Practical application of Standard Operating Procedures (SOP) Guidelines for COVID-19 autopsies: an Italian experience

ABSTRACT

Introduction: SARS-CoV-2, responsible for severe human infection with high mortality rate, has been classified as HG3 pathogen. Despite the need to perform autopsy to clarify the pathogenesis of COVID, such procedures are at high risk of contagion due to the direct contact with aerosols and body fluids. To ensure the safety of the personnel against contagion, it is mandatory to follow the SOP for the management of autopsy environment and infected body. Several studies have shown that SARS-CoV-2 persists on inanimate surfaces for a long time and is also ubiquitously detected in many human tissues, even after long time after death. Material and Methods: Many international scientific societies have drowned up various guidelines on biosafety and exposure precautions, but none of these is uniquely adopted. So, in the daily practice our greatest difficulty was to identify SOP adherent to the guidelines but applicable to our reality. In our experience, COVID autopsies were performed accordingly to the following SOP - COVID mortuary refrigerators - BSL3 autopsy facility - Autopsy saw with aspiration system - PPE surgical scrub, rubber medical shoes, coverall, shoe leggings, FFP3 mask, waterproof gown or apron, eyes protection, two pairs of medical gloves and one of cut-resistant gloves - Sanitization of surgical tools in autoclave - Sanitization of the environments with VHP - Periodic nasopharyngeal swabs from personnel Results and Conclusions: Our work aims to share our experience and to demonstrate that adopting these measures is effective in reducing risk of infection. In fact, the periodic COVID swabs were negative in 100% of cases.