This interim guidance is based on what is currently known about COVID-19. The virus is spread through contact with contaminated respiratory droplets released when an infected person coughs or sneezes, or from contact with contaminated hands, surfaces or objects.
Hospital staff are unlikely to contract COVID-19 when transmission based, contact and droplet infection prevention precautions (appropriate PPE and hand hygiene) are used when handling the deceased. The following precautionary strategies must be used to minimise the risk of becoming infected:
- In addition to the procedures below, routine contact and droplet infection control procedures should be maintained when handling or transferring deceased persons confirmed or suspected to have COVID-19
- Wear appropriate Personal Protective Equipment (PPE) at all times without contaminating environmental surfaces
- Avoid unnecessary manipulation of the body that may expel air or fluid from the lungs
- Use two body bags (double bagged) to prevent any leaks to store and transport the body
- Label the outer bag “COVID-19 – Handle with care”
- To minimise transmission of the virus viewing of the deceased by family or relatives in a hospital setting is not recommended
- If family viewing of the deceased is allowed to take place it should occur in a funeral director’s mortuary facility and standard precautions should be observed
- Family members should not kiss or touch the deceased to minimise the risk of transmission
- If a family member does touch the body, they should wash their hands with soap and water immediately afterwards or use an alcohol-based hand rub.
What is the COVID-19 virus?
COVID-19 is a new strain of disease caused by a coronavirus, SARS-CoV-2, that has not been previously identified in humans. It was first identified in Wuhan, Hubei Province, China, where it has caused a large and ongoing outbreak. Cases have since been identified in several other countries, including Australia.
COVID-19 is spread through droplets produced when an infected person coughs or sneezes, or by indirect contact with contaminated hands, surfaces or objects. People are at risk of infection if they come in close contact (face to face for at least 15 minutes or in a closed space for at least 2 hours) with someone who has COVID-19.
Personal Protective Equipment (PPE)
Hospital personnel should employ infection prevention and control measures and avoid unnecessary handling of deceased bodies to decrease the risk of transmission of COVID19 from deceased persons infected with the virus.
Personal Protective Equipment (PPE) must always be used when preparing the deceased body. The Australian Guidelines for the Prevention and Control of Infection in Healthcare recommends applying transmission-based precautions when providing care for patients.
Persons in close contact with the body must wear:
- a clean protective outer garment, such as a gown
- disposable gloves
- a disposable surgical mask
- appropriate eye protection such as safety glasses or a face shield.
After use, PPE should be carefully removed and decontaminated or disposed into general waste as soon as practicable.
Family viewing of the deceased in a clinical unit or ward
Family viewing of the deceased is not recommended for a deceased patient known or suspected to have COVID-19.
If family members are permitted to view the deceased at the hospital, family members should not touch or kiss the deceased. If family members touch the body, they should wash their hands with soap and water immediately afterwards or use an alcohol-based hand rub. Gloves are not necessary unless there are visible bodily fluids present on the body.
Mourners with symptoms of COVID-19 or who are part of a household with possible COVID-19 infection, should not participate in the viewing.
Family viewing of the deceased in the hospital mortuary
No family or relative viewings are to be held after the body bag has been closed for storage and transported to the mortuary.
Verification of the deceased
Hospital staff should wear appropriate PPE if examination of the body is required for identification (ID) and completing the Medical Certificate of Cause of Death (MCCD) or cremation permit. Immediately after doffing PPE, hands should be washed with soap and water or staff should use an alcohol-based hand rub.
The Australian Bureau of Statistics has published a guide advising how COVID-19 deaths should be recorded on the death certificate.
Aerosol generating procedures
The potential for airborne spread of COVID-19 is still unknown. Aerosol generating procedures should be avoided if possible. Airborne precautions should be employed when performing aerosol generating procedures, such as removing tracheal tubes. The removal of surgical drainage tubes and urinary catheters are not classified as aerosol generating procedures.
Airborne precautions include:
- fluid resistant long-sleeved gown
- P2/N95 respirator (mask) – should be fit checked with each use
- face shield or safety glasses
- disposable non-sterile gloves when in contact with patient
- hand hygiene before donning and after removing gloves.
For more information, visit Clinical Excellence Commission - Transmission-Based Precautions.
Preparing deceased bodies with COVID-19
All deceased patients should be treated with the utmost dignity and respect. For all non-Coroner’s cases the following is recommended to care for the body:
- Avoid unnecessary manipulation of the body that may expel air from the lungs.
- Remove any mechanical aids or drainage tubes.
- Cover any wounds with a waterproof dressing.
- Remove all patient valuables and record in a property registry as per facility protocol. Where there are personal effects that the family would collect, wipe the effects with disinfectant and bag these effects for return to the family. If clothing place in a bag for the family and encourage them to:
- wash laundry thoroughly
- read and follow directions on labels of laundry or clothing items and detergent. In general, wash and dry with the warmest temperatures recommended on the clothing label.
- Complete local identification requirements and affix mortuary tags, information tags and external toggles.
- Use two body bags (double bagged) to prevent any leaks to store and transport the body.
- Label the outer bag “COVID-19 – Handle with care”.
- Practice hand hygiene practices before and after contact with the body.
- Perform regular environmental decontamination including all surfaces and equipment.
Strategic Reform and Planning Branch
- NSW Health Pathology
- Infection Prevention and Control, NSW Clinical Excellence Commission
- Health Protection NSW
- COVID-19 Response Team Medical Advisor
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
6 May 2020
- Infection Prevention and Control, NSW CEC
- Pathology Community of Practice
For use by
Interim guidance for NSW hospital facilities and staff for handling deceased bodies with suspected and confirmed COVID-19.