Health and Safety Issues in New Zealand ... - Business.govt.nz

Discussion
Only one institution met the facility and work practice standards required of a
mortuary carrying out high-risk procedures.
Eight institutions do not meet the standards required of a basic facility and require
immediate improvement. OSH departmental medical practitioners (DMPs) have
written letters to the managers outlining the sorts of improvements required to
achieve compliance.
Seven other facilities required engineering improvements of changes in work practices
to achieve compliance with the HSE Act to meet the standards of a “basic facility” that
OSH would see as the minimum for “standard” autopsies.
OSH developed the “standards” for this audit from international documents. Although
the risks of an autopsy are relatively low, they are potentially fatal and OSH feels that,
given the presence of these international recommendations, New Zealand institutions
must meet this standard.
It is OSH’s view that elimination of these risks is not practicable.
Isolation (of the high-risk cases) does seem a practical option for some institutions
and, in OSH’s view, should be considered if the cost of upgrading a local facility is
excessive. Isolating the risk to well-maintained, suitable facilities with well-trained
staff not only decreases the health and safety risk but must have important benefits
for quality control issues. Isolation is, however, complicated by forensic and cultural
issues.
Minimisation will remain the risk control mechanism of choice for most institutions. It
is vital, however, that institutions accept that some investment in engineering
solutions is necessary, particularly ventilation, and that strict adherence to work
practices, however familiar, is required. It is OSH’s recommendation that the
following principles apply to any mortuary facility:
1. That an “autopsy manager” (circulator) with responsibility for the health and
safety aspects (as well as the quality control, professional standards, etc.) be
appointed for each case. This person has the authority to set the health and
safety standards for that case, including the ability to stop or decline the case if
necessary. The pathologist would seem the logical choice.
2. That the autopsy facility be purpose-designed and kept abreast of new or
changing recommendations in the future.
3. That each facility have clearly demarcated “dirty”, “transition” and “clean” areas.
Changing, rest and eating areas are confined to the clean area, as are storage and
other general use areas.
4. That the “dirty” area of the mortuary complex be at a negative air pressure to the
rest of the facility and that there be at least 6 air changes per hour in this area.
OSH’s preference is for 12 air changes per hour 4 . The air flow should be from
ceiling entry to floor exit.
5. That the air from the “dirty” area of the complex be either vented directly to the
exterior (but not into surrounding buildings) or to the atmosphere via an HEPA
filter. The air should not be recirculated.
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Health and Safety Issues in New Zealand Mortuaries