April 2024 ONCOLOGY CARTOON by DR KANHU CHARAN PATRO
Autopsy of HIV Infected Body
1. Prerequisites , Precautions During
The Autopsy of HIV Infected Body
& Post exposure Prophylaxis for
HIV Infection
Presenter- Dr. Shailendra Patel
Moderator- Dr. Manish Nigam
3. The occupational acquired HIV
infection in the forensic practice has
made mortuary workers overcautious,
but there has been hardly any
evidence that HIV infection can readily
be acquired through participation in a
necropsy.
The period for which the corpse
remains potentially contagious with
HIV is disputable-
Liquid blood at room temp 3 wks
4. Refrigerated bodies 17 days.
HIV has been detected in skull bone at
six days post-mortem .
Spleen specimens up to 14 days.
5. Risk / Benefit Doctrine-
Pre autopsy testing for HIV
However , a blood test before autopsy
tends to be governed by ethical
considerations, mortuary
ethos, laboratory facilities and
budgetary constraints.
False +ve results – Emotional harm
False –ve results- False sense of
security
6. The period b/w infection and
detectable antibody development (
silent / window period about 4 wks)
increases potential for false negative
results.
Unfortunately sophisticated tests such
as immunocellular culture , genomic
RNA or proviral DNA with PCR or
direct p 24 core antigen capture
immunoassay are too costly to routine
use.
7. Autopsy preparation-
No unauthorized person should be
present during the autopsy.
The dead body should be transported
to the mortuary by duly plugging all
the natural orifice and sites of IV lines
.
The dead body should be wrapped in
a plastic bag and closed tightly.
Use AIDS suit- Disposable scrub suit-
A Plastic apron, double rubber gloves,
cap, shoe covering, face mask and
8. Precautions in the autopsy room
and laboratory-
It is almost impossible to know the
status of each and every deceased
person due to
practical, financial, ethical and legal
reasons.
Therefore, it is preferable to change
our work culture and follow universal
work precautions, so consider all
bodies as potentially infected with HIV.
9. Universal Precautions-
Entry to the laboratory / work area should be
restricted only to persons who are trained to
handle infectious material.
Sign ‘Biohazard No Admission’ should be
placed on door of lab / work area.
Proper protective clothing.
Handling sharp instruments.
Disposal of used instruments.
Worker with skin lesion should be refrain from
work.
Work surfaces should be cleaned and
disinfected when procedure is completed.
10. After completion of autopsy-
Sink , table surface should be washed
and disinfected.
Body tissues , specimens should be
properly sealed in robust and leak-
proof packing.
All sharp instruments , AIDS suits put
in double plastic bags label it with
‘Infectious Risk’ and send to
incineration.
11. After an autopsy it is mandatory to
disinfect the mortuary with 1% sodium
hypochlorite or 1: 10 dilution of bleach
(available chlorine 10,000 ppm) before
another autopsy is performed in the
same room. A contact period of at
least 30 minutes is required for
disinfection.
12. Disinfectants-
Phenol- Active against many bacterial
pathogens and do not corrode metal.
Hypochlorites- Active against viruses
, they corrode metals. In autopsy room
it is used to decontamination of
nonmetallic surfaces.( 1000 or 10,000
ppm)
Glutaraldehyede-2% Active against
viruses, and do not corrode metal.
13. Embalming-
All the precautions detailed above are
to be followed while embalming of
cadavers. The usual fluids for
embalming (ethanol, formalin, phenol)
are effective against HIV.
14. Post-exposure prophylaxis (PEP)
-
In the event of an exposure to HIV by
needle stick injury, splash or other
means, post-exposure prophylaxis
should be instituted as per the general
guidelines laid down vide DGAFMS
letter No. 5496/DGAFMS/DG 3A dated
18 Jun 2001.
15. The exposed individual will therefore
need the expanded regimen of PEP
(Zidovudine 300 mg b.i.d., Lamivudine
150 mg b.i.d. and Indinavir 800 mg
t.i.d. (or Nelfinavir 750 mg t.i.d.) for 28
days).
16. NACO Guidelines For Morgue
Organization -
Have a full time morgue staff and not an
unwilling assistant sent for some days
from some other section of the hospital.
Get the longest and widest autopsy table
possible and see that it is installed with
just sufficient tilt to allow free drainage of
a constant flow of water from top to
bottom. Stainless steel is the best
material, with a raised edge all around to
prevent spillage. At the foot end have a
large deep sink with hot and cold water
taps.
17. A post-mortem room should be well ventilated
and much lighted. Illumination should be
quite independent of daylight. Have ample
overhead fluorescent lamps plus at least one
lamp with a flexible metal neck so that it can
shine at an angle into the base of the skull
and into the thorax and abdomen.
Tiles are recommended for the walls, at least
to shoulder height. For the floor smooth
terrazzo is much better than tile which
collects dirt in innumerable cracks between
the tiles. The floor should incline towards a
drainage point so that it can be easily hosed.
Regular repairs of cracks in the floor are
needed. Windows should be high.
18. Have separate
toilet, shower, changing room and
some office space and linen room for
morgue attendant. The pathologist
requires desk office of his own and
hand basin along with antiseptic and
first aid supplies.
Have numerous sponges and needle
boards for cutting and disinfecting the
removed organs.
Every morgue should have a corner
for photography.
19. NACO Guidelines For Treatment
Of Cadaver And Instruments -
After the postmortem procedure, the cadaver
should be stitched properly so that no fluid
can come out. Cadaver is washed with tap
water and then with 1% sodium hypochlorite
solution. Nose and mouth should be plugged
with cotton swab soaked with appropriate
dilution.
Cadaver is then put in a plastic bag for
handing over to the relatives to avoid
dissemination of HIV/AIDS. There should be
a hospital policy to provide plastic bags to all
cadavers.
20. The tables and floors should be carefully
wiped out with a 1% hypochlorite to
remove bloodstains, body fluids and
soap and water.
The instruments used for autopsy should
be wiped out with sodium hypochlorite
solution. Aluminium and stainless steel
instruments are damaged by sodium
hypochlorite and instruments made of
these materials should be
decontaminated with a 2% aqueous
glutaraldehyde solution. After 4
hours, the instruments are washed and
autoclaved, and are then reusable.
21. Adequate washing facilities must be
available in the vicinity of the autopsy
room. After autopsy, pathologist and
other staff must wash their hands
thoroughly with soap and water. Plastic
apron, plastic shoe cover, gloves, plastic
cap and mask must be discarded in a
plastic bag. Tie the bag properly and
send it for incineration. The pajama, shirt
and cotton gown worn inside the above
plastic apron should be soaked in
sodium hypochlorite solution and
washed with water, and then sent for
autoclaving.
