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.
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.
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:
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.OSHA Issues H1N1 Enforcement Procedures for Inspectors
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.
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
quaternary ammonium compounds [quats]
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.)
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
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:
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.
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.
Religious and Ethnic Groups:
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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