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

1. double gloves facemask, gum boots and goggles must be used by the doctor and assistants;
2. the body should be carefully packed and disposed;
3. bleaching powder (sodium hypochlorite), hydrogen peroxide or Lysol should be used generously to cover areas wherever blood and body fluids are spilled; and
4. soiled laundry and the instruments used should be heat sterilized and put in a solution of bleaching powder.

 Universal Work Precautions or Universal Blood and Body Fluid Precautions

1. Entry to the laboratory/work area should be restricted only to persons who are trained to handle infectious material.
2. Laboratory door should be closed and should have a ‘Bio-hazard-No admission’ sign to prevent unauthorized entry.
3. Proper protective clothing: Staff should wear a fully covered laboratory coat instead of simple surgical gowns, heavy autopsy gloves or double rubber gloves, caps, masks, protective eye-wear or goggles, shoe covers. Staff should cover completely. Gloves should be worn for all manipulations of infectious material or where there is a possibility of exposure to blood or body fluids. Gloves should be changed at the least suspicion of damage. Hands and other skin surfaces should be washed immediately and thoroughly if contaminated with blood or other body fluids.
4. Handling sharp instruments: All workers should have special precautions in handling needles, scalpels and other sharp instruments used during procedure and prevent accidental pricks and cuts.
5. Disposal of used instruments: After use, disposable needles and syringes, scalpel blades and other sharp items should be placed in puncture resistant container for disposal. The puncture resistant container should be locate as close as practical to the used area. to prevent needle stick injuries, needles should not be recapped, purposely bent or broken by hand, removed from the disposable syringes, or otherwise manipulated by hand.
6. Workers who have exudative lesions or weeping dermatitis should refrain from work in those areas until their condition resolves.
7. Clean up procedure: Wear new intact gloves. Work surfaces should be cleaned and disinfected when procedure is completed at the end of each working day. Small spatters and spills of blood and other body fluids can be wiped up with disposable tissues or towels which are discarded in a special bio-hazard bag and properly disposed.
8. Pregnant workers are not known to be at greater risk of contracting HIV infection than workers who are not pregnant. However, if a pregnant worker develops HIV infection during pregnancy, the infant is at risk of infection resulting from perinatal transmission. In view of this risk, pregnant workers should be especially familiar with a strictly adhere to precautions to minimize the risk of HIV transmission.

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..