2.3  Technical recommendations for body handlers
"Body handler" refers to any individual involved in the physical handling of human remains. This includes, but is not limited to, healthcare practitioners and healthcare assistant personnel, death care workers including forensic doctors, pathologists and other forensic experts, autopsy technicians, non-forensic personnel charged with recovery and transportation of human remains, individuals involved in body preparation for body disposal, for funerals or other commemorative events. Body handlers should take precautions when handling the remains of individuals that have died from COVID-19.• Use of standard PPE – Gloves (Ensure that gloves are unpunctured, nitrile gloves preferred)/aprons/long sleeved gowns/overalls to protect skin and clothing from contamination by infected material/Face masks and eye protection: Googles or face shields/Full-face masks: FFP3 masks or N95 respirators are currently considered best for preventing inhalation of aerosols and in case of splashes during the body handling process to protect the face, eyes, nose, and mouth (Table 1 ).
Table 1 Transmission based precautions (TBPs): Personal protective equipment (PPE) for care of deceased during COVID-19 pandemic. Table adapted from guidance developed by Department of Health and Social Care, Public Health Wales, Public Health Agency (PHA) Northern Ireland, Health Protection Scotland and Public Health England [7].
Low risk Procedures∗:Admission of deceasedPreparation for viewingRelease of deceased Medium risk Procedures∗∗:Rolling deceasedUndressing deceasedSignificant manual handling High risk Procedures:Autopsy and other invasive procedures
Disposable gloves Yes Yes Yes
Disposable plastic apron Yes Yes Yes
Disposable gown No No Yes
Fluid-resistant (Type IIR) surgical mask (FRSM) Yes No No
Filtering face piece (FFP)∗∗∗ No FFP2 or FFP3 FFP3
Disposable eye protection Yes Yes Yes
Protective footwear (e.g. rubber boots which can be disinfected after use) Yes Yes Yes
∗If procedure likely to cause droplet contact, use medium risk procedure.
∗∗If procedure likely to generate aerosols, use high risk procedure. ∗∗∗ECDC (European Centre for Disease Prevention and Control) recommends the use of FFP3 masks for performing aerosol-generating procedures [15]. In case of shortage of Class 3 respirators, the use of Class 2 respirators (e.g. FFP2) may be considered, on a case by case basis and after assessing the risks of the procedures required.
• Shoe protection is desirable, ideally consisting of rubber boots which can be disinfected after use.
• If there is a risk of cuts, puncture wounds, or other injuries that break the skin, wear heavy-duty gloves over the nitrile gloves.
• Where possible use double body bags or body bags for infectious cases if available.
• Disinfect any non-disposable equipment being used during the handling of the remains as per standard practice.
• Used PPE should be properly disposed of to avoid contact with people, food, drink, or eating and drinking utensils. Biohazardous waste incineration is best.
• Avoid contact with your face and mouth, as well as food, drink, or eating and drinking utensils, during body handling.
• Rigorously wash hands after body handling and prior to eating or drinking.
• Do not engage in any other activity during the body handling or preparation process.
• Following the body handling or preparation process, rigorously wash hands and disinfect surfaces that may have come in contact with the infected body.
• Be aware of any hazards, in addition to COVID-19, which may be present in the environment and site of the location of the body.
• Ensure that any potentially contaminated staff clothing is not taken to their place of residence or those of others before proper cleaning.
• The potential for COVID-19 in human remains continues to pose a cross contamination hazard for some time after they have been removed from the site of recovery (hours and possibly days [6]).
• Similarly, personal effects of the deceased may also continue to pose a cross contamination hazard. If they are to be returned to next of kin, careful consideration must be given to an appropriate means of decontamination to ensure that the health of those receiving these items is not endangered.
• Similarly, documentation created during the recovery, transport, examination, storage and burial process may become infected with COVID-19 and should be disinfected accordingly.
• The process of recovering and identification of human remains of COVID-19 fatalities will generate waste products which are also potentially infected with COVID-19. Careful consideration must be given to safe management and disposal of this waste to ensure that the safety of those involved is not compromised and the spread of COVID-19 is avoided.
• Transport the body to the mortuary (or disinfection location if no post-mortem examination will occur) as soon as possible.