Coronavirus (COVID-19) - Tips

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Funeral Homes, Mortuaries and Related Services

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Introduction

This tip sheet is intended for employers and workers of funeral homes, mortuaries, cemeteries, and crematoriums. It also includes medical personnel and community members in remote and isolated communities.

In all cases, guidance from local public health authorities must be followed and general COVID-19 prevention practices should be implemented, as outlined in Protect Yourself and Others from COVID-19.

Consider the Risks

The risk of COVID-19 transmission increases when people gather with others from outside of their household in crowded places and in closed spaces with poor ventilation. Risk is higher in settings where these factors overlap and/or involve activities such as close-range conversations, singing, shouting or heavy breathing (e.g., during exercise).

Participation in funeral and visitation services may involve close contact with others and contact with frequently touched surfaces The chance of COVID-19 spreading at these events also depends on the number and characteristics of people who attend (e.g., age, maturity, physical ability, comprehension), proximity, and durations of interactions between people as well as the measures put in place by employers.

Each death care service will be unique. Conduct a risk assessment for each worksite and activity to determine what measures need to be put in place to control the transmission of COVID-19. Consider the following:

  • Who will be handling the body?
  • What personal protective equipment (PPE) is required and is it available?
  • Are there additional cleaning and disinfecting protocols required if the deceased was known or suspected to have been infected with COVID-19?
  • How will the body be prepared for transportation?
  • What is the protocol for repatriation of dead bodies within and outside of Canada?
  • Can autopsies be performed? If so, where?
  • Will in-person visitations, funerals and other services continue, or will the service take place virtually?
  • How will cultural and/or religious considerations be addressed?
  • How will bereavement and grief support be provided?
  • Are there any additional psychosocial considerations for employers, employees, and family of the deceased?

Communication

  • Inform individuals (employees, family, spiritual and religious leaders, etc.) in advance about any public health measures in place. This information can be shared online, through advertisements, with notices at the front door, and by employees.
  • Involve spiritual and religious leaders in funeral planning, communication, and bereavement services.
  • While the risk of transmission when handling a deceased body is low, transmission may also occur via contaminated surfaces. If contact with the body is important, encourage families to consult their community, cultural or religious leaders and funeral home staff. If touching the body, at minimum, wear a long- sleeved gown, apron, and disposable gloves. Dispose in a no-touch waste bin and perform proper hand hygiene immediately after.
  • Help individuals understand that protective measures and any modified or reduced services are necessary, and that their experience might be different than expected. Ask them to be considerate of employees, family and others providing death care services.
  • Make sure that communication is suitable for people’s age, ability, reading level, and language preferences.
  • Post signs throughout the facility to encourage physical distancing, the use of non-medical masks, cleaning and disinfecting of frequently touched surfaces, hand hygiene, and respiratory etiquette.
  • Send any necessary forms electronically.
  • Notify individuals of any closed or reduced amenities including restricted access to viewing rooms, washrooms, and food or beverage stations.
  • Record the names and contact information of all employees and visitors to assist with contact tracing if needed. Make sure that privacy is protected, and the list is only used for contact tracing purposes.

Control Measures

  • Community transmission of COVID-19 continues, and new variants of concern are circulating. Everyone including employees, families, visitors and spiritual and religious leaders should be encouraged to use multiple personal preventative measures recommended by their local public health authority to protect themselves and others.
  • The most effective way for employers to reduce their risk of COVID-19 transmission in the workplace is to follow the hierarchy of controls and to use a layered approach in developing their safety plan.

Screening

  • Post signs for employees, families and visitors not to enter the and to stay home if they feel sick or have any symptoms of COVID-19, have been diagnosed with COVID-19 or are waiting for the results of a lab test for COVID-19, have been in close contact with someone who has or is suspected to have COVID-19, or are in quarantine (self-isolation) or isolation.
  • Consider asking screening questions before employees, families and visitors enter, using a screening tool from your local public health authority, or have them complete a questionnaire.
  • Anyone who does not pass screening or becomes sick while in the facility should wear a medical mask. If not available, properly wear a well-constructed and well-fitting non-medical mask, notify their supervisor or employer, return home preferably not by public transit, and contact their health care provider or local public health authority for guidance on next steps.

Physical Distancing, Engineering and Administrative Controls

  • Close contacts of persons who have died from COVID-19 may likely be in isolation or quarantine and should not attend in-person services.
  • Consider the use of virtual technologies (e.g., telephone, video conference, video recordings) in place of in-person services and gatherings.
  • Determine the maximum amount of people and available room or space to consistently maintain the greatest physical distance possible (e.g., at least two meters) from others. It may be necessary to lower occupancy limits below the maximum gathering size.
  • Ensure that visitations and other activities allow for proper physical distancing. For example, consider staggering visitation times or spacing out visitors at the burial.
  • Install solid barriers between workstations and equipment (e.g., plexiglass wall or window higher than head height at the reception area).
  • Provide floor markings, and other visual cues to promote physical distancing and one-way routes.
  • Rearrange and limit use of seating areas, visitor rooms, locker rooms, common areas, main lobbies, washrooms, etc.
  • Restrict access to areas of the facility that visitors do not need to go.
  • All visitors should be permitted in the facility only for the time allowed, to properly clean and disinfect the area between visitations.
  • Allow adequate time between each visitation to minimize interactions between people, optimize air exchange, and for cleaning and disinfecting.
  • Choose to hold services outdoors whenever possible (weather permitting).
  • When possible, consider postponing services until individuals have finished their period of quarantine (selfisolation) or isolation.
  • Discourage activities that increase the risk of transmission including hugs, handshakes, singing and shouting.
  • Self-serve buffets should not be included in ceremonies.
  • Shut off water fountains or replace them with water bottle refill stations. Each employee should have their own labelled water bottle.
  • Plan for an increase in death care services during the COVID-19 pandemic.
  • Assess the need for additional mental health and grief support available for employees and in response to the needs of bereaved individuals and families.

Ventilation

  • Ensure that ventilation systems of indoor spaces operate properly
    • Autopsies should only be performed in adequately ventilated, negative pressure rooms should be used when performing any aerosol-generating procedures.
  • Increase introduction and circulation of outdoor air as much as possible by opening windows and doors using fans, or other methods. However, do not open windows and doors if doing so poses a safety risk to employees or visitors (e.g. propping open a fire door).
  • Powerful portable cooling fans might increase the spread of COVID-19 in enclosed spaces. Use other ways to keep rooms cool, such as adjusting building ventilation systems and air conditioning units.
  • Ventilation systems should be adjusted to:
    • Increase filtration efficiency to the highest level appropriate for the system.
    • Increase fresh air flow/percentage of outdoor air (increase % of outdoor air in HVAC air supply, open windows, and doors, etc.).
    • Limit use of demand-controlled ventilation; keep system running at the optimal setting.
  • Explore the use of portable high efficiency particulate air (HEPA) filtration units.
  • Consult a HVAC professional before making changes to the ventilation system.

Personal Hygiene

  • When the deceased is known or suspected to have been infected with COVID-19, family and friends should be discouraged from touching or kissing the body following death, after body preparation, and during funeral services. Individuals should perform proper hand hygiene if the body is touched.
  • Limit handling of the body where the deceased will remain in the family home (e.g. in remote and isolated communities).
  • Individuals should follow protocols for preparing the body for transport, wear appropriate PPE, perform proper hand hygiene and cleaning and disinfecting practices.
  • Provide hand wash and sanitizer stations including near the entrance and other appropriate areas. Make sure they are accessible to persons with disabilities.
  • Everyone should avoid touching their eyes, nose or mouth with washed hands. Hand hygiene should be performed when entering and exiting the facility, after using washrooms, before and after death care services, before and after touching shared equipment and surfaces, and after contact with another person.
  • Encourage good respiratory etiquette. Everyone should sneeze or cough into a tissue or into the bend of their arm instead of their hands and follow up with hand hygiene.
  • Encourage use of tissues and other means to prevent the spread of bodily fluids. Immediately dispose of used tissues in lined garbage cans and follow up with hand hygiene.

Cleaning and Disinfecting

  • Transmission from COVID-19 can occur from contact with commonly used materials in death care services, including cardboard and polypropylene. Continue to practice routine infection prevention and control practices including cleaning and disinfecting using products with a drug identification number (DIN) approved for use in Canada.
  • Read and follow manufacturer’s instructions for the safe use of products (e.g., wear gloves, use in well-ventilated areas, allow enough contact time for disinfectant to kill germs based on the product being used).
  • If approved commercial disinfectant products are not available, hard surfaces can be disinfected using a mixture of 5 mL of bleach (5% sodium hypochlorite) and 250 mL of water. Test surfaces before using a bleach solution. Bleach can be corrosive. Follow instructions for safe handling of bleach.
  • Develop a cleaning and disinfecting program with a schedule and checklists for all areas and equipment.
  • Increase the frequency of routine cleaning and disinfecting, as needed.
  • Clean and disinfect shared work areas, facilities, and equipment between users or shifts.
  • Focus on high-touch surfaces and objects such as doors, counters, chairs, handles, railings, lounge chairs, table tops, debit machines and ATMs, touchscreens, phones, light switches, faucets, taps, sanitizer dispensers, diaper changing stations, showers, water bottle refill stations, and any protective barriers, etc.
  • Remove soft furnishings and objects (e.g., magazines, newspapers) from viewing rooms and reception areas that cannot be easily cleaned.
  • Continue to use hospital grade disinfectants to clean and disinfect equipment and facilities.
  • Follow standard operating procedures for cleaning and disinfecting body bags and pouches if not disposable or discard as hazardous waste.
  • Discourage the sharing of items that are difficult to clean or disinfect.
  • When laundry is generated, do not shake dirty laundry. Use disposable gloves and perform hand hygiene after handling laundry. Clean and disinfect hampers and bins before putting clean laundry back in.
  • Provide employees with training on cleaning and disinfecting procedures, adequate supplies, and access to required personal protective equipment. Check the product’s safety data sheet or label for safe use instructions.
  • Use dedicated re-useable cleaning materials (towels, sponges, mops, etc.) that can be washed using laundry soap and then dried completely.
  • Dispose of single-use tissues, wipes, gloves, and other cleaning materials in a plastic lined waste container. Empty garbage at least daily. Use disposable gloves when handling garbage and follow up with hand hygiene.
  • Replace garbage bins with no-touch receptacles or remove lids that require contact to open.

Personal Protective Equipment (PPE)

  • Continue to use PPE for existing occupational safety hazards and emergencies as directed by applicable laws and your employer.
  • Workers should continue to wear PPE required to perform standard mortuary care (disposal gloves, medical masks, long-sleeved gowns, face shield).
  • When aerosol generating procedures are performed (e.g., use of power saws), add rubber gloves, an apron and respiratory protection (e.g., N95 respirator) in addition to the above PPE.
  • Train workers on how to wear, remove, work with, and care for the equipment, and to understand its limitations.
  • Clean and disinfect any shared PPE before wearing.
  • Wash hands before putting on and after removing PPE.

Transportation and Handling of Dead Bodies

  • Follow routine infection prevention and control practices for handling human remains with a respiratory infectious disease (e.g., similar to protocols for tuberculosis), including the use of PPE when preparing, handling, and transporting human remains.
  • Bodies may continue to be transported in standard equipment (e.g., body bags or pouches) especially if there is excessive body fluid leakage.
  • Ensure the oral and nasal cavities of the deceased are covered with a non-medical mask or a piece of cotton fabric or packed with cotton to prevent any potential escape of the virus from the lungs.
  • Remains should be unwrapped from a body bag or pouch slowly and moved carefully.
  • For repatriation of bodies from outside of Canada, the body is to be transported in a hermetically sealed container or cremated.
  • Avoid procedures that generate aerosols.
  • Avoid splashing or spraying bodies with power hoses. Bathing is preferred when washing remains.
  • Embalming and autopsies may increase splash related risk. Consult with your Chief Medical Examiner or Coroner for specific guidance and directives about embalming and autopsies during the COVID-19 pandemic.
  • Standard safety and infection prevention and control measures for bodies confirmed or suspected to have been infected with a communicable disease should be followed.
  • Once the deceased has been cremated or placed in a casket, standard protocols are acceptable for transport. Specialized caskets, vehicles, or driver’s licenses are not necessary.
  • Follow safe work procedures for the amount and type of involvement grounds personnel have with the casket or urn at the cemetery or burial site.
  • Follow up with cleaning and disinfecting of all tools and equipment.

Non-Medical Masks

  • Follow the mask recommendations as issued by your local public health or other authority. Note that some people may choose to wear masks regardless if there is a formal requirement.
  • A mask should not be worn by anyone who is unable to remove it without assistance (e.g., due to their age or ability).
  • Wear well-constructed, well-fitting non-medical masks ensuring the nose, mouth and chin are covered. Do not touch the mask while wearing it.
  • Be aware that non-medical masks have limitations , and improper mask use and disposal can increase the risk of infection.
  • Change your mask if it becomes wet or soiled. You may wish to bring a second mask in a clean paper bag, envelope or container that does not trap moisture. Reusable soiled masks should be stored in a separate bag or container. Do not touch the outside of the mask while removing it and wash your hands when finished.
  • Consider using a transparent mask or face shield if appropriate, for those that may require that visibility.
  • Do not allow the mask to be a hazard to other activities, such as getting caught on moving machinery or equipment.

External Service Providers

  • For visits by external services such as deliveries, contractors, and others:
    • Communicate with service providers about your COVID-19 safety requirements before their visit, and work with them to meet their safety requirements.
    • Clean and disinfect the work area before and after the service provider does their work.

It is important that mental health resources and support are provided to all workers, including access to an employee assistance program, if available.

For further information on COVID-19, refer to the Public Health Agency of Canada.

Note that this guidance is just some of the adjustments organizations can make during a pandemic. Adapt this list by adding your own good practices and policies to meet your organization’s specific needs.

Disclaimer: As public and occupational health and safety information is changing rapidly, local public health authorities should be consulted for specific, regional guidance. This information is not intended to replace medical advice or legislated health and safety obligations. Although every effort is made to ensure the accuracy, currency and completeness of the information, CCOHS does not guarantee, warrant, represent or undertake that the information provided is correct, accurate or current. CCOHS is not liable for any loss, claim, or demand arising directly or indirectly from any use or reliance upon the information.

Document last updated February 25, 2021