Handling the deceased with suspected or confirmed COVID-19

This guidance has been developed to ensure that people who come into contact with the deceased through work, or who work in services providing care for the deceased, are protected from COVID-19 infection. This may include people such as funeral directors, mortuary operators, medical practitioners and those involved in transporting the deceased.

Contents

• Risk of infection
• Managing a death in the community (for example funeral directors)
• Preparations and final disposition
• Management of cleaning and waste
• Precautions for others who are involved in the care of the deceased
• Transporting the deceased
• More guidance

Risk of infection

While the risk of transmission of COVID-19 from the deceased is low there is likely to be a continuing risk of infection from handling body fluids and tissues where infection is suspected or confirmed. The exact duration that SARS-CoV-2 can remain infectious in body fluids and tissues in a deceased body is unknown.

Residual hazard of infection from COVID-19 may arise from:

• droplet generation emanating from the deceased during their care
• post-mortem examination or implant removal involving the use of power tools, which is a risk for aerosol generation
• direct contact with contaminated material such as soiled clothing or bedding from the deceased and the surrounding environment

Standard infection control precautions (SICPs) and transmission-based precautions (TBPs) should be sufficient to protect those handling the deceased with suspected or confirmed COVID-19 while deceased individuals remain in the care environment. This includes under refrigeration conditions.

You can find out more about SICPs and TBPs in HSE publication Managing infection risks when handling the deceased.

The UK Health Security Agency have published a brief update of the rapid review examining risk of COVID-19 transmission from the deceased.

Managing a death in the community (for example funeral directors)

Meeting with the bereaved

Where possible, you should provide support and advice over the phone.

If you need to meet with the bereaved but will not make direct contact with the deceased, follow the public health advice for the nation you’re working in:

• Scotland - Scottish Government
• England - GOV.UK
• Wales - Welsh Government

Precautions where there is close contact with the deceased

If you are required to have close contact with the deceased, you should take the following precautions:

• you should wear PPE as described in Table 2
• maintain a safe distance (at least 2 metres) from the bereaved and other members of the household, who may be staying at home and avoiding contact with other people due to suspected or confirmed COVID-19 infection. Ask people to leave the room and any areas the deceased will travel through as they are moved
• place a barrier, such as a cloth or mask, over the mouth of the deceased when moving them as this may prevent the release of droplets from the respiratory tract
• body bags are not essential but may minimise the infection risk. They are recommended where leakage of bodily fluids is likely. If body bags are used for cremation, they must not contain any PVC or any highly chlorinated materials
• cloth wrappings (shrouds or wraps) and coffins may be used to manage the risk of contact transmission but are not a replacement for body bags in situations where they are recommended
• wipe down the external surface of the body bag or coffin with a combined detergent disinfectant solution as normally used within mortuary practice. Follow manufacturer’s instructions for dilution, combination, application and contact times for all detergents and disinfectants

Further guidance for staff who manage the deceased and those involved in the exhumation of human remains is available in publication Managing infection risks when handling the deceased.

Volunteers

In some communities, deceased bodies are cared for by appropriately trained volunteers. If you are a volunteer with an underlying condition that puts you at higher risk of severe illness if infected with COVID-19, you should consider seeking advice from your health professional on whether you should provide care for the deceased.

Preparations and final disposition

Viewing, hygienic preparations such as washing and post-mortem investigations are permitted when overseen or undertaken by those trained in handling bodies of the deceased.

PPE requirements for mortuary staff, pathologists, pathology technologists, funeral directors and embalmers

While embalming can take place, where aerosols could be generated through the use of high-speed tools or the removal of fixion nails, you should use PPE as indicated in the RCPath and AAPT guidance for autopsy procedures. This is also shown in Table 1 below.

Cremation is permitted and where the deceased has a medical device that requires removal beforehand, use PPE as detailed in Table 1.

Table 1: Transmission-based precautions for suspected or confirmed COVID-19

Employees should:

• make sure they understand their employer’s procedures regarding PPE
• make sure that they have been trained in their use and that they are using them correctly
• remove any PPE and contaminated clothing when they leave a dirty work area
• not enter clean areas wearing PPE

RCPath and AAPT have published guidance on the PPE requirements for care of the deceased during the COVID-19 pandemic.

The UK Health Security Agency (UKHSA) has guidance (including posters and videos) on putting on and taking off PPE.

If you process samples taken from bodies you should follow guidance in the section on ‘Managing Risks from Infection in Post Mortem Room and Mortuary’ in the publication Managing infection risks when handling the deceased.

Management of cleaning and waste

Advice on cleaning and disinfection for the mortuary and similar workplace environments is available in HSE publication Managing infection risks when handling the deceased with specific reference to appendix 3. You should read this in conjunction with the Department of Health guidance.

Precautions for others who are involved in the care of the deceased

Staff involved in the care of the deceased outside of the formal funeral home or mortuary setting should consider what actions they need to take to ensure safe working.

We strongly advise that any rituals or practices that bring people into close contact with the deceased with suspected or confirmed COVID-19 should be undertaken using appropriate PPE under supervision of somebody trained in its use.

Table 2 below details activities involved in the care of the deceased and the appropriate PPE required.

Table 2: PPE requirements for care of the deceased in non-clinical settings

Note: eye or face protection (full face visor or goggles) is recommended only if there is an anticipated/likely risk of contamination with splashes or droplets of blood or body fluids.

Transporting the deceased

Cloth wrappings (shrouds or wraps) and coffins may also be used to manage the risk of contact transmission but are not a replacement for body bags in situations where they are recommended.

If neither body bag nor coffin has been used, cleaning and disinfection of the vehicle should be sufficiently thorough to prevent transmission. 

More guidance

The guidance above has been co-created with UKHSA, and should be read in conjunction with the following:

Managing infection risks when handling the deceased

This HSE publication details the standard infection control precautions and transmission-based precautions that should be followed by all those handling the deceased. It covers the safe handling, storage and examination of bodies in hospitals, mortuaries and post-mortem rooms. The guidance is not specific to COVID-19 but the SICPs and TBPs described are sufficient for managing the risk, with additional precautions taken for aerosol generating procedures (AGPs). Paragraphs 12 to 18 give details on the related legal duties which apply.

Transmission-based precautions: Guidance for care of deceased during COVID-19 pandemic.

Royal College of Pathologists (RCPath) and Association of Anatomical Pathology Technology (AAPT) guidance, which details the Personal Protective Equipment (PPE) required for TBPs that should be used by any professional involved in the care of the deceased during the COVID-19 pandemic.