Morticians Fear CJD Victims
Procedural Guidelines For Mortuary Care Of CJD - Creutzfeldt-Jakob Disease

Wyoming Funeral Directors Association
© 2000, Management Associates, All Rights Reserved
Special Thanks To Halene Shields For Sending This Report
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 These procedures may become outdated based on more current information.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 CJD.
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.
© Copyright 2000, Management Associates, All Rights Reserved
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