Epistemic_Statements  

CORD-19:066fef88b0b0d9db3e48192fa13e6665486115bf JSONTXT 8 Projects

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Id Subject Object Predicate Lexical cue
T1 13-169 Epistemic_statement denotes "The danger to the operator can be eliminated in the most simple and complete manner without in the least degree impairing the efficacy of the examination."
T2 170-302 Epistemic_statement denotes J. Jackson Clarke 1 During the course of work, the autopsy pathologist and staff members encounter a number of potential biohazards.
T3 516-631 Epistemic_statement denotes This chapter provides an overview of important autopsy biosafety recommendations for usual hospital-based practice.
T4 632-694 Epistemic_statement denotes Many points cannot be discussed in sufficient detail, however.
T5 695-936 Epistemic_statement denotes Pathologists must work with their local infection control and occupational health and safety departments to implement a complete biosafety plan that includes ongoing review of all safety concerns and a continuing program of safety education.
T6 937-1117 Epistemic_statement denotes In the current age of global travel and bioterrorism threats, there is heightened awareness of the possibility of epidemics of severe disease caused by highly transmissible agents.
T7 1399-1574 Epistemic_statement denotes Suspected cases of these conditions should be referred to the Centers for Disease Control and Prevention (CDC) as soon as possible and hopefully before postmortem examination.
T8 1575-1662 Epistemic_statement denotes Local medical examiners or offices and public health laboratories may provide guidance.
T9 1663-1878 Epistemic_statement denotes 3 The CDC, in association with other federal, state, and local agencies, has designated regional laboratories (Laboratory Response Network) to aid in the diagnosis and containment of lethal transmissible conditions.
T10 2104-2199 Epistemic_statement denotes 5 The occupational exposure, however, places them at risk for developing communicable diseases.
T11 2657-2729 Epistemic_statement denotes To minimize the risk of infection, adequate barriers should be in place.
T12 2884-3030 Epistemic_statement denotes Because it is difficult to ascertain which cases harbor infective agents, it is prudent to consider all autopsies as a potential infective source.
T13 4070-4189 Epistemic_statement denotes Whenever possible, postmortem examinations are carried out during normal working hours by adequate, well-trained staff.
T14 4365-4516 Epistemic_statement denotes If multiple autopsies are to be performed sequentially, those with the greatest infective risk should be done first, before the staff becomes fatigued.
T15 4623-4785 Epistemic_statement denotes All contaminated equipment, instruments, containers, and so forth should be confined to designated areas (autopsy table, instrument table, dissection area, sink).
T16 4848-5134 Epistemic_statement denotes For all autopsies, personal protective equipment (PPE) includes scrub suits, gowns, waterproof sleeves, plastic disposable aprons, caps, N95 particulate masks, eye protection (goggles or face shields), shoe covers or footwear restricted to contaminated areas, and double sets of gloves.
T17 5135-5283 Epistemic_statement denotes Cut-resistant and puncture-resistant hand protection (plastic or steel gloves) is also available and certainly recommended for high-risk procedures.
T18 5365-5366 Epistemic_statement denotes 8
T19 5367-5472 Epistemic_statement denotes One should exercise extraordinary care to minimize the risk of injury from sharp instruments and needles.
T20 5473-5529 Epistemic_statement denotes Whenever possible, the use of needles should be avoided.
T21 5530-5706 Epistemic_statement denotes Needlestick injuries occurring during routine autopsy procedures are entirely preventable; blunt needles and bulb syringes should be used to aspirate fluids in most situations.
T22 5707-5819 Epistemic_statement denotes Because many needlestick accidents occur during disposal of needles, needles should never be recapped after use.
T23 5820-5957 Epistemic_statement denotes Needles and other sharps should be disposed of directly into the approved receptacle; they should not be left lying around the work area.
T24 6205-6335 Epistemic_statement denotes The frequency of hand injuries sustained while performing autopsy procedures can be reduced by several simple practices (Box 3-2).
T25 6336-6450 Epistemic_statement denotes A pair of scissors can adequately substitute for a scalpel during most autopsy procedures, including evisceration.
T26 6561-6783 Epistemic_statement denotes When dissecting with a sharp implement in one hand, one should apply countertraction on tissues by using a long-handled tissue forceps held in the opposite hand; do not hold tissues with the fingers of the noncutting hand.
T27 6784-6891 Epistemic_statement denotes For high-risk cases or dissections, steel-link gloves or some other scalpel-resistant material can be used.
T28 6892-7036 Epistemic_statement denotes Plastic or Kevlar cut-resistant gloves provide protection while still allowing relative dexterity, and we encourage their use whenever possible.
T29 7159-7258 Epistemic_statement denotes Surgical towels should be placed over the cut edges of the ribs to protect against a scrape injury.
T30 7411-7552 Epistemic_statement denotes When suturing the body wall at the end of the autopsy, hold skin flaps with a large toothed forceps or toothed clamp rather than with a hand.
T31 7553-7725 Epistemic_statement denotes Aerosolization of bone dust during the removal of the calvaria or vertebral bodies can be reduced with a plastic cover or a vacuum bone dust collector, or both, on the saw.
T32 7841-7928 Epistemic_statement denotes Bone surfaces should be moistened before sawing to cut down the dispersal of bone dust.
T33 8317-8448 Epistemic_statement denotes Rather, the organ surface should be swabbed centrifugally with an iodine solution and incised centrally before a sample is removed.
T34 8800-8926 Epistemic_statement denotes Whether the specimen is fresh or fixed, a pan is used for cleanliness during transport of the organ to the photographic stand.
T35 8927-9614 Epistemic_statement denotes The camera should be handled with clean gloves or by a second person Box 3-1 Basic biosafety principles for standard (universal) precautions Prevention of puncture wounds, cuts, abrasions by safe handling of needles and sharp instruments Protection of existing wounds, skin lesions, conjunctiva, and mucous membranes with appropriate barriers Prevention of contamination of workers' skin and clothing with appropriate barriers and hand washing Control of work surface contamination by containment and decontamination Safe disposal of contaminated waste Box 3-2 Rules that reduce injury from scalpels and other sharp autopsy instruments Minimize the use of scalpels for tissue dissection.
T36 10341-10427 Epistemic_statement denotes After photographs have been taken, the photostand should be cleaned with disinfectant.
T37 10428-10578 Epistemic_statement denotes Cameras, lenses, and other photographic equipment may be disinfected with a variety of germicidal substances without compromising their functionality.
T38 10579-10646 Epistemic_statement denotes 10 A hands-free camera system would also reduce contamination risk.
T39 10931-11079 Epistemic_statement denotes Mycobacteria remain viable in tissues for days, and these organisms are even difficult to kill with standard formalin fixatives or embalming fluids.
T40 11469-11786 Epistemic_statement denotes For routine decontamination, all instruments and autopsy devices should be immersed in an enzymatic cleaner or detergent solution for at least 10 minutes, then rinsed with water and decontaminated with disinfectant such as 5.25% sodium hypochlorite (1:10 solution of household bleach in water) for another 10 minutes.
T41 12071-12155 Epistemic_statement denotes One should rinse work surfaces with hot water followed by a 1:10 solution of bleach.
T42 12216-12244 Epistemic_statement denotes Splashing should be avoided.
T43 12245-12360 Epistemic_statement denotes Floors in the autopsy work area should be cleaned with a detergent solution, decontaminated, and rinsed with water.
T44 12464-12547 Epistemic_statement denotes All laundry should be treated as contaminated and disinfected in a routine fashion.
T45 12548-12664 Epistemic_statement denotes Any wet clothing, towels, or other reusable laundry should be placed into leakproof biohazard bags before transport.
T46 12665-12801 Epistemic_statement denotes After autopsy, one should wash the body with a detergent solution followed by an antiseptic such as a 1:10 solution of household bleach.
T47 12802-12893 Epistemic_statement denotes The body should be rinsed with water and placed in a disposable leakproof plastic body bag.
T48 12894-13053 Epistemic_statement denotes By law, in many states, all bodies with known infective diseases must be labeled as such for the mortician and others who may come in contact with the remains.
T49 13054-13113 Epistemic_statement denotes Usually this is indicated on the death certificate as well.
T50 13114-13236 Epistemic_statement denotes Absence of this warning, however, should not be taken to mean there is no risk; all bodies should be handled with caution.
T51 13237-13380 Epistemic_statement denotes We find it helpful to inspect bodies in storage on a daily basis to assess whether there has been any undue leakage of fluid into the body bag.
T52 13381-13466 Epistemic_statement denotes Obviously, fluid accumulations should be carefully removed by aspiration or blotting.
T53 13467-13582 Epistemic_statement denotes If necessary, place a warning on the outside of the body bag, alerting others to the possibility of leaking fluids.
T54 13583-13668 Epistemic_statement denotes Tissue to be stored should be placed in a nonbreakable, watertight plastic container.
T55 13669-13793 Epistemic_statement denotes Before transporting tissue outside the autopsy suite, the container should be placed in a plastic bag and sealed adequately.
T56 13794-13946 Epistemic_statement denotes Waste for disposal should be doublebagged in specially designated biohazard waste bags, secured, and stored in metal or plastic canisters until removal.
T57 13947-14015 Epistemic_statement denotes Spills should be cleaned up with absorbent, disposable paper towels.
T58 14016-14124 Epistemic_statement denotes The contaminated area should be cleaned with detergent, then decontaminated using a 1:10 dilution of bleach.
T59 14178-14266 Epistemic_statement denotes After removing gloves, the pathologist should wash his or her hands with soap and water.
T60 14267-14360 Epistemic_statement denotes In fact, hands should be washed immediately and thoroughly any time they become contaminated.
T61 14702-15007 Epistemic_statement denotes 16 However, if exposure as defined by the Centers for Disease Control and Prevention (i.e., potential introduction of virus through skin puncture or contact with mucous membranes) occurs, postexposure prophylaxis that includes vaccination and administration of rabies immune globulin should be undertaken.
T62 15008-15084 Epistemic_statement denotes Smallpox vaccinations for healthcare workers is advisable but controversial.
T63 15085-15166 Epistemic_statement denotes 15 All employees should have yearly purified protein derivative (PPD) skin tests.
T64 15167-15255 Epistemic_statement denotes Cuts and puncture wounds should be washed and irrigated immediately with soap and water.
T65 15256-15379 Epistemic_statement denotes If conjunctival splashes occur, the eyes should be washed immediately at the nearest eye wash station in the autopsy suite.
T66 15380-15559 Epistemic_statement denotes Injured employees should go to the emergency department or employee health service; the infection control nurse or appropriate employee health official can be notified from there.
T67 15712-15798 Epistemic_statement denotes The employee should always protect his or her rights by completing an incident report.
T68 15799-15988 Epistemic_statement denotes Persons with uncovered wounds or dermatitis should not assist in autopsy procedures unless the injured skin can be completely covered with a waterproof dressing or other acceptable barrier.
T69 16257-16433 Epistemic_statement denotes While performing these autopsies, personnel are limited to only those necessary-the pathologist, autopsy assistant, and possibly a circulating assistant-to accomplish the task.
T70 16562-16657 Epistemic_statement denotes With proper precautions, overhead ultraviolet lights may be used for secondary decontamination.
T71 16658-16819 Epistemic_statement denotes If an isolation room is nonexistent and there is more than one autopsy table in the room, the table with the least traffic should be used for the infective case.
T72 16964-17172 Epistemic_statement denotes Health and safety requirements may exceed the capabilities of even the best hospital morgues in suspected cases of infection with highly contagious organisms such as arboviruses, arenaviruses, or filoviruses.
T73 17173-17261 Epistemic_statement denotes In such situations, guidance should be sought from the appropriate public health agency.
T74 17451-17675 Epistemic_statement denotes [17] [18] [19] [20] [21] [22] Other infections including rabies, plague, legionellosis, meningococcemia, rickettsioses, coccidiomycosis, and anthrax may also be acquired by aerosols such as those generated during an autopsy.
T75 17676-17790 Epistemic_statement denotes 23 Thus, it is clear that the utmost care must be taken to provide adequate protection against infective aerosols.
T76 18301-18508 Epistemic_statement denotes Placing plastic bags over the head of the decedent during removal of the calvarium with a Stryker saw or saws equipped with HEPA filters within the vacuum system can also reduce the amount of aerosolization.
T77 18632-18934 Epistemic_statement denotes 24 Practices Specific to Autopsies if a Prion Disorder Is Suspected The infective agent that transmits Creutzfeldt-Jakob disease (CJD) and related prion disorders has been termed a prion because it does not have the morphologic and chemical composition of a virus or other conventional infective agent.
T78 18935-19086 Epistemic_statement denotes Rather, all the evidence indicates that the sole functional component of the prion is an abnormal protease-resistant isoform of a normal brain protein.
T79 19788-20053 Epistemic_statement denotes Although CJD can be transmitted to laboratory animals by intracerebral inoculation of formalin-fixed tissues, it should be noted that aldehyde fixatives cross-link proteins in a tissue block, and therefore prions are not readily transmissible from the tissue block.
T80 20715-20762 Epistemic_statement denotes The prosector should wear cut-resistant gloves.
T81 21041-21169 Epistemic_statement denotes Formaldehyde is a highly toxic chemical, and exposure to formaldehyde or its vapors may cause a variety of symptoms or diseases.
T82 21707-21876 Epistemic_statement denotes Exposure studies performed in rats have shown that formaldehyde appears to induce nasal squamous cell carcinomas 27, 28 ; however, implications for humans are equivocal.
T83 21877-22176 Epistemic_statement denotes Studies relating the rat and human data indicate that the carcinogenic risk for humans at relevant levels of formaldehyde exposure is minimal; further, it is likely that precautions effective against noncancer toxic effects of the chemical are sufficient to protect against its carcinogenic effects.
T84 22177-22317 Epistemic_statement denotes 29 The autopsy suite should have sufficient ventilation and effective chemical fume hoods to reduce employee exposure to formaldehyde vapor.
T85 22318-22511 Epistemic_statement denotes As mandated by the Occupational Health and Safety Administration (OHSA), employers must monitor formaldehyde levels in the workplace and maintain employee exposures below the legal safe limits.
T86 22512-22665 Epistemic_statement denotes Institutions should provide a mandatory training program for all employees exposed to formaldehyde at or above 0.1 ppm on an 8hour time-weighted average.
T87 22774-23106 Epistemic_statement denotes On rare occasions, the autopsy pathologist may be required to examine the body of a patient who died shortly after receiving diagnostic or therapeutic radioactive substances or after Box 3-4 Autopsies of patients with suspected prion disease (human transmissible spongiform encephalopathies)-modifications of standard precautions 1.
T88 23107-23200 Epistemic_statement denotes Attendance is limited to three staff members, including at least one experienced pathologist.
T89 23365-23437 Epistemic_statement denotes However, a disposable, waterproof gown is worn in place of a cloth gown.
T90 24051-24236 Epistemic_statement denotes Because prion infectivity is retained after drying and the dried material is harder to clean from surfaces, reusable instruments should be kept wet between time of use and disinfection.
T91 24237-24394 Epistemic_statement denotes c. Use disposable equipment (headrest, cutting board, scalpels, forceps, scissors, brain knife, plastic formalin containers) to the greatest extent possible.
T92 24395-24620 Epistemic_statement denotes d. Dedicate a set of instruments for autopsies involving possible transmissible spongiform encephalopathies, to include Stryker saw, blade and wrench, skull breaker and hammer, 5-inch forceps, 5-inch scissors, and rib cutter.
T93 25807-25979 Epistemic_statement denotes Tissue remnants, cutting debris, and contaminated formaldehyde solution should be discarded in a water-tight plastic container as infective hospital waste for incineration.
T94 26018-26150 Epistemic_statement denotes 30 In such circumstances, the body may contain a level of radiation that would result in a radiation exposure risk to autopsy staff.
T95 26536-26730 Epistemic_statement denotes Patients who die after receiving therapeutic doses of radioisotopes or implanted radioactive sources may require special handling, depending on the level of radioactivity remaining (Table 3-1) .
T96 26731-26891 Epistemic_statement denotes Hospitals where such patients are treated will have patient treatment records available, as well as radiation safety specialists who can advise the pathologist.
T97 27150-27380 Epistemic_statement denotes However, because radioisotopes may be concentrated in tissue or body fluids, the attending physician signing the death certificate should alert the pathologist and the radiation safety officer if the body contains more than 5 mCi.
T98 27381-27426 Epistemic_statement denotes The assigned mortuary should also be advised.
T99 27427-27597 Epistemic_statement denotes A form identifying the isotope, the amount given, and the time of administration should be attached to the death certificate, the autopsy consent, and the medical record.
T100 27598-27988 Epistemic_statement denotes If an implanted radioactive source cannot be removed from the patient before an autopsy, if radioactive fluid is present after administration of an isotope, or if high levels of radioactivity are likely to be present in a specific organ, a radiation safety specialist should be consulted for assistance in the safe collection and proper disposal of the radioactive source, fluid, or tissue.
T101 27989-28136 Epistemic_statement denotes In consultation with the specialist, the amount of activity remaining in the body should be estimated by reference to the half-life of the isotope.
T102 28581-28711 Epistemic_statement denotes A team of pathologists, each prosector performing a limited portion of the autopsy, may be required to limit individual exposures.
T103 28712-28760 Epistemic_statement denotes Film badges may be required to monitor exposure.
T104 28761-28887 Epistemic_statement denotes The pathologist should drain potentially contaminated body fluids carefully first and immediately shield them for assay later.
T105 28975-29101 Epistemic_statement denotes Highly radioactive fluids should be stored behind appropriate shields until they can be safely removed from the autopsy suite.
T106 29102-29238 Epistemic_statement denotes After the body is opened, a second survey should be made to estimate the level of beta dose for 32 P or other betaemitting radionuclide.
T107 29239-29424 Epistemic_statement denotes In cases of 131 I administration, the thyroid gland may emit a sufficient gamma dose that it should not be touched by hand directly but rather removed with the aid of a long instrument.
T108 29425-29660 Epistemic_statement denotes After the autopsy, all instruments, towels, and clothing involved in the procedure should be checked for radioactivity and either stored shielded until safe or decontaminated before being returned to general use or sent to the laundry.
T109 29661-29760 Epistemic_statement denotes The autopsy room should be monitored for radioactive contamination and decontaminated if necessary.
T110 29934-30103 Epistemic_statement denotes The radiation safety specialist should assist the pathology department in monitoring and complying with any safety measures required for the operation of these machines.
T111 30604-30702 Epistemic_statement denotes Prahlow and colleagues 33 have reviewed the safety issues surrounding ICDs encountered at autopsy.
T112 30846-31060 Epistemic_statement denotes Although shocks of this magnitude are unlikely to cause death, manufacturers recommend that the ICDs be deactivated before manipulation and that high-quality latex surgical gloves be used when handling the devices.
T113 31372-31602 Epistemic_statement denotes A description of the medical surveillance program including potential health hazards, signs and symptoms, and instructions to report the development of signs and symptoms the employee suspects are related to formaldehyde exposure.
T114 31650-31882 Epistemic_statement denotes However, in cases in which history is incomplete or totally lacking, the pathologist encountering an implanted device during autopsy dissection should ascertain whether it is a pacemaker or an ICD before continuing with the autopsy.
T115 31883-32033 Epistemic_statement denotes If an ICD is present, the pathologist should discontinue the postmortem examination until the device is properly deactivated (Box 3-8 and Table 3 -2).
T116 32034-32132 Epistemic_statement denotes Because ICDs may explode if incinerated, they should never be discarded without special attention.
T117 32307-32416 Epistemic_statement denotes Bullet Recovery Bullets may fragment on impact or may by design raise pointed edges on entering their target.
T118 32417-32561 Epistemic_statement denotes In either case, the resulting deformation can produce sharp edges in shrapnel that present a risk for injury to those who remove or handle them.
T119 32562-32757 Epistemic_statement denotes For autopsies of gunshot victims, Russell and coworkers 34 recommended that anteroposterior and lateral radiographs be taken to locate bullets, bullet fragments, and any sharp or irregular edges.
T120 32758-32835 Epistemic_statement denotes Bullets should be handled only by personnel wearing double heavy-duty gloves.
T121 32836-33072 Epistemic_statement denotes To prevent marring of the projectile surface, a rubber-tipped bullet extractor fashioned from a Kelly forceps fitted with 2 cm of rubber catheter over its ends or a plastic forceps should be used to recover bullets and bullet fragments.
T122 33073-33260 Epistemic_statement denotes After collection of any trace evidence on the projectile itself, the bullet should be gently rinsed to remove contaminating blood or body fluids to decrease its subsequent infective risk.
T123 33261-33454 Epistemic_statement denotes Finally, the bullet or bullet fragments should be double packed in leakproof packaging with at least one of the containers composed of hard plastic to prevent injury during subsequent handling.
T124 33455-33568 Epistemic_statement denotes In addition to the appropriate identifying information, the container should be labeled with a biohazard sticker.
T125 33569-33741 Epistemic_statement denotes Medical devices such as surgical staples, vena-caval (Greenfield) filters, and other devices may have sharp edges or points that can be encountered unexpectedly at autopsy.
T126 33742-33848 Epistemic_statement denotes 35 Needle fragments are a potential hazard to pathologists performing autopsies on drug-addicted patients.
T127 34807-34945 Epistemic_statement denotes human immunodeficiency virus-positive cases, along with the standard recommendations for protection against injury from sharp instruments.
T128 34946-35088 Epistemic_statement denotes Exposure to cyanide vapors during autopsy has been associated with clinical symptoms and toxic concentrations of cyanide in autopsy personnel.
T129 35089-35196 Epistemic_statement denotes 39, 40 Autopsies on victims of cyanide poisoning should be performed in a negative-pressure isolation room.
T130 35197-35400 Epistemic_statement denotes Although cyanide may vaporize from other tissues, stomach contents containing ingested cyanide salts present the highest risk, because the gastric acid converts cyanide salts to volatile hydrocyanic gas.
T131 35573-35763 Epistemic_statement denotes Similarly, toxicology laboratory workers handling samples possibly containing cyanide should wear gloves and face and eye protection and manipulate the specimen only in a chemical fume hood.
T132 35832-36008 Epistemic_statement denotes The objective of any autopsy biosafety program must be to provide autopsy staff and any visiting personnel with an environment as free from hazardous exposure risk as possible.