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H1N1 (“Swine Influenza”) Flu Outbreak: Information and Resources

Updated: December 1, 2009

Overview

CDC Recommendations for Mitigating the Spread of the H1N1 Flu

Handling Deceased Persons

OSHA Issues H1N1 Enforcement Procedures for Inspectors

H1N1 Virus on Surfaces and Disinfection Protocol

Workforce Considerations

Federal Government H1N1 Resources

Preparing Your Funeral Home for a Pandemic

Other Pandemic Flu Resources


Overview

On Sunday, April 26, 2009 the Department of Homeland Security (DHS) declared a "public health emergency" in response to the H1N1 ("swine influenza") outbreak that started in Mexico and has spread to other countries, including the United States.

On April 29, 2009 the Centers for Disease Control and Prevention (CDC) confirmed the first fatality in the U.S. - a child, approximately two-yearsof age, from Texas. On June 11, 2009, the World Health Organization declared the H1N1 outbreak to be a pandemic.

The most up-to-date and comprehensive information from the federal government on the H1N1 outbreak including the number and location of confirmed cases in the U.S., and information about symptoms, treatments, tips for staying healthy, travel advisories and more, can be found here: http://www.cdc.gov/h1n1flu. NFDA encourages you to monitor the CDC site, as well as your state and local health departments for updates.

Please note, this is an evolving situation, and things could change at any time. Thanks to NFDA's prior work with the federal government on pandemic, disaster and mass-fatality management planning, association staff members have been receiving daily communication from DHS, CDC and other agencies responding to the H1N1 outbreak. NFDA will continue to keep you apprised of important funeral service-related developments as they become available.

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CDC Recommendations for Mitigating the Spread of the H1N1 Flu

  • Stay informed. The CDC Website (http://www.cdc.gov/h1n1flu) is being updated regularly as information becomes available. NFDA will continue to update its H1N1 page as new funeral service -related information becomes available.
  • Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.
  • Take everyday actions to stay healthy.
    • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
    • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand sanitizers are also effective.
    • Avoid touching your eyes, nose or mouth. Germs spread that way.
    • Stay home if you get sick. CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.
  • Develop a family emergency plan as a precaution. This should include storing a supply of food, medicines, facemasks, alcohol-based hand rubs and other essential supplies.

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Handling Deceased Persons

Please share this important information with all members of your funeral home's staff.

The CDC is reporting to NFDA that there is little to no chance of contracting the H1N1 virus from the body of a deceased person who died or is thought to have died of H1N1 influenza because the virus becomes inactive at death. Therefore, standard universal precautions for handling human remains should provide adequate protection.

Universal Precautions
Employing universal precautions required by OSHA's Bloodborne Pathogens standard mean that you treat all blood and body fluids as if they contain a blood-borne pathogen and act accordingly.

When handling the body, embalmers and funeral directors should wear a head cover, a shield to protect the eyes, a nose-and-mouth mask to screen out particles, a gown impervious to fluids, surgical gloves and shoe covers.

Embalmers and funeral directors should also use a combination of proper engineering and work practice controls to reduce or remove the possibility of exposure to blood and bodily fluids.

For more information about OSHA's Bloodborne Pathogens standard, visit www.osha.gov. NFDA members may call the association's FREE OSHA hotline at 800-633-2674.

The primary risk that you face as a funeral director is with people who may have come into contact with the infected person prior to their death, and, therefore, may themselves be contagious (i.e., family, friends, etc.). You may encounter these contagious individuals when they come into plan the funeral for their loved one or at the visitation/funeral/memorial service.

The CDC recommends the following strategies to all people in order to minimize risk/exposure to the H1N1 virus:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands sanitizers (containing at least 60 percent alcohol) are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread that way.
  • Try to avoid close contact with sick people. Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people. If you get sick, CDC recommends that you stay home from work or school and limit contact with others to keep from infecting them.
  • If you must be in contact with people who are known to have swine flu or who may be infected, the CDC recommends "social distancing" - maintaining a distance of six feet from anyone who may or is known to be infected.

The CDC released "Post-mortem Care and Safe Autopsy Procedures for Novel H1N1 Influenza" on May 28.  Review this Web page for additional recommendations; the CDC will update this Web page as new information becomes available.

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OSHA Issues H1N1 Enforcement Procedures for Inspectors
In late-November 2009, OSHA issued instructions to its inspectors to ensure uniform procedures when conducting inspections in work sites with a high- to very high-occupational exposure risk to H1N1 by workers whose occupational activities involve contact with patients or contaminated material in a health care or clinical laboratory setting.

While funeral service is not specifically mentioned in the instruction document's definition of "health care personnel," it is not eliminated. Autopsies, however, are included in the instructions as an aerosol generating procedure requiring engineering controls, administrative controls and protective equipment. If fatalities from H1N1 flu mount, however, in addition to autopsy suites and medical examiners facilities, it is highly likely that funeral homes involved in the preparation of the remains of deceased H1N1-infected individuals will be targeted for inspections.

If it is determined that there is a high- to very high-occupational risk of exposure, as defined in the instruction, citations and penalties could be issued under the OSHA General Duty Clause, and OSHA standards such as those related to use of personal protective equipment, eye and face protection, respiratory protection, bloodborne pathogens, sanitation, and accident prevention signs and tags.

OSHA will send notification letters, as part of an outreach effort, to alert employers who may have employees with high to very high occupational exposure risks to H1N1 influenza. Any NFDA member who receives such a letter should treat it as an indication that the members' funeral home is a potential inspection target for an OSHA inspection. The letter itself describes the hazard and is accompanied by several fact sheets and guidance documents, which would have the effect of placing the employer on notice of the hazards in the workplace, arguably eliminating a defense of a general duty violation, as well as establishing some ground work for a willful violation of an applicable cited standard.

NFDA OSHA Consul Edward Ranier has drafted an explanation of these new instructions for inspectors for funeral homes. Further information, including the full instructional document, can be found on the OSHA Website.

If you have questions about protecting your employees or yourself against H1N1 or about complying with OSHA standards, NFDA members may call NFDA's FREE OSHA Hotline, 800-633-2674, answered by experts from Stericycle.

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H1N1 Virus on Surfaces and Disinfection Protocol

According to the federal government's pandemic flu planning Website (http://www.pandemicflu.gov):

Cleaning and disinfection can reduce the number of viruses present on environmental surfaces, which can help to minimize hand transfer of virus. Influenza viruses are enveloped, lipid-containing viruses, and as such are readily sensitive to a wide variety of chemical disinfectants. While historically there has been a clear distinction between pandemic strains of influenza viruses and seasonal influenza viruses based on antigenic specificity, there is no new evidence to suggest that pandemic influenza viruses are biophysically or biochemically different than seasonal influenza virus. Although pandemic influenza viruses may cause severe disease, influenza viruses are among the least resistant microorganisms to chemical disinfection. Therefore, routine cleaning and disinfection strategies used during influenza seasons could be applied for the environmental management of pandemic influenza.

Cleaning with soap or detergent in water is the first step in surface treatment. Cleaning will remove soil and organic matter that would otherwise reduce the effectiveness of the disinfection step that follows. There is no indication for cleaning procedures that differ from what is done routinely. Any commercially-available soap or detergent can be used. Water can be cold or warm, or as recommended on the label of the cleaning product being used (if a specific temperature is listed).

Influenza viruses can be inactivated by many low- or intermediate-level disinfectants containing any of the following ingredients:

chlorine or hypochlorite
aldehydes
quaternary ammonium compounds [quats]
phenolics
alcohols
peroxygen compounds

Use of disinfectants registered by the U.S. Environmental Protection Agency (EPA) is recommended whenever these are available. Lists of all registered disinfectants can be found at http://www.epa.gov/oppad001/chemregindex.htm. Many, if not all, of these products indicate potency for several target pathogens on the label. There are approximately 400 registered disinfectants with human influenza A and/or B listed on the product label, and all will inactivate influenza viruses when used according to manufacturer instructions. (Note: the H1N1 influenza virus is a strain of the influenza A virus.)

(taken from: http://www.pandemicflu.gov/plan/healthcare/influenzaguidance.html)

According to the CDC, influenza A viruses can live on hard surfaces for approximately seven hours and on porous surfaces for shorter periods of time. Given this, it would seem prudent for funeral home staff to use one of the EPA-recommended chemicals and take special care to clean and disinfect the public areas of their funeral home (i.e., bathrooms, door knobs, tables, etc.), office equipment (telephones, computer keyboards and mice; desks; tables; etc.) and the prep room at least daily, if not more frequently, depending on traffic, in order to mitigate the spread of the H1N1 flu.

More information about disinfecting surfaces which may be contaminated with the H1N1 virus may be found here: http://www.pandemicflu.gov/plan/healthcare/influenzaguidance.html

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Workforce Considerations

Based on information from CDC, SESCO Management Consultants, NFDA's endorsed human resources consultants, ask business owners/human resources managers to consider the following strategies for mitigating the spread of the H1N1 flu:

  • Request that employees report to their supervisors immediately if they are experiencing any flu-like symptoms. Subsequently, request employees to go home and stay home while sick.
  • Post in washrooms, bathrooms, break rooms and lunch areas signs encouraging employees to wash their hands frequently and to practice good hygiene. This includes covering coughs and sneezes, avoiding human contact in the workplace and practicing good housekeeping by cleaning up after themselves.
  • Ensure bathrooms are equipped with anti-bacterial soaps and alcohol cleansing products. Place alcohol cleansing products in reception areas, bathrooms, break rooms, lunch areas, conference rooms and other public locations.
  • Encourage staff to wipe down phones at least twice a day with alcohol cleaning products -- especially for phones that are available to the general employee population and/or public.
  • Communicate with cleaning personnel or services about additional cleaning that they may be able to provide to sanitize work areas.
  • Should the outbreak continue to spread, consider temporarily altering attendance and/or sick leave policies so that employees feel that they don't have to show up to work or otherwise be penalized when they are sick. Of course, there will be abuse of such policies, so communication and training, particularly with supervisors, is appropriate.

OSHA has released fact sheets for workers and employers, on its new "Workplace Safety and H1N1" Website, www.osha.gov/h1n1. The Website includes general guidance for employers and workers, and specific recommendations for healthcare employers and workers.

Another resource, Flu.gov, is a one-stop access to U.S. government H1N1, avian and pandemic flu information for businesses and individuals.

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Federal Government H1N1 Resources

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Preparing Your Funeral Home for a Pandemic

Health officials have declared the H1N1 outbreak to be a pandemic; In doing so, however, officials have stated that the declaration was made because the virus was spreading rapidly throughout the world, and not because the severity of the disease or fatalities associated with the H1N1 virus.  Please note, this is an evolving situation, and things could change at any time.

Funeral directors will play a very important role in the should the nature of the H1N1 virus change and it begins causing mass-fatalities. Funeral directors will be counted on to provide the same high level of care and compassion for families during such a challenging time as they do today.

Here are some things you will need to consider as your funeral home plans to handle any pandemic.

Work Force:

  • Expect to double or even triple the number of calls your funeral home will receive over a 10- to 12-month period. Most likely they will come in three surges, each lasting about six to eight weeks: one at the beginning of the outbreak, another about four weeks after the end of the first surge and a third about four weeks after the end of the second surge.
  • Plan for additional staffing during a pandemic situation (Are there tasks which can easily delegated to retired funeral directors in the area, mortuary school students and, finally, to volunteers from church or civic groups?).

Dispositions:

  • Crematoriums and cemeteries must look at surge capacity within their facilities.
  • Cremations, which have fewer resource requirements than burials, may be a more expedient and efficient way of managing large numbers of remains.
  • If the body is not to be cremated, plans to expedite the embalming process should be in place.
  • Remains may need to be stored temporarily before embalming, after embalming or for the duration of the pandemic wave (four to six weeks), so funeral directors should work with local medical examiners/coroners and public health officials to address such a situation, which may include refrigeration, temporary interment or storage in vaults.

Death Certificates:

  • In a pandemic, there could be as many unattended deaths as attended deaths. The former will require that the remains be processed by the medical examiner or coroner. In a surge situation with a reduced workforce and doctors otherwise occupied, it is expected that death certificates will be batch processed on a daily or weekly basis. The latter will be processed normally.
  • Plan in advance for this situation and the potential delay in receiving remains or obtaining a death certificate.

Infection:

  • Take special precautions to protect yourself and your employees from infection. Go to www.pandemicflu.gov and download the Pandemic Flu Business Checklist.
  • Making arrangements for visitations, memorial services and gravesite services may be a concern because of possibility of contagion.
  • Consult with your local or state public health officials to determine if such gatherings would be permissible. If not, you should plan now how to conduct all of these activities in a restricted environment.
  • All staff shots and vaccinations should be up to date.

Supplies:

  • Stock at least six months of supplies to handle the first wave of a pandemic.
  • Families with multiple deaths are unlikely to be able to afford multiple higher-end products or arrangements.
  • Your funeral home could quickly run out of lower-cost items, so be prepared to offer alternatives or plan to have these items in stock.
  • Contact suppliers and develop a plan for timely delivery in the event of a pandemic.

Transportation:

  • Transporting bodies from place of death or morgue to the funeral home and then to the place of burial may become an issue. Transporting remains from the place of death to their hometown may also be difficult, especially if air service is restricted.
  • Work with your state and local emergency response and public health officials to plan for these eventualities, especially in a surge environment.

Religious and Ethnic Groups:

  • Reach out now to religious and ethnic leaders in your community and involve them in planning for funeral management, bereavement counseling and communication. This is especially important in communities where large numbers of people do not speak English and where traditional funeral and burial rituals and ceremony may have to be curtailed.

Preneed Contracts:

  • A funeral home may not be able to fulfill the terms and conditions of a preneed contract due to the unavailability of specific merchandise or other conditions.
  • Consult with the state attorney general or local city/ county attorney to provide some sort of legal immunity against a lawsuit that might be filed for noncompliance due to the pandemic.

More information on preparing your workforce and workplace for a pandemic can be found on the U.S. Department of Labor/Office of Safety and Health Administration Website

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Other Pandemic Flu Resources

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