1.4 Identify diseases and conditions that necessitate specialist treatment or precautions when caring for and transferring deceased individuals

This guide will help you answer 1.4 Identify diseases and conditions that necessitate specialist treatment or precautions when caring for and transferring deceased individuals.

When caring for and transferring deceased individuals, some diseases require extra precautions. These measures protect the worker, other people, and the wider public. Certain infections can remain in the body after death. Some are contagious through contact with bodily fluids, surfaces or airborne particles. Knowing which diseases need specialist handling helps prevent spread of infection.

These diseases may carry a higher infection risk or pose chemical hazards if treatments are still active in the body. Health and safety guidance comes from public health bodies and must be followed exactly.

Common Infectious Diseases Requiring Precautions

Some infections stay active in the body after death. Handling, preparing, and transporting the remains can release infectious material. Infection can spread through cuts, splashes, inhalation, or contact with mucous membranes.

Below are examples of diseases that require heightened protection.

Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS)

HIV affects the immune system and can still be present in blood and other body fluids after death. The virus can be spread through:

• Cuts or punctures from needles or sharp objects
• Splashes to the eyes, mouth, or broken skin

Precautions include wearing gloves, aprons, and eye protection. Any sharps must be disposed of in a sharps bin. Workers should cover any cuts or grazes before handling the body.

Hepatitis B and Hepatitis C

Both viruses affect the liver. They are spread through contact with infected blood and some other fluids. The viruses survive outside the body for some time. This increases the risk if there is contamination of surfaces or equipment.

Precautions mirror those for HIV:

• Use gloves, aprons, and eye/face protection
• Use disposable equipment where possible
• Clean surfaces with an appropriate disinfectant

Tuberculosis (TB)

TB is an airborne bacterial infection mainly affecting the lungs. In some cases, the bacteria are present in the airways after death. TB particles can be released if air is expelled from the lungs during movement.

When TB is confirmed or suspected:

• Use respiratory protection such as an FFP3 mask
• Limit movement of the body to reduce risk of dispersal
• Seal the body in a body bag

Meningitis and Meningococcal Septicaemia

Meningococcal bacteria can be present in blood or secretions after death. Infection spreads through direct contact with these fluids. Though the risk after death is reduced, it is still possible.

Workers should:

• Wear gloves and aprons
• Avoid direct contact with fluids
• Dispose of contaminated waste safely

Creutzfeldt-Jakob Disease (CJD) and Variant CJD

CJD is a rare, fatal brain disease caused by abnormal proteins called prions. Prions resist standard disinfection and can survive for long periods. Infection risk mainly comes from direct brain or spinal tissue contact.

Special handling includes:

• Avoiding procedures that could create aerosols
• Using dedicated, disposable equipment
• Following strict decontamination processes if surgical instruments are involved

Other Infections That Pose a Risk

Many other diseases and conditions need care. Some examples:

• Severe Acute Respiratory Syndrome (SARS)
• Middle East Respiratory Syndrome (MERS)
• Ebola Virus Disease (EVD)
• Lassa fever
• Cholera
• Plague

These may spread by air, droplets, direct contact or contaminated water supply. Public health guidance will specify procedures based on each disease.

Non-Infectious Hazards

Not all risks are infectious. Some hazards come from treatments given before death.

Cytotoxic Medication Residues

Cytotoxic drugs are used for cancer treatment. Traces can remain in the body after death. These drugs can cause harm through skin contact or inhalation of dust from contaminated bedding or dressings.

Precautions include:

• Wearing gloves and aprons
• Using protective eyewear if splashing is possible
• Using leak-proof body bags if any risk of leakage exists

Radioactive Implants or Tracers

Some cancer treatments involve radioactive substances. The level of radiation risk depends on the treatment type and time since it was given.

Safety measures:

• Liaise with the radiation protection officer
• Avoid non-essential handling
• Use monitoring equipment if needed
• Follow set pathways for disposal or transfer

Levels of Risk and Legal Duties

The Control of Substances Hazardous to Health Regulations (COSHH) apply to handling deceased individuals with infectious diseases. Employers must:

• Assess the risk
• Provide protective equipment
• Give clear training
• Maintain safe systems of work

Public Health England (now the UK Health Security Agency) provides guidance on infection risks after death. This includes category classification of diseases based on risk.

Category 3 or 4 pathogens present the highest risk and require the strictest controls, often in designated facilities.

Infection Control Measures

Personal Protective Equipment (PPE)

PPE acts as a physical barrier between the worker and infection sources. For higher-risk cases this may include:

• Single-use gloves
• Disposable apron or gown
• Eye/face protection
• Respiratory protection if airborne risk exists

PPE must be put on before contact starts and removed safely to avoid contamination. Hands must be washed immediately after removal.

Safe Handling

To reduce infection risk when moving the body:

• Keep handling to a minimum
• Use leak-proof sealed body bags for high-risk cases
• Avoid procedures that expel air from the lungs
• Transport directly to the mortuary without delay

Cleaning

After handling, clean and disinfect any surfaces or equipment. Use disinfectants that are effective against the specific organism involved. Dispose of waste by clinical waste routes.

Documentation

Record any suspected or confirmed infectious risk in transfer paperwork. This alerts the receiving facility to take proper precautions. Confidentiality rules still apply — information should be shared on a need-to-know basis only.

Communication and Training

Workers must receive clear information on what precautions to take. Regular training helps them handle such cases safely. Topics to cover include:

• Recognition of infection risks from paperwork or health professionals
• Correct PPE use
• Safe lifting and moving techniques
• Decontamination procedures
• Waste disposal rules

Role of Public Health Authorities

Doctors must report certain infectious diseases to public health authorities under the Notification of Death Regulations if infection is suspected or confirmed. This ensures correct measures are followed and may trigger broader public health responses.

Authorities can advise on:

• Risk assessment
• Appropriate PPE and handling
• Mortuary arrangements
• Transport restrictions

Transport of High-Risk Cases

Some infectious diseases require controlled movement of the deceased. This may involve:

• Sealing in double body bags
• Placing labels indicating infection hazard
• Using authorised transport routes
• Avoiding public exposure

Airborne or highly contagious diseases may restrict movement to certain facilities.

Ethical Considerations

Even with infection control in place, respect and dignity for the deceased should be maintained. PPE and sealed bags are safety measures, but handling should still be carried out with care and professionalism.

Families may not be able to view or touch the body if risk is high. Staff should explain this clearly and compassionately. Providing clear reasons helps avoid distress and maintains trust.

Handling of Autopsy Cases

Post-mortems can pose increased risk as they may expose infectious tissues and fluids. Pathologists and mortuary staff use enhanced precautions, including powered respirators for airborne risks and special containment mortuaries for high category pathogens.

For CJD, post-mortem work is restricted to specialist centres due to prion resistance to normal sterilisation. Any instruments used may be destroyed after use.

Special Precautions for International Transfers

Bodies may be transported across borders for burial or cremation. Different countries have rules on infectious disease deaths. In some cases, countries refuse entry for remains with certain pathogens.

Air transport has strict airline and international regulations. The International Air Transport Association (IATA) provides rules for the shipment of human remains, including packaging and documentation.

Final Thoughts

In health and social care, safety for both workers and the public depends on strict handling procedures for certain infectious or hazardous cases after death. Recognising the diseases that carry lingering risks is a key skill. By following best practice, workers protect themselves, maintain public health, and ensure respect for the deceased.

These situations demand a balance between infection control and dignity. Equipment, procedures, and training all play a role in keeping that balance. With the right information and clear action, the risks can be managed safely and the final stage of care can be carried out in a professional and respectful way.