(1) For purposes of
239 CMR
3.12, the following terms shall have the following meanings:
Blood. Human blood, human blood
components, and products made from human blood.
Bloodborne Pathogens. Pathogenic
microorganisms that are present in human blood and can cause disease in humans.
These pathogens include, but are not limited to, hepatitis B virus (HBV) and
human immunodeficiency virus (HIV).
Contaminated. The presence or the
reasonably anticipated presence of blood or other potentially infectious
materials on an item or surface.
Contaminated Laundry. Laundry which
has been soiled with blood or other potentially infectious materials.
Occupational Exposure. Actual or
reasonably anticipated skin, eye, mucous membrane or parenteral contact with
blood or other potentially infectious materials which results or may result
from the performance of an employee's duties.
Other Potentially Infectious
Materials:
(a) the
following human body fluids: semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic
fluid, saliva, urine, feces, any body fluid that is visibly contaminated with
blood, and all body fluids in situations where it is difficult or impossible to
differentiate between body fluids;
(b) any unfixed tissue or organ (other than
intact skin) from a human (living or dead); and
(c) HIV-containing cell or tissue cultures,
organ cultures, and HIV- or HBV-containing culture medium or other solutions,
and blood, organs, or other tissues from experimental animals infected with HIV
or HBV.
Personal Protective Equipment.
Specialized clothing or equipment worn by an employee for protection against a
hazard. General work clothes not intended to function as protection against a
hazard are not considered to be personal protective equipment.
Remove. The moving of a dead human
body from a home, hospital, or other place of death to a Licensed Funeral
Establishment for the purpose of preparing it for burial or cremation.
Ship or Shipment. To convey a dead
human body by train, boat, airplane, express or motor freight or other means of
transportation either within, into or out of Massachusetts after said body has
been prepared for burial or cremation.
Source Individual. Any individual,
living or dead, whose blood or other potentially infectious materials may be a
source of occupational exposure to the employee. Examples include, but are not
limited to, hospital or clinic patients, clients in institutions for the
developmentally disabled, trauma victims, clients of drug and alcohol treatment
facilities, residents of hospices and nursing homes, human remains, and
individuals who donate or sell blood or blood components.
Sterilize. The use of a physical or
chemical procedure to destroy all microbial life including highly resistant
bacterial endospores.
Transport. To convey a dead human body
in a closed hearse or other appropriately registered vehicle used exclusively
for the purpose of transporting dead human bodies and/or funeral equipment,
either within, into or out of Massachusetts for any purpose other than that
referred to in the definitions of 239 CMR 3.12: Remove
and Ship or Shipment;
Universal Precautions. An approach to
infection control in which all human blood and certain human body fluids are to
be treated as if known to be infectious.
(2) As part of their function of being health
care responsible, every Type 3 and Type 6 shall adopt all proper means to
safeguard the public health, including but not limited to the use of universal
precautions during the embalming or preparation of a body, as set forth in 239
CMR
3.12.
(3) Every person, while
engaged in removal of a dead human body from the place of death to a Licensed
Funeral Establishment, shall be provided with and shall use personal protective
clothing and equipment to protect against exposure to bloodborne pathogens.
(a) Disposable OSHA approved gloves shall be
worn for barrier protection against contact with blood or other potentially
infectious materials. Non-disposable autopsy, kevlar or rubber gloves shall be
worn for additional protection if warranted. Non-disposable gloves shall be
cleaned and carefully inspected for punctures, tears or other damage after each
use. Damaged gloves, whether disposable or non-disposable, shall be replaced
immediately. Other soiled clothing shall be removed before the removal of
gloves. Gloves shall be carefully removed to avoid skin contact with the
exterior of the gloves.
(b) The
body being removed shall be enclosed in a body bag or other suitable, sealed
container which will prevent leakage or escape of blood or other potentially
infectious materials during removal from the place of death to the Licensed
Funeral Establishment accepting responsibility for the care and preparation of
said body.
(4) Every
person, while engaged in actually preparing a dead human body for burial or
cremation, shall be provided with and shall use personal protective clothing
and equipment to protect against exposure to bloodborne pathogens.
(a) Disposable OSHA approved gloves shall be
worn for barrier protection against contact with blood or other potentially
infectious materials. Other soiled clothing or equipment shall be removed
before the removal of gloves. Gloves shall be carefully removed to avoid skin
contact with the exterior of the gloves.
(b) Non-disposable autopsy, kevlar or rubber
gloves shall be worn for additional protection if warranted. If non-disposable
gloves are used, they shall be cleaned and carefully inspected for punctures,
tears or other damage after each use. Damaged gloves shall be replaced
immediately. Other soiled clothing or equipment shall be removed before the
removal of gloves. Gloves shall be carefully removed to avoid skin contact with
the exterior of the gloves.
(c)
Disposable face masks shall be worn for barrier protection against sprays of
blood or other potentially infectious materials to the mouth or nose. Soiled
masks shall be replaced immediately.
(d) Goggles shall be worn for barrier
protection against sprays of blood or other potentially infectious materials to
the eyes and for vapor protection against exposure to formaldehyde.
(e) Face shields shall be worn for barrier
protection against sprays of blood or other potentially infectious materials to
the face.
(f) Gowns which are
impervious to moisture, are washable or disposable, and are long-sleeved shall
be worn for barrier protection against skin contact with chemicals, blood or
other potentially infectious materials. Soiled gowns shall be replaced
immediately.
(g) Disposable head
and shoe covers shall be worn for barrier protection against blood or other
potentially infectious materials.
(5) All instruments, appliances and equipment
used in the preparation of a dead human body shall be used and maintained in a
manner which prevents, insofar as is reasonably possible, conversion of blood
or other potentially infectious bodily fluids or materials into aerosols or
airborne particles.
(6) Every
Licensed Funeral Establishment shall ensure proper disposal of personal
protective clothing and equipment. Disposable items contaminated with blood or
other potentially infectious materials shall be placed immediately in an
appropriately labeled disposal container and removed in accordance with
applicable federal, state and local laws and regulations governing hazardous
waste disposal. Non-disposable items contaminated with blood or other
potentially infectious materials shall be placed immediately in an
appropriately labeled laundry container.
(7) No sheets or linens which have come in
contact with a dead human body shall be re-used unless they have first been
thoroughly laundered and disinfected. No other materials or supplies of any
kind which have come in contact with a dead human body shall be used more than
once. Contaminated laundry shall be handled as little as possible with a
minimum of agitation, shall be bagged or containerized at the location where it
was used, and shall not be sorted or rinsed at the location of use.
Contaminated laundry shall be placed and transported in bags or containers
which are labeled or color-coded in accordance with the applicable requirements
of the United States Occupational Safety and Health Administration.
(8) All instruments, appliances and equipment
used in the preparation of a dead human body shall be thoroughly cleansed and
sterilized in accordance with all applicable state and federal laws and
regulations, including but not limited to all applicable regulations of the
United States Occupational Safety and Health Administration and the
Massachusetts Department of Public Health, immediately at the conclusion of
each individual case.
(9) Each
preparation room in a Licensed Funeral Establishment shall be equipped with
proper and convenient receptacles for refuse, bandages, cotton and other waste
materials and supplies, and all such refuse, bandages, cotton and other waste
materials shall be disposed of in accordance with all applicable federal, state
and local laws governing disposal of hazardous waste.
(10) Whenever a dead human body is
transported within, into or out of Massachusetts prior to being embalmed or
otherwise prepared for burial or cremation, all persons engaged in the
transportation of said body or who may come into physical contact with that
body during transportation shall follow the precautions required by 239 CMR
3.12(3).
(11) Whenever a dead human
body is transported or shipped within, into or out of Massachusetts after being
embalmed or otherwise prepared for burial or cremation, the use of disposable
gloves shall be required only for persons who come into actual physical contact
with the body itself. Said body shall be transported or shipped in a sealed
casket, body bag or other appropriate sealed container which will prevent
leakage or escape of blood or other potentially infectious materials during
such shipment or transportation.
(12) Notwithstanding the provisions of 239
CMR
3.12(1) through (11), where a body is dead of a disease which has been
identified by the Massachusetts Department of Public Health or the Center for
Disease Control as one which requires precautions above and beyond those
required by 239 CMR
3.12(1) through (11), a Licensed Funeral Establishment and
its agents and employees shall follow such additional precautions as may be
required or recommended by the Center for Disease Control with respect to said
body.
(13) In accordance with the
regulations of the United States Occupational Safety and Health Administration
(
29 CFR
1910.1030) , every Type 3 and Type 6 shall
inform all workers performing tasks in and for any Licensed Funeral
Establishment, including any trade Type 6s or other workers who are not
directly employed by that establishment, about bloodborne pathogen exposure
risks associated with specific tasks, how to protect themselves and others from
exposure, and the actions to be taken in the event of an exposure
incident.
