4.1 Water Supply

A hot and cold water supply should be readily accessible in the mortuary. Cleaning arrangements should avoid the creation of aerosols.

4.2 Power Supply

4.2.1
Power supply outlets must be protected from wetting by having protective covers.
4.2.2
An emergency back-up system for the power supply should be available for refrigeration, high priority equipment and illumination.

4.3 Disposal of Hazardous Materials Derived from the Autopsy Procedure

4.3.1
Such materials comprise the following:
  • Human organs and tissues
  • Syringes, needles, blades and other sharps
  • Contaminated disposable items such as paper towels and rubber gloves
  • Formalin and other chemical waste associated with the processing of tissue samples
  • Gowns and other protective clothing
  • Wound dressings, cannulae, tubing, catheters and prostheses.

    4.3.2
    The Mortuary Procedures Manual shall contain protocols for dealing with each of these types of materials, in accordance with relevant legislation.
    4.3.3
    Organs and tissues for disposal following a hospital autopsy should be disposed of in accordance with the wishes of the next of kin and in compliance with institutional policies and relevant statutory requirements.
    4.3.4
    All sharps should be placed in containers which comply with Australian standards for sharps disposal.
    4.3.5
    Contaminated disposables should be bagged in clearly labelled biohazard bags and be dispatched for disposal by a company licenced for the disposal of medical waste.
    4.3.6
    Formalin and other chemical waste should be dealt with in accordance with institutional guidelines and relevant legislation.
    4.3.7
    Soiled theatre clothing and other fabrics should be dealt with in accordance with institutional policy.

    4. 4 Body Storage

    4.4.1
    A body cold store having a capacity appropriate for the mortuary workload should be maintained at a temperature of about 4oC. If long-term storage is required, a freezing facility operating at about -20oC should be available.
    4.4.2
    The body cold store should have adequate space for the accommodation of each body. There should be storage space suitable for large bodies.
    4.4.3
    The operating temperatures of all cooled and freezing facilities should be continuously monitored. The facilities should be fitted with alarms which are activated when the temperature exceeds a predetermined level. Action to be taken if an alarm is activated must be specified in the Mortuary Procedures Manual.
    4.4.4
    The need for manual lifting of bodies should be minimised by the provision of suitable body hoists, elevating trolleys or elevating dissection barouches.
    4.4.5
    The body store should only be accessible to authorised persons and must be lockable if not located within a secure area.

    4.5 Lighting

    4.5.1
    Adequate lighting shall be available in all areas.
    4.5.2
    Shadow-free lighting shall be provided for the autopsy table and dissection benches.

    4.6 Airconditioning, Heating and Ventilation

    4.6.1
    To maintain a high level of staff concentration and to minimise the possibility of accidents, the temperature of the mortuary theatre should be maintained within a comfortable range not exceeding 25oC.
    4.6.2
    The ventilation system for the mortuary shall be designed to minimise the spread of odours and airborne pathogens by being isolated from other ventilation systems, where possible.
    4.6.3
    Adequate ventilation must be available on the benches where formalin-fixed organs and tissues are handled.

    4.7 Flooring

    4.7.1
    Non-slip flooring is essential for all work areas.
    4.7.2
    The floor surface should be impervious, easy to clean, sealed with coving at the edges and have adequate drainage. Floors should have drains with appropriately filtered traps.

    4.8 Storage Facilities

    4.8.1
    Adequate storage space is necessary to ensure that the mortuary is uncluttered and has clear identified separation of clean and dirty areas.
    4.8.2
    Tissues immersed in formaldehyde should be stored in an area equipped with an exhaust system positioned to extract vapours heavier than air.

    4.9 Special Autopsy Suites for High-Risk Autopsies

    4.9.1
    Prior to commencement of an autopsy, the pathologist scheduled to conduct or supervise the conduct of the autopsy by another medical practitioner shall ensure that procedures for notifying the mortuary of the presence of known or suspected high-risk infections have been complied with.
    4.9.2
    Cases designated high risk include those with a known or suspected infectious disease such as HIV, Hepatitis B and C, Tuberculosis, CJD and Meningococcal Septicaemia. In circumstances where there is an increased possibility that an infectious disease may be present, such as in IV drug use or unsafe sexual practices, the autopsy should be regarded as high risk even if serological testing is negative. The Mortuary Procedures Manual shall contain detailed instructions for the additional procedures to be implemented for each of these circumstances.
    4.9.3
    Autopsies presenting possible or known high risk hazards should only be performed in institutions by appropriately trained staff using autopsy facilities which minimise the possibility of transmission of infection from the body to staff involved in the procedure.
    4.9.4
    The Mortuary Procedures Manual shall contain detailed instructions for the identification, body handling and the autopsy techniques to be used in high-risk cases.

    4.10 Observation Area

    The mortuary design should enable procedures to be viewed without placing the audience at risk and without contaminating the autopsy.

    4.11 Body Reception and Release

    4.11.1
    Persons having access to the bodies of deceased persons must only do so in accordance with institutional policy or, when relevant, the Coroner’s documented procedures. Bodies may only be released from the mortuary with the appropriate approval of institutional management or the Coroner.
    4.11.2
    At the time of transfer of a body to a funeral director, the funeral director should sign an acknowledgment that the body was received in an acceptable condition.
    4.11.3
    Funeral directors should have their access to the mortuary shielded in such a manner as to prevent body transfer being seen by the public or hospital patients.
    4.11.4
    Bodies to be stored in the mortuary and which are known to harbour or are suspected of harbouring infectious diseases must be contained both before and after autopsy within a body bag of approved construction which is durable and impermeable to body fluids. Apart from total uncovering during an autopsy or partial uncovering during a viewing procedure, bodies not posing a risk of infection shall be completely covered using fabric shrouds during transport or while within the body store.
    4.11.5
    Bodies to be stored in the mortuary must have securely affixed to the body some form of indelible label which records the full name of the deceased and at least one other identifier (date of birth, unit record number) which enables identification of the deceased with certainty. Secure identification information should also be fixed to the exterior of the body bag or shroud enclosing the deceased.

    If the body is temporarily removed from a body bag or shroud, such as during autopsy, extreme care must be taken to match the body label with the label on the body bag or shroud before restoring the body to its covering.

    4.12 Security and Access

    The mortuary should have a security system in place which prevents access by unauthorised persons to the mortuary or body store.

    4.13 Body Viewing and Identification Area

    4.13.1
    The viewing and identification area shall be located at a suitable distance from the mortuary theatre to avoid the possibility of visitors seeing or hearing an autopsy in progress.
    4.13.2
    It is recommended that relatives initially view the body through glass but they should be able to readily enter the body room if they choose to do so. A member of staff of the hospital or institution administering the mortuary should be readily available nearby throughout the viewing process to provide assistance or advice, if needed, but should not intrude into the privacy of the family unless they are responding to a request by the family.
    4.13.3
    The viewing facility should have a suitably located waiting area for relatives, fitted out in an appropriately dignified fashion, with easy access to washroom facilities.

    4.14 Autopsy Theatre

    4.14.1
    The main autopsy theatre should utilise only appropriate tables or trolleys. The provision of height-adjustable equipment is encouraged.The mortuary should have a security system in place which prevents access by unauthorised persons to the mortuary or body store.
    4.14.2
    Working bays should be of sufficient size to allow staff to be able to work in uncrowded space.
    4.14.3
    Instruments, containers and other items needed during the conduct of an autopsy should be readily accessible within each work bay.

    4.15 Dissection Facilities

    4.15.1
    The air conditioning system should ensure that the volume and direction of air flow is satisfactory in each working bay.
    4.15.2
    Each working bay should have illuminated benching for the examination and dissection of removed organs and tissues.
    4.15.3
    Facilities for weighing and measuring organs should be readily available within the mortuary theatre. Facilities for photography are recommended.

    4.16 Radiology and Photography

    Safe arrangements to prevent exposure to radiation and spread of contamination must be in place when undertaking radiology or photography in the mortuary.

    4.17 Cleaning

    The Mortuary Procedures Manual shall specify the arrangement for the cleaning of all areas of the mortuary, including procedures for disinfection and the cleaning of instruments and equipment.