Review: The safe handling of a corpse (suspected) with COVID-19.

INTRODUCTION: Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. RESULTS: The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. CONCLUSION: In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a "business as usual" attitude and others a "code-red" attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse.

Manejo de cadáveres en el contexto del nuevo coronavirus (COVID-19). Recomendaciones provisionales, 7 de abril de 2020 / Dead body management in the context of the novel coronavirus (COVID-19). Interim recommendations, 7 April 2020

Proporcionar recomendaciones sobre la gestión de cadáveres en el contexto del nuevo coronavirus (COVID-19) en las instalaciones de atención de salud. Estas recomendaciones son preliminares y están sujetas a revisión a medida que se disponga de nuevas evidencias.* Consideraciones clave: • En diciembre de 2019 se identificó un nuevo coronavirus (SARS-CoV-2) como el agente causal de una enfermedad respiratoria aguda grave (COVID-19) en Wuhan, China. El virus se propagó a diferentes países y la Organización Mundial de la Salud (OMS) declaró una pandemia el 11 de marzo de 2020. • Hay todavía algunas incertidumbres en la historia natural de COVID-19, incluyendo fuentes, mecanismos de transmisibilidad, desprendimiento viral y persistencia del virus en el medio ambiente. Se ha documentado la transmisión de persona a persona, con un período de incubación de 2 a 14 días. • La transmisión de enfermedades infecciosas asociadas con el manejo de cadáveres puede ocurrir y puede ser amplificada por el incumplimiento de las precauciones estándar y basadas en mecanismos de transmisión, especialmente en entornos sanitarios.

To provide recommendations on the management of dead bodies in the context of the novel coronavirus (COVID-19) in healthcare facilities. These recommendations are preliminary and subject to review as new evidence becomes available.* Key considerations: • In December 2019 a novel coronavirus (SARS-CoV-2) was identified as the causative agent of a severe acute respiratory illness (COVID-19) in Wuhan, China. The virus spread to different countries and WHO declare a pandemic on March 11, 2020. • There are still some uncertainties in the natural history of the COVID-19, including source(s), transmissibility mechanisms, viral shedding, and persistency of the virus in the environment. Human-to-human transmission has been documented, with incubation period from 2 to 14 days. • Transmission of infectious diseases associated with management of dead body can occur and can be exacerbated by non-compliance to standard and transmission-based precautions, especially in healthcare settings. Aerosol-generating procedures (AGP)† have a role in the spread of the disease , as well as contaminated hands of healthcare providers, surfaces and fomites. • Assess the risk during the mortuary care process and provide adequate explanation to the family, respecting the cultural context of the local community. If indicated, provide personal protective equipment (PPE) to the family, with instruction in its use.

Microbial contamination and tissue procurement location: A conventional operating room is not mandatory. An observational study.

BACKGROUND: Standard operating rooms (SOR) are assumed to be the best place to prevent microbial contamination when performing tissue procurement. However, mobilizing an operating room is time and cost consuming if no organ retrieval is performed. In such case, non-operating dedicated rooms (NODR) are usually recommended by European guidelines for tissue harvesting. Performing the tissue retrieval in the Intensive care unit (ICU) when possible might be considered as it allows a faster and simpler procedure. OBJECTIVE: Our primary objective was to study the relationship between the risk of microbial contamination and the location (ICU, SOR or NODR) of the tissue retrieval in heart-beating and non-heart-beating deceased donors. MATERIALS AND METHOD: We retrospectively reviewed all deceased donors' files of the local tissue banks of Montpellier and Marseille from January 2007 to December 2014. The primary endpoint was the microbial contamination of the grafts. We built a multivariate regression model and used a GEE (generalized estimating equations) allowing us to take into account the clustered structure of our data. RESULTS: 2535 cases were analyzed involving 1027 donors. The retrieval took place for 1189 in a SOR, for 996 in a hospital mortuary (NODR) and for 350 in an ICU. 285 (11%) microbial contaminations were revealed. The multivariate analysis found that the location in a hospital mortuary was associated with a lower risk of contamination (OR 0.43, 95% CI [0.2-0.91], p = 0.03). A procurement performed in the ICU was not associated with a significant increased risk (OR 0.62, 95% CI [0.26-1.48], p = 0.4). CONCLUSION: According to our results, performing tissue procurement in dedicated non-sterile rooms could decrease the rate of allograft tissue contamination. This study also suggests that in daily clinical practice, transferring patients from ICU to SOR for tissue procurement could be avoided as it does not lead to less microbial contamination.