Personal Protective Equipment (PPE)

• Your local and/or state public health officials may be making recommendations for the care of decedents and/or public gatherings that are more stringent than what the CDC and federal government have recommended. In these cases, you should defer to your state and/or local public health officials.
• The CDC has advised if you think you have been exposed to COVID-19 and/or develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice. If you are concerned about a potential exposure, this risk assessment for healthcare personnel (HCP) from the CDC may be useful.

We know the availability of PPE is a critical concern for funeral directors everywhere. Your access to PPE is vital to your ability to continue to safely serve families. NFDA is continually petitioning federal officials – CDC, FEMA, Health and Human Services, the President, Congress, state governors and others – about ensuring funeral home are on the priority list for receiving these critical supplies. We are also exploring private avenues from around the world that can offer PPE to funeral professionals. 

Securing PPE continues to be a top priority for NFDA.

NFDA has learned that PPE in the Strategic National Stockpile and PPE being manufactured now are being sent to FEMA, which will distribute it to each state’s Emergency Operations Center (EOC) based on need. Each state EOC manages requests from entities within its respective state, including deathcare professionals. To place a request for PPE, you’ll need to contact your state’s EOC, which we understand many of you continue to do without reply.

Due to the unprecedented nature of this pandemic, we have observed some shortcomings in communication between local, state and federal agencies and funeral homes making requests for PPE at the local or state level are being met with confusion. NFDA will continue to discuss logistics with our federal partners, and suggest you also contact your state association as they are on the front lines at the state level and have been working in conjunction with NFDA to address issues as they arise.

If you become aware of a solid lead for PPE, please contact NFDA at nfda@nfda.org.

We will continue to provide updates on this essential issue.

Other information: 

• FEMA: Coronavirus (COVID-19) Pandemic: Addressing PPE Needs in Non-Healthcare Setting
• CDC: Strategies for Optimizing the Supply of PPE and Equipment: this web page includes guidance for sanitizing and reusing PPE should your supplies begin to dwindle.

NFDA is aware of the challenges with PPE. We have spent more than a decade building relationships with federal officials responsible for responding to public health crises and mass-fatality situations. We are leading a discussion with federal officials about ensuring funeral home staff are on the priority list for receiving these critical supplies.

Already, the White House has issued an Executive Order that would fast-track FDA approval and domestic production of PPE and other pharmaceutical and medical supplies needed by those on the front lines of the COVID-19 pandemic.

During a live NFDA Facebook event with the CDC on March 16, the federal experts recommended that funeral homes that are concerned about a potential or imminent shortage of PPE should contact their state health department or local healthcare coalition as they are best positions to help troubleshoot through potential shortages. The CDC has offered guidance:

• Strategies for Optimizing the Supply of N95 Respirators
  • Conventional Capacity Strategies
  • Contingency Capacity Strategies
  • Crisis/Alternate Strategies

See also: 

• CDC: Strategies for Optimizing the Supply of PPE and Equipment
• FEMA: Coronavirus (COVID-19) Pandemic: Addressing PPE Needs in Non-Healthcare Setting

Per OSHA guidelines, universal precautions are an approach to infection control to treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens, (Bloodborne Pathogens Standard 29 CFR 1910.1030(b) definitions).

Bloodborne Pathogen Standard 29 CFR 1910.1030(d)(1) requires:

• Employees to observe Universal Precautions to prevent contact with blood or other potentially infectious materials (OPIM).
• Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials.
• Treat all blood and other potentially infectious materials with appropriate precautions such as:
• Use gloves, masks, and gowns if blood or OPIM exposure is anticipated.
• Use engineering and work practice controls to limit exposure.

The CDC recommends Standard Precautions for the care of all patients, regardless of their diagnosis or presumed infection status. Standard Precautions apply to 1) blood; 2) all body fluids, secretions, and excretions, except sweat, regardless of whether or not they contain visible blood; 3) non-intact skin; and 4) mucous membranes. Standard precautions are designed to reduce the risk of transmission of microorganisms from both recognized and unrecognized sources of infection in hospitals.

Standard precautions includes the use of: hand washing, appropriate PPE (e.g., gloves, gowns, masks, eye protection, etc.) whenever touching or exposure to patients' body fluids is anticipated.

CDC guidance for funeral directors handling decedents indicates that funeral professionals should follow Standard Precautions, including additional personal protective equipment (PPE) if splashing of fluids is expected, during both transfers and embalming. It is always better to don (put on) more PPE and be safe than sorry. See: Frequently Asked Questions about Personal Protective Equipment (CDC).

All PPE should be donned (put on) and doffed (taken off) and disposed of properly.

Per CDC guidelines, if it is necessary to transfer a body to a bag, follow Standard Precautions, including additional PPE if splashing of fluids is expected. See: Frequently Asked Questions about Personal Protective Equipment (CDC)

For transporting a body after the body has been bagged, disinfect the outside of the bag with a product with EPA-approved emerging viral pathogens claims is expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).

Wear disposable nitrile gloves when handling the body bag.

After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water is not available. Soap and water should be used if the hands are visibly soiled.

Per CDC guidelines, follow Standard Precautions when making a transfer from any facility. See: Frequently Asked Questions about Personal Protective Equipment (CDC).

Anyone who enters a home of an infected individual should don a face mask and proper PPE. See: Frequently Asked Questions about Personal Protective Equipment (CDC)