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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. 44 Health and Safety Issues in New Zealand Mortuaries
6. That “risk assessment” occurs on each case to determine the possibility of the case fitting the “high-risk” category. These assessments will be far from perfect, particularly in forensic cases, but in OSH’s view is an important procedural step to take. All cases where details are unknown should be treated as high-risk if the principles of “standard precautions” are to apply. The risk assessment should be the function of the “autopsy manager” rather than delegated to ward staff. 7. That all bone saws/band saws be provided with local exhaust systems (see Appendix 2). Some institutions have minimised this hazard by encasing the skull in a plastic bag (as per CJD recommendations). 8. That suitable personal protective equipment be worn during procedures. Suggestions are made in Appendix 2. There is no room for personal choice by staff if PPE is the control mechanism of choice. 9. That all staff working in the mortuary complex be immunised (or have natural antibodies) against Hepatitis B Virus. OSH encourages mortuary employees to have had a BCG vaccination 8 . 10. That an active treatment and follow-up system exists for staff who suffer occupational exposures to HBV, HCV, Tb, HIV, etc. Health and Safety Issues in New Zealand Mortuaries 45
Page 1 and 2: Health and Safety Issues in New Zea
Page 3 and 4: Contents Executive Summary.........
Page 5 and 6: Acknowledgements This project arose
Page 7 and 8: Relevance of the Health and Safety
Page 9 and 10: Standards Applied Facility and Proc
Page 11 and 12: Methods A list of mortuaries in its
Page 13 and 14: Comments on Institution A • Meets
Page 15 and 16: Comments on Institution B • Does
Page 17 and 18: Comments on Institution C • This
Page 19 and 20: Comments on Institution D • This
Page 21 and 22: Comments on Institution E • This
Page 23 and 24: Comments on Institution F • This
Page 25 and 26: Comments on Institution G • This
Page 27 and 28: Comments on Institution H • This
Page 29 and 30: Comments on Institution I • This
Page 31 and 32: Comments on Institution J • This
Page 33 and 34: Comments on Institution K • This
Page 35 and 36: Comments on Institution L • This
Page 37 and 38: Comments on Institution M • This
Page 39 and 40: Comments on Institution N • This
Page 41 and 42: Comments on Institution O • This
Page 43: Comments on Institution P • This
Page 47 and 48: References 1. Lunn J, Mayho V. Inci
Page 49 and 50: Minimum Standards Observed Measures
Page 51: Appendix 2: Generic Recommendations

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