Biohazard Waste Disposal for Mortuaries. The role of mortuaries has expanded and changed as the social requirements of various cultures of our society changes in dealing with loved ones that have died. No one wants to refer to the bodies as “medical waste” as there is an emotional tie that transcends that idea. However, there is a scientific ideology that must look at a body as biological waste and that it may have the potential to transmit infectious diseases. There are therefore local, state, and federal guidelines that must be complied with at every step of managing a corpse, while making every attempt at respect for the dead.
Facilities involved in the death care industry include mortuaries, morgues, funeral homes, and cemeteries. There are laws of compliance for each of these facility types. A morgue is required to keep a body until it can be identified as well as if an autopsy is needed. Standard procedures for hospitals is to have an onsite morgue where the deceased is kept in refrigerated conditions until a funeral home can remove it. As long as the deceased was in an institution where there is medical care, autopsies are typically not required. However, if the deceased was involved in a criminal case, an autopsy is common.
The ultimate disposition of the body is dependent upon the culture, religion, family and individual requests. The two most common methods of disposition in the United States is internment (burial) and cremation, however, liquid dissolution of a body in an alkaline bath has increased interest today. Those that choose to have a public viewing of the body prior to burial will require the funeral home or mortuary to prepare
The preparation involves an in-depth process that typically includes embalming so that the body is preserved for the length of time needed prior to burial. A funeral home will dress the deceased and attend to the body to improve appearance which includes taking care of hair and makeup.
Some religions have specific requirements that include burial within a specific amount of time as well as the refusal to do any autopsies. In the case of criminal activity or investigation, state and/or federal laws can supersede these religious requests.
Given the vast duties and responsibilities of mortuaries/funeral homes that offer potential exposure to infectious diseases due to hazardous medicalconditions, it comes as no surprise that these institutions must comply with strict laws and guidelines. These institutions come into contact with all forms of biohazardous medical waste including but not limited to: sharps, blood and blood products, body fluids, body parts, chemicals, PPE (personal protection equipment), and pharmaceuticals.
Embalming is a process to assist in preserving the body from deterioration. The process requires that all of the blood is drained from the body through the veins and replaced with an embalming fluid through the arteries. The solution used for embalming consists of harsh chemicals including formaldehyde and water as well as potentially glutaraldehyde, methanol, ethanol, phenol, and dyes. The blood that has been removed is flushed into the sewage system so that it can be treated through wastewater treatment. Each mortuary/funeral home is required to check with their local sewage plant to ensure that they can handle safe treatment of blood. Embalming has become less popular in the last number of years, being replaced with cremation as a preference.
Sharps are identified as any item that can pierce the skin and has been exposed to potentially infectious agents. These can include but are not limited to hypodermic needles, scissors, blades, scalpels, incision needles, broken glass, trocars, lancets, pipettes, and sharp medical tools. Mortuaries use a variety of sharps to prepare the body and are required to comply with the local, state, and federal laws regarding handling, labeling, and storing sharps and the proper disposal of sharps to render them harmless. Funeral homes typically contract with a licensed and trained medical waste disposal company for the removal of the sharps containers and ultimate safe disposal. Mortuaries comply with the same guidelines as any medical institution regarding sharps so that there is no potential for infectious transmission.
Individuals that have been ill at the time of their death may have a number of pharmaceuticals in their systems. Some cancer treatment pharmaceuticals may include those used in chemotherapy and these can be dangerous to others if not properly and safely dealt with. This makes body fluids that may leave the body a more hazardous situation and they should be labeled and stored in leak-proof containers for pickup by licensed medical waste disposal companies.
Compared to the incredibly large volumes of biohazardous wastes generated by hospitals and physician offices, mortuaries general very little. However, all forms of biohazardous waste that is derived from exposure to, working with, and preparing a dead body is considered to be contaminated and is required by local, state, and federal laws to be handled, labeled and stored for pickup by a licensed medical waste disposal company so that it can be rendered harmless.
Dressings, swabs, and personal protection equipment including gloves, gowns, and surgical masks could be potentially contaminated with bodily fluids which could contain infectious and transmittable diseases, as well as harsh and dangerous chemicals from the embalming process. All employees and staff and a mortuary and funeral home is required to be trained by OSHA (Occupational Safety and Health Administration) guidelines so that they can protect themselves and others from communicable diseases. The training includes the methods of proper handling, labeling, and containment for these materials so that they can be picked up and properly disposed of by a licensed and professional medical waste disposal company, rendering them harmless.
Not all funeral homes have onsite cremation facilities so some work in conjunction with the locations that have the facilities available. Cremation the process of placing the body, possibly with garments and the container into a heated chamber. Natural gas or propane is used to heat the chamber to extremely high temperatures and any exhaust is put through a scrubber that makes sure that the exhaust and/or some doesn’t leave the facility. Prior to entering the heated chamber the mortuary is required to take an x-ray of the body to avoid placing any mechanical devices such as pacemakers, or jewelry and watches into the chamber. If any of these are found, the operator of the crematory must perform surgery to remove them. Over sixty percent of the human body is made up of water, with twenty percent protein such as bone and skin. The temperatures in the chamber reach over 1000 degrees Fahrenheit, causing bone to lose organic material. Cremation takes several hours and the remains which are often referred to as “ash” are around three to six pounds. A majority of the body is converted to water vapor and carbon dioxide which is allowed to exit into the atmosphere. All staff within the crematory are required to comply with OSHA safety and training guidelines. Crematories must also follow strict laws for the state that they do business in and federal laws for all activities.
Another option for death care from some mortuaries is alkaline hydrolysis, which may also be known as “flameless cremation.” In this case, an alkaline solution is heated so that it rapidly breaks down the tissues of the body. This has been a standard process used for years to dispose of animal bodies. Popularity has increased due to the fact that it is more eco-friendly than cremation and is energy efficient. Some have referred to alkaline hydrolysis as “green cremation.” Some states have legalized this form of cremation of dead bodies in general, especially in the situation of the bodies that have been donated to science and research. The process of alkaline hydrolysis involves placing the body into a container with water and lye. The vessel has been constructed to withstand pressure and the temperature of the vessel is raised to three hundred degrees. Based on the vessel manufacturer specifications, the body remains in the vessel for anywhere from three to twelve hours, and the temperature and pressure are reduced to ambient levels. The contents of the vessel is now mostly liquid and acid is then added to reduce the pH and create a state of neutralization. The contents are then filtered, with the fluid flushed down the drain to be processed by the municipal wastewater treatment system. Any solids that have been filtered are treated in the same manner as standard cremation and can be buried or venerated. Each mortuary/funeral home is required to check with their local sewage plant to ensure that they can handle safe treatment of the fluids.
The federal laws of the United States has defined and regulated certain hazardous waste under RCRA. Although this form of waste may be generated in funeral homes in only small amounts, they must be separated and placed in containers that are labeled as RCRA. The containers must be picked up by licensed and regulated medical waste disposal companies for treatment and safe disposal.
A majority of funeral homes no longer use some of the older chemicals that were once used in the process of embalming. Such chemicals were extremely hazardous and could not be flushed into the water system. They often included chlorinated compounds such as trichloroethylene and perchloroethylene, which were commonly used in the dry cleaning industry. Any waste that is generated using these chemicals is classified under RCRA (Resource Conservation and Recovery Act) as hazardous and must be disposed of in methods to render them harmless.
Many states have established their own OSHA guidelines that complement the federal laws. In cases where states don’t have a state OSHA plan, the federal laws kick in. Funeral homes and mortuaries, like many medical institutions may be required to have written plans and training regarding actions and contacts in the case of an emergency exposure to potentially infectious materials. Depending upon the state, the individuals trained may only be management, but may also include other staff member types. The plans set in place often require that emergency kits and procedures be in place to assist in neutralizing the exposure.
Each state is in charge of regulating the death care industry and there is just as much concern regarding safety and protection for consumers, the community and the environment as there is within the standard medical industry. However, in the case of mortuaries and funeral homes, there is a required balance of respect for the dead. States are required to audit the death care industry on a periodic basis and therefore the administrators within the industry must have all of their documentation in order. Various states require different forms of documentation, fees, permits, and licensing, so each mortuary must research their individual state requirements. The best medical waste management companies maintain up-to-date knowledge on the laws and guidelines for the states that they do business in and can act as advisors.
One of the most important aspects of documentation comes in the form of compliance with the cradle-to-grave philosophy of medical waste. In this case the funeral home is considered to be the generator of the medical waste and must have all documentation regarding the handling, labeling, and storage along with the medical waste disposal company contracted for the waste removal and confirmation of rendering it harmless.
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