In all cases of highly Infections deaths the Pathologist have no reason to deny the Postmortem Examination but he needs to take extra precautionary measures prior to, during and after the Postmortem Examination, however it is well known fact to a pathologist that many Highrisk cases goes unnoticed in the guise of Accidental Deaths or Homicides. Hence the Author advises to treat all cases as Potential high Risk cases and handled accordingly.
CARE IN THE POST-MORTEM ROOM
The room where the post-mortem examination is carried out as well as the annexe, should be washed and cleaned regularly, in view of the high risk autopsies like HIV and Hepatitis-B. Cleaning with bleaching powder (10 percent) solution after autopsy helps in removing the HIV virus. Instruments should also be soaked in 10 percent bleaching powder solution. Except while intentionally noting the smell, in the remaining period during the autopsy, the autopsy surgeon is advised to wear a cap, mask, plain goggles, gumboots, gloves reaching up to the elbows, and double gloves in all high-risk cases. A chest X-ray once in six months, tetanus toxoid every six months, and Hepatitis-B immunization should be done.
Embalming: It may be required to keep the body embalmed to enable the relatives from far off places to have a better glimpse. It is done by injecting formalin solution by gravity or with the help of power- pump.
Precautions in Autopsies of AIDS Patients
Sterilization of instruments can be obtained either by steilisation by steam, or sterilization by dry heat. High-level of disinfection is achieved either by boiling for 20 minutes or by soaking in chemical disinfectants like glutaral (glutaraldehyde) 2 percent and hydrogen peroxide 6 percent. Decontamination of environmental surfaces is done by chlorine-releasing compounds like sodium hypochlorite, calcium hypochlorite, sodium dichloroisocyanurate (NaDCC) and Chloramine (tosylchloramide sodium; chloramines T). Disinfection of living tissues is performed by the antiseptics like ethanol and 2-propanol and polyvidone iodine (PVI).
In addition to commercially available chemical germicides, a solution of sodium hypochlorite prepared freshly is an inexpensive and effective germicide. Concentrations ranging from approximately 500 ppm (1:100 dilution of household bleach) sodium hypochlorite to 5000 ppm (1:10 dilution of household bleach) are effective depending on the amount of organic material, ie, blood or mucus present on the surface to be cleaned and disinfected.
Before performing post-mortem examination on such a suspected case, tests to diagnose HIV should always be carried out. High-risk post-mortems are those wherein lies the danger of infection to the mortuary staff and doctors connected with autopsies.
Precautions to be Followed in Autopsies in AIDS Patients
Universal Work Precautions or Universal Blood and Body Fluid Precautions
In case of accidental injuries or cut with sharp instruments contaminated with blood or body fluids, while working on a body, the wound should be immediately disinfected and the incident should be reported to the proper authority to get their blood checked for HIV sero-positivity. In addition, to minimize exposures no unauthorized persons should be admitted to the autopsy rooms. Universal precautions are meant to apply to blood, semen and vaginal secretions as well as to cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid. Universal precautions do not apply to faeces, nasal secretions, sputum, sweat, tears, urine and vomitus unless they contain visible blood..