 1988 –
Section 10 of the Act defines those diseases to which sections 43-45 of the Act
applies (see below and also refer to Appendix 19) when dealing with dead
bodies.
5. References:
Bakhshi SS 2001: Code of Practice for funeral workers: managing infection risk
and body bagging. Communicable Disease and Public Health vol 4 no 4
Department of Health2010: Health Protection Legislation (England) Guidance
2010
Healing TD, Hoffman PN, Young SEJ, (1995), Communicable Disease Report,
CDR Report, The Infection Hazards of Human Cadavers, vol 5, R62-R68.
Health and Safety Executive (HSE 2005) Controlling the risks of infection at
work from human remains a guide for those involved in funeral services
(including Embalmers) and those involved in exhumation. HSE 06/2005
Sally Bestwick, (2008) Policy for the Management of the Cadaver. Western
Cheshire NHS Primary Care Trust.
The Health and Social Care Act 2008: Code of Practice on the prevention and
control of infections and related guidance (DH 2010).
No* The degree of (A, B, C &D) are absolute and, in most cases, are not specified in
law. The advice given in a specific case may be varied if the Clinician-in-
Charge/Hospital Infection Control Doctor or Consultant in Health Protection has
deemed it appropriate after assessing the risks.
Yes*** Means Last offices can be performed unless there is leakage of body fluids.
Standard precautions are always required and supervision of relatives.
Please place in an envelope marked for the attention of the undertaker to accompany
the deceased.
Name of the deceased
Address
DOB
GP & Surgery
Date and time of death
Signed:
Print name:
NOTES:
Note 1: Not all service users display typical symptoms, therefore some infections
may not have been identified at the time of death.
Note 2: In accordance with the Health and Safety law and the information provided in
Health Services Advisory Committee Guidance
In hospital/community At home/community
Death
Risk of infection to
others
May consult Infection Control Doctor (at May consult Consultant in Public Health
local Acute Trust)