Care and Disposition of Remains - Army Publishing Directorate ...

g . C a s k e t s a n d t h e o u t e r s h i p p i n g c o n t a i n e r t h e c o n t r a c t o r p r o p o s e s t o p r o v i d e c o n f o r m t o a r m e d s e r v i c e s
specifications.
h. Establishment has, either through outright ownership or rental agreement, suitable rolling stock (funeral coach,
passenger car, and so forth) to satisfy contract requirements. Vehicles are to be clean and in good condition.
i . B i d d e r u n d e r s t a n d s m i n i m u m r e q u i r e m e n t s o f t h e c o n t r a c t f o r c a r e o f r e m a i n s , e s p e c i a l l y a r m e d s e r v i c e s
specifications.
Appendix I
Armed Forces Public Health Guidelines
I–1. Purpose
The purpose of this appendix is to provide procedural guidelines in the areas of public health, personal hygiene, and
safety, as they pertain to the practices of personal and environmental disinfection and decontamination by practitioners
of mortuary services. Prevention of the following is a reasonable expectation of the proper practice of these guidelines:
a. Transmission of actual (recognized) or opportunistic pathogens from human remains to the embalmer.
b. Transmission of pathogens from embalmer to susceptible hosts within the mortuary facility environment or to
members of the embalmer’s family.
c. Transmission of pathogens from preparation room environment to family and friends of the deceased or to other
visitors to the mortuary.
I–2. Premise
a. Many infectious agents associated with medical and paramedical environments are classified as “opportunistic”
pathogens or microbial agents normally considered to be of low virulence. Such organisms commonly are associated
with human remains and environmental areas adjacent to the storage of these remains.
b. Postmortem anatomic translocation and multiplication of these “opportunists” together with the necessary handling
and manipulation during transfer, pathologic examination, and embalming may enhance the exiting of the
contaminants from natural body orifices or body openings resulting from routine postmortem handling.
I–3. Concurrent disinfection and decontamination
a. Human remains.
(1) Thoroughly cleanse and disinfect body surface and orifices with a suitable generic category of chemical
disinfectant (for example, 100–105 ppm of an Iodophor or a 1:200 (0.5 percent) use-concentration of a phenyphenol).
Case evaluation or analysis may be performed during this sanitation procedure, with special emphasis on observation
for puncture or missile wounds, neoplasms, necrotic lesions, gas gangrene, and so forth.
( 2 ) T h o r o u g h l y r i n s e s a n i t i z e d s u r f a c e s , e s p e c i a l l y i f r e m a i n s h a s b e e n e x p o s e d t o a c c i d e n t a l o r t h e r a p e u t i c
radiation.
(3) Injection and drainage protocol should include the following recommended guidelines when applicable.
(a) Multipoint or multisite injection and drainage.
(b) Continuous injection and intermittent (interrupted) drainage to enhance chemical distribution and penetration.
(c) Use of minimum of a 2.0 percent by volume concentration of an aldehyde or aldehyde derivative preservative for
arterial injection.
(d) Each primary cavity (thoracic and abdominal) should be treated with a minimum of 16 ounces of concentrated
cavity chemical, or a minimum of 32 ounces per adult case.
b. Embalmer.
(1) Always wear an outer protective garment, preferably one that is impervious to penetration of liquids and
aerosols, for example, a rubber or plastic wrap-around apron or gown.
(2) Always wear rubber or plastic gloves during handling of human remains. The gloves should be discarded after
each use, especially in cases of known reportable infectious diseases or in cases of gangrene.
(3) Wear protective head and shoe coverings, especially in handling of autopsied cases or infectious disease cases.
( 4 ) W e a r a p r o t e c t i v e o r a l - n a s a l m a s k d e s i g n e d t o p r e v e n t i n h a l a t i o n o f i n f e c t i o u s o r h a z a r d o u s c h e m i c a l
particulates.
(5) Rinse gloved hands in appropriate dilution of chemical disinfectant periodically during preparation of the
remains to minimize transfer of contaminants to skin surfaces of the embalmer.
(6) Concurrently immerse instruments in separate pan or container of chemical disinfectant between actual use
during preparation of remains.
c. Air handling in preparation room.
(1) An efficient air exhaust system or air purification system is highly recommended to be in operation during
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