Historical risks of autopsy

	Early 20^th century – skin infections from cuts and punctures
	1970s – Hep B/ Hep C
	1980s - HIV / prions (enter the phase of high risk autopsy)

HIV

Risk of contracting HIV at autopsy = low

	occupational needle stick injuries with blood = 0.36%
	no documented cases of definite contraction at autopsy

	Autopsy injuries – 1 in 11 amongst pathology residents; 1 in 55 experienced pathologists
	Advice

	universal precautions
	barrier protection
	avoidance of sharp injuries through safe practice
	using cut resistant gloves

Hepatitis

Methods of handling tissue and avoiding infection

	barrier protection
	treatment with hepatitis immunoglobulin/ immunisation

No evidence of spread of hepatitis by aerolisation

Risk of contracting Hep C from needle stick = 3% (30% for Hep B)

TB

	Historically it was common for pathologists to contract TB
	Now extra hazard of MDRTB
	50% of autopsy cases reported were diagnosed at autopsy
	Risk of contracting TB

	Japan – occupational related TB 6-10 times higher for pathologists/ technicians
	UK – 100-200 times more likely for staff of labs/ autopsy rooms than public to develop TB

Risk from fixed tissues – unclear (need adequate fixation)

Suggested regime = take cultures then perfuse unseparated lungs via trachea with 10% formalin; immerse specimen in 10% formalin for 24 hours before further dissection

Risks from aerolisation – need HEPA (High Efficiency Particulate Air) filters or battery powered respirators (must anticipate the need for precautions e.g. in HIV/ AIDS cases, or undiagnosed pulmonary disease where TB is a possibility)

‘. it is inconsistent to take precautions against AIDS or CJD which have a low risk of infectivity in autopsy workers, but not to take precautions against undiagnosed TB, which has an impressive infectivity rate’

Prions and CJD

	Made known to autopsy pathologists in late 1970s – early 1980s
	Risks

	direct inoculation (small)
	no evidence of aerolisation
	transmission of CJD considered possible

Precautions

	autoclave instruments/ small tissue samples (1 hour at 120 C and 20 psi)
	5% hypochlorite (bleach); phenols; iodine solutions and permanganate solutions are adequate disinfectants

2M NaOH for cleaning surfaces

Brain only autopsies (over flat shallow pan; disposable instruments; autopsy table covered by double layer plastic sheets)

Tissues for histology – 1hr immersion in 95-100% formic acid

Risks – no reported case to pathologists etc in last 25 yrs

Hantavirus

	Rodent spread
	Fatal pulmonary infection especially in South Western USA
	Follow universal precautions
	Use respirators (N-95/ N-100)
	Brain not examined

Viral Haemorrhagic fevers

Avoid autopsy/ limited autopsy

	Cover skin defects with occlusive bandage
	PPE

	Scrub suit
	Sleeve covers
	Plastic apron
	Cap
	Surgical mask
	Full face shield
	2 pairs rubber gloves
	cut resistant gloves (at least 1)

	HEPA filter respirators (masks cost $0.44 each) – known or suspected TB
	General – no smoking/ eating etc
	Cover rib ends with disposable pads
	Don’t cut small pieces of tissue with fingers
	Exposure? – brisk clean with soap and water/ eye wash, then to occupational health/ A+E

(Full autopsy PPE - source MEDISCAN in BMJ 2004; 329:527 (4 September))

The Decline of the Teaching Autopsy

Read recent articles concerning the decline of the teaching autopsy in New Zealand and the Uk, and letters published on the BMJ website in response to these articles ...

Decline of the teaching autopsy article and Rapid response letters to this article

Resuscitating the teaching autopsy article and Rapid responses to this article

Links :

Autopsy (links to autopsy books courtesy of Barnes and Noble Bookstores, and other related sites (some of the links were not operational though).

Internet Autopsy Resource Image Archive (The John Hopkins Medical Institution, Department of Pathology) - histology specimens via a search engine.

Forensicmed.co.uk book store T-shirt store

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