CHAPTER 3

1. CHAPTER 3 Personal & Public Health Considerations

2. Responsibility • The embalmer is responsible for: • public health safety and • personal health safety • Don’t forget to protect YOURSELF!!!!

3. Occupational Risks • The CDC has concluded that funeral directors have an increased risk of contracting tuberculosis as a result of direct contact with the deceased.

4. Occupational Risk • The most frequently reported diseases include: • hepatitis • staphylococcal and other skin infection • pulmonary and skin tuberculosis. • Expose occurs most often by • direct contact with blood • needle sticks

5. Occupational Risk • The longer you’re an embalmer the higher the risk factor of contracting an HBV infection. • So Please, Please, Please BE CAREFUL!!!

6. Exposure to Chemicals • Exposure to formaldehyde is probably the most significant chemical exposure an embalmer has to face. • The most common health problems in the prep room include chemical contact with the skin, eye and nose irritation, and upper respiratory irritation.

7. Non-Chemical Hazards • Non-Chemical Hazards Include • Heat • Ionizing Radiation • Non-Ionizing Radiation

8. Heat • With all of the Personal Protective Equipment an embalmer is required to wear it is no wonder why they can get so hot. • Breathing in chemicals while you’re sweating is not good. If the ventilation system in the funeral home is not enough, an additional fan on the embalmer may be necessary.

9. Heat • Just make sure that the fan is placed in a position that works with the ventilation system and not against it. • This is a very simple and silly suggestion, but you would be surprised what some facilities do to cut operating costs. • Be aware of your surroundings and know when you are enduring unhealthy exposure.

10. Ionizing Radiation • If the deceased has undergone radiation treatment the facility should not call the funeral home until the levels no longer pose a threat. The embalmer would have no way of knowing if a body had recently undergone radiation, we have to rely on the medical community in this matter. • (This is the radiation officer question I had on my NBE - I know I missed it.)

11. Non-Ionizing Radiation • This is very rare. It is in the case of microwave ovens or computer monitors. But employees still have a right to know that they are being potentially exposed.

12. Exposure Control Plan • Every funeral home should have an Exposure Control Plan that includes: • exposure determination • methods of compliance • hepatitis B vaccination • hazard communication • record keeping

13. Exposure Determination • In a funeral home exposure most often includes: • embalmers • transfer personnel • hairdressers • funeral directors • housekeepers (laundry workers)

14. Exposure Determination • Many funeral home managers are only letting essential employees into the exposed areas. That means many receptionists and drivers can no longer go into the preparation room. • What can you do to prevent “unauthorized” individuals from entering the preparation areas or room?

15. Methods of Compliance • Compliance with the Blood-borne Pathogens Rule is accomplished by: • universal precautions engineering controls • work practice controls

16. Universal Precautions • Universal Precautionsis the act of treating every deceased as if they have a potential communicable disease. • Many embalmers never see a death certificate or cause of death which makes Universal Precautions very important. • General Washington Pancake

17. Practicing Universal Precautions • Practicing Universal Precautions includes: • using personal protective equipment • properly decontaminating infected surfaces; like an embalming table for example • What other areas need to be decontaminated? • properly handling and disposal of infectious waste

18. Practicing Universal Precautions • Applying appropriate measures to control leaks, drips, and spills of infectious materials. • Applying proper work practice skills. • Properly handle contaminated laundry.

19. Engineering Controls • Engineering controls are parts of the design of the building and include: • Adequate Ventilation • Proper Plumbing

20. Adequate Ventilation • The purpose of the ventilation system is to remove the airborne contaminates which include embalming fluid vapors and replace them with fresh air. • The number of exchanges per hour vary but the average for a room with 1 table is 12 to 20 air exchanges.

21. Proper Plumbing • Examples of controls that could reduce the possibility of water contaminates include: • vacuum breakers on the main water line leading into the building • vacuum breakers on the hydroaspirator • discharge basins/flush sinks

22. Proper Plumbing • having a suitable water source for the embalming table • having an eyewash station • having a proper drench shower • having a proper hand washing station • having proper shower room facilities for the embalmer to use after the embalming

23. Work Practice Controls • Work Practice Controls include: • hand washing • proper handling of disposal of contaminated waste and sharps • avoiding splashing, spraying, or splattering • use of personal protective equipment • keeping a record of housekeeping

24. Personal Protective Equipment • A personal note about PPE: • I always kept a pair of old jean, sneakers, and a shirt (Oingo Boingo Concert Shirt) to wear under my ppe. They were clothing items that if they got blood on them I would just throw them away. I never embalmed in my or suit. I took off my ppe to go direct a funeral. I always embalmed in old clothes. • Now with the availability of full body suits, I can use a jumpsuit if needed.

25. Hepatitis B Vaccination • Once it is determined that a person has an occupation exposure the vaccination program must be: • offered at no cost to the employee • offered at a reasonable time and place • performed by a health care professional • provided under the U.S. Public Health Service

26. Hepatitis B Vaccination • An employee has the right to decline the vaccination but at any point in time, if the employee changes their minds then the vaccination must be given.

27. Post-exposure Evaluation • If there has been an incident the evaluation will include: • a detailed explanation of what occurred including the events and circumstances of what happened • identification and documentation of the source individual • collecting and testing the blood for HBV and HIV

28. Post-exposure Evaluation • Taking steps necessary to assist in the prevention of infection or disease • offering counseling • conducting an evaluation of any reported illnesses

29. Hazard Communication • Labels must used to mark infectious hazards. • Employees must be provided training on the infectious hazards in the work place. • The training program is very extensive and is outlined on page 40 of your book. You should read this information carefully.

30. Hazard Communication • Perhaps the most important things listed are numbers 10 and 11. You need to know what to do if an emergency occurs including what procedures to follow.

31. Record Keeping • Record Keeping in this case refers to the documentation of training with respect to occupational exposure to blood-borne pathogens. • Employers are required to make all records available to the employees.

32. Terms referring to disinfection & sterilization • Asepis- freedom from infection and from any form of life; sterility. • Bactericidal- destructive to bacteria • Bacteriostatic- inhibiting the growth or multiplication of bacteria (no destruction of viability implied).

33. Terms referring to disinfection & sterilization • Cleaning- removal of infectious agents by scrubbing and washing, as with hot water, soap, or a suitable detergent. • Disinfectant- an agent, usually chemical, applied to inanimate objects/surfaces for the purpose of destroying disease causing microbial agents, but usually not bacterial spores.

34. Terms referring to disinfection & sterilization • Germicide- A germicide is the same thing as a disinfectant except it can also be applied to living tissue. • Sanitizer- An agent, usually chemical, that possesses disinfecting properties when applied to a pre-cleaned object/surface.

35. Terms referring to disinfection & sterilization • Sterilization- a process that renders a substance free of all microorganisms.

36. Hazard Communications • The Hazard Communications Rule requires that employers must tell their employees about the dangers that exist in the work place as a result of hazardous chemicals or materials and they must train their employees in how to use these chemicals and materials safely.

37. Formaldehyde Standard • Under the Formaldehyde Standard, employers must monitor employees to determine how much exposure exists in the workplace. • The specific point at which exposure is unsafe in called the action level. • The permissible exposure limit (PEL)sets the maximum exposure that is allowed.

38. Formaldehyde Standard • The two tests are: (This is MAS IMPORTANTE) • the time-weighted average (TWA) done over an 8 hour time period which must read below 0.5ppm or re-testing must be done, and • the short-term exposure level (STEL) done over a 15 minute period which must read below 0.2ppm or re-testing must be done.

39. Conclusion • There are many things that you can be exposed to as an embalmer. • Your best defense is education. • Know how to protect yourself and know your rights. • Above all, use common sense.