- And that is where the original manuscript ended in 1998.
- Since that time, we really haven't learned that much
more about CJD, but as more and more embalmers become aware of it and the
potential danger it presents, it becomes obvious that we as a profession
need some guidelines or protocols on the handling of a known or suspected
case of CJD.
- What follows then is what we hope is a reasonable set
of procedural guidelines for the embalmer based on what we know today.
- Before using them, read the entire article on CJD so
you better understand the disease and its risks to you and other employees.
You also need to know the legal and business risks of not preparing the
body. We recommend that you read the other material available listed in
Appendix A to make a fully informed decision.
- Notice and disclaimer
- These CJD preparation guidelines are based on the knowledge
available to the industry at the date of writing. These procedures may
become outdated based on more current information. The embalmer must keep
apprised of the latest information available.
- The procedures outlined are, in the professional opinion
of the author, a reasonable response to the potential risks posed by CJD.
The individual funeral home owner and embalmer must make their own independent
decisions based on the risks presented by preparing or not preparing a
person with known or suspected CJD and be responsible for them.
- The decision then to proceed or not to proceed is purely
the decision of the funeral home and/or the individual embalmer. The author
can not be held responsible for the consequences or results of either decision.
- The "exposure level" rating of 1 (low) to 5
(high) indicates the level of potential exposure to the prion. Basically,
no exposure to blood or cerebro-spinal fluid creates a negligible or very
low potential exposure level. Exposure to blood or certain other body fluids
produces a medium potential exposure level, since the causative agent for
CJD is found in the blood, though in small amounts. Exposure to the brain
and/or cerebro-spinal fluid produces a high potential exposure level since
these (and to a lesser degree, other internal organs) are the primary reservoirs
for the prion.
- It does not in any way imply a risk of developing CJD,
since the chances of contracting the disease from exposure to blood, body
fluids, brain and spinal fluid, etc. is not known.
- It simply makes sense however, that the lower the exposure
to the prion, the lower the chances of contracting CJD. But even maximum
exposure to the prion is no indicator that a person will eventually contract
- The term "intact" as used here is defined as
a body that has not been autopsied, has no brain or spinal column injury,
and does not display any excessive blood or body fluid leakage.
- Since we maintain that a person deceased with CJD can
not technically be "embalmed" (since the body can not be disinfected,
which defines embalming) we will use the words "prepare" or "inject"
to refer to the procedures that on any other body would be considered "embalming".
- "Universal Precautions" refers to an approach
to infection control that considers all deceased human bodies to be infectious
and must be handled as such. OSHA regulations require that universal precautions
be practiced. This requires the proper use of personal protective clothing
and equipment (PPE). In the case of a CJD case, universal precautions must
also take into consideration the possibility that the deceased could have
other diseases of concern to the embalmer. Therefore, recommendations concerning
universal precautions will be based on other diseases also and indeed should
be utilized on every case regardless of any assumed cause of death. For
instance, we recommend the use of face masks not because CJD is an airborne
disease (there is no evidence to suggest that) but because TB is an airborne
disease and the principle of universal precautions says we assume the person
may have this and other diseases also and we must protect ourselves accordingly.
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