The Centers for
Disease Control and Prevention (CDC) and the World Health Organization have
received reports of patients with severe acute respiratory syndrome (SARS) from
Canada, China, Hong Kong Special Administrative Region of China, Indonesia,
Philippines, Singapore, Thailand, and Vietnam. The most current definition can
be accessed at
recommendations for infection control precautions for patient care can be
http://www.cdc.gov/ncidod/sars/ic.htm and include Standard, Contact, and
Airborne precautions (1).
procedures require adherence to standard precautions with use of appropriate
personal protective equipment (PPE) and facilities with appropriate safety
features. Mechanical devices used during autopsies can efficiently generate fine
aerosols that may contain infectious organisms. Thus, PPE should include both
protective garments and respiratory protection as outlined below.
For autopsies and
postmortem assessment of SARS cases, PPE should include:
Protective garments: surgical scrub suit, surgical cap, impervious
gown or apron with full sleeve coverage, eye protection (e.g., goggles or face
shield), shoe covers and double surgical gloves with an interposed layer of
cut-proof synthetic mesh gloves.
Respiratory protection: N-95 or N-100 respirators; or powered
air-purifying respirators (PAPR) equipped with a high efficiency particulate
air (HEPA) filter. PAPR is recommended for any procedures that result in
mechanical generation of aerosols, e.g., use of oscillating saws. Autopsy
personnel who cannot wear N-95 respirators because of facial hair or other
fit-limitations should wear PAPR.
For autopsies and
postmortem assessment of SARS cases, safety procedures should include:
Prevention of percutaneous injury:
including never recapping, bending or cutting needles, and ensuring that
appropriate sharps containers are available.
Handling of protective equipment: protective outer garments must be
removed when leaving the immediate autopsy area and discarded in appropriate
laundry or waste receptacles, either in an antechamber to the autopsy suite or
immediately inside the entrance if an antechamber is not available. Hands
should be washed upon glove removal.
Engineering strategies and facility design
handling systems: autopsy suites must have adequate air-exchanges per
hour and correct directionality and exhaust of airflow. Autopsy suites should
have a minimum of 12 air-exchanges per hour and should be at a negative
pressure relative to adjacent passageways and office spaces. Air should not be
returned to the building interior, but should be exhausted outdoors, away from
areas of human traffic or gathering spaces (e.g., off the roof) and away from
other air intake systems. For autopsies, local airflow control (i.e., laminar
flow systems), can be used to direct aerosols away from personnel; however,
this safety feature does not remove the need for appropriate personal
Containment devices: biosafety cabinets should be available for
handling and examination of smaller specimens. Oscillating saws are available
with vacuum shrouds to reduce the amount of particulate and droplet aerosols
generated. These devices should be used whenever possible to decrease the risk
of occupational infection.
1. Garner JS.
Guideline for isolation precautions in hospitals. Infect Control Hosp
Epidemiol 1996; 17:53-80.