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Aunque pueda contener afirmaciones, datos o apuntes procedentes de instituciones o profesionales sanitarios, la información contenida en el blog EMS Solutions International está editada y elaborada por profesionales de la salud. Recomendamos al lector que cualquier duda relacionada con la salud sea consultada con un profesional del ámbito sanitario. by Dr. Ramon REYES, MD

jueves, 25 de junio de 2020

COVID-19 Guidance for Funeral Directors by CDC



CDC Releases Practical COVID-19 Guidance for Funeral Directors
Posted March 11, 2020
https://www.nfda.org/covid-19

NFDA continues to lead the conversation with federal officials about the role of funeral service as it relates to the novel coronavirus (COVID-19) situation. At the request of NFDA and as a follow up to the postmortem guidance released by the CDC in late-February, today, the agency released specific information about funeral and visitation services to help funeral directors safely care for people who have died of confirmed or suspected COVID-19.

Specifically, this answers the following questions:

Am I at risk if I go to a funeral or visitation service for someone who died of COVID-19?
Am I at risk if I touch someone who died of COVID-19 after they have passed away?
What do funeral home workers need to know about handling decedents who had COVID-19?
What should I do if my family member died from COVID-19 while overseas and what are the requirements for returning the body to the U.S.?
In summary:

You can still have a funeral or visitation.
Bodies can be embalmed using proper PPE.
Decedents can be buried or cremated but check with state and local requirements.
We urge you to review this critical information immediately and share it with your staff.

This is the most up-to-date information that we have. From the very beginning of this situation, NFDA has been receiving information from the CDC, Department of Health and Human Services and other agencies about the evolution of COVID-19 in the United States. As we receive new information, we are sharing it with you and will continue to do so as long as necessary. Our COVID-19 information page can be found at www.nfda.org/covid-19.

Embalming
According to the CDC, bodies of those who die of confirmed or suspected COVID-19 can safely be transported and embalmed. The new guidance for funeral home staff emphasizes:

Transporting bodies in a body bag and disinfecting the bag with a product that contains EPA-approved emerging viral pathogens claims.
The guidance offers PPE recommendations for transfers and embalming, depending on the circumstances funeral home personnel expect to encounter. It is always better to don more PPE and be safe than sorry. All PPE should be doffed (taken off) and disposed of properly.
Additional guidance on PPE can be found on the CDC website.
Disinfecting contaminated surfaces using products with EPA-approved emerging viral pathogens claims is of utmost importance.
The guidance also notes that if “washing the body or shrouding are important religious or cultural practices, families are encouraged to work with their community cultural and religious leaders and funeral home staff on how to reduce their exposure as much as possible. At a minimum, people conducting these activities should wear disposable gloves. If splashing of fluids is expected, additional personal protective equipment (PPE) may be required (such as disposable gown, face shield or goggles and facemask).”

There has been concern expressed about the availability of PPE. NFDA is aware this may be a challenge and we are in touch with government officials about ensuring funeral home staff are on the priority list for receiving critical supplies.

The CDC’s Emergency Operations Center (EOC) – phone: 770-488-7100 – is available for urgent consultation should you need additional guidance regarding a confirmed or suspected case of COVID-19.

Cremation or Burial
At this time, the CDC states that decedents with COVID-19 may be buried or cremated according to the family’s preferences. However, you should “check for any additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.”

Please see the information provided by the Department of Veterans Affairs National Cemetery Administration for information about interment in veterans cemeteries.

Visitations and Funerals
At this time, CDC guidance states, “There is currently no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19.” However, the CDC also notes, “People should consider not touching the body of someone who has died of COVID-19.”

As with any gathering or event, you should check with local health officials to determine whether there are any prohibitions on holding public events, such as a visitation or funeral.

As an extra layer of precaution for you, your staff and those you serve, you may want to consider other measures such as:

Remind families about how to prevent the spread of COVID-19, such as by staying home if you are sick, washing your hands, and covering coughs and sneezes. The CDC has great informational flyers, such as “How to Stop The Spread of Germs,” you can post in your funeral home or hand out to families.
Keep soap dispensers filled in public (and employee) restrooms.
The CDC has several informational flyers on handwashing you can post in public and staff restrooms.
Offer alcohol-based hand sanitizer that contains at least 60% alcohol to guests (and employees).
Have extra tissues on hand.
If, for some reason, an individual is unable to attend a service, discuss options with the family:
Can the service be webcast using either a webcasting service or Facebook Live?
Can the service be postponed?
Can the family hold a memorial gathering – either in addition to or in lieu of a funeral service – at a later date?
As a business open to the public, it’s important that you and your staff be vigilant about cleaning, especially after services or arrangement conferences. The CDC offers guidance for businesses – including recommendations on cleaning products – on cleaning facilities open to the public.

Funeral Home Owners
As a funeral home owner, it is your responsibility to protect the health and safety of your staff. We urge you to carefully review this funeral home-specific guidance as well as:

CDC Resources for Businesses and Employers.
Information from OSHA about employer obligations during the COVID-19 situation: Guidance on Preparing Workplaces for COVID-19 and OSHA’s COVID-19 Information Page.
An FAQ on COVID-19 prepared by SESCO Management Consultants, NFDA’s endorsed human resources consultants.
NFDA members are also entitled to free advice via NFDA's Human Resources Hotline, 800-764-4127 or sesco@sescomgt.com.
The Department of Labor’s information regarding COVID-19-related issues.
We encourage you to prepare a plan of action for your business and then meet with all full- and part-time staff – from funeral directors to administrative assistants to maintenance staff – to ensure everyone is aware of the role they can plan in keeping themselves, their co-workers and client families safe. As new information comes up, share it with all staff.

In addition to discussing your plan of action with staff, also be in communication with other third-parties you may work with such as florists, caterers, removal services, etc.

NFDA cares deeply about the health and safety of you and those you serve. We pledge to do all we can to keep everyone informed of the latest information. Watch the NFDA website, your email and NFDA’s social media accounts for updates as they become available. Our COVID-19 information page can be found at www.nfda.org/covid-19.

Supporting You: NFDA Work/Life Resource Program 
The COVID-19 pandemic is stressful for every funeral director. You’re concerned about yourselves, your coworkers, the families you serve, and your own families that you go home to at night; therefore, you need to take care of ourselves during these stressful times.

If you need to help working through the stress of this situation and need better ways to take care of yourself so you can be at your best at work and at home, the NFDA Work/Life Resource Program is here for you. 

This program is an EAP or Employee Assistance Program; you may have heard that term before from a previous employer or perhaps as a benefit offered by your spouse’s employer. 

The Work/Life Resource Program is available to NFDA members 24 hours a day, seven days a week and it is completely confidential and free of charge. Your issues, whether they be personal or professional are your business. Our third-party partner, Beacon Health Options, never tells us who calls. We simply want to provide support when you need it so you can be at your best at work and with your family. 

Whether your concern is big or small, advice and help are available whenever you need it. Beacon offers many services and referrals, but what you might find most useful in helping you manage your stress during these trying times are the three in-person or virtual sessions with a licensed counselor. Again, these calls are 100% confidential –Beacon’s strictly adheres to federal privacy laws. 

You can find more information about the Work/Life Resource Program on the NFDA website or by calling NFDA at 800-228-6332.


COVID-19 and Funerals
There is currently no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19.

COVID-19 is a new disease and we are still learning how it spreads. The virus that causes COVID-19 is thought to mainly spread from close contact (i.e., within about 6 feet) with a person who is currently sick with COVID-19. The virus likely spreads primarily through respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory infections spread. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. This type of spread is not a concern after death.

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

People should consider not touching the body of someone who has died of COVID-19. Older people and people of all ages with severe underlying health conditions are at higher risk of developing serious COVID-19 illness. There may be less of a chance of the virus spreading from certain types of touching, such as holding the hand or hugging after the body has been prepared for viewing. Other activities, such as kissing, washing, and shrouding should be avoided before, during, and after the body has been prepared, if possible. If washing the body or shrouding are important religious or cultural practices, families are encouraged to work with their community cultural and religious leaders and funeral home staff on how to reduce their exposure as much as possible. At a minimum, people conducting these activities should wear disposable gloves. If splashing of fluids is expected, additional personal protective equipment (PPE) may be required (such as disposable gown, faceshield or goggles and facemask).

Cleaning should be conducted in accordance with manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against COVID-19 based on data for harder to kill viruses. After removal of PPE, perform hand hygiene by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available. Soap and water should be used if the hands are visibly soiled.

A funeral or visitation service can be held for a person who has died of COVID-19. Funeral home workers should follow their routine infection prevention and control precautions when handling a decedent who died of COVID-19. If it is necessary to transfer a body to a bag, follow Standard Precautions, including additional personal protective equipment (PPE) if splashing of fluids is expected. For transporting a body after the body has been bagged, disinfect the outside of the bag with a product with EPA-approved emerging viral pathogens claimspdf iconexternal icon expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). Wear disposable nitrile gloves when handling the body bag.

Embalming can be conducted. During embalming, follow Standard Precautions including the use of additional PPE if splashing is expected (e.g. disposable gown, faceshield or goggles and facemask). Wear appropriate respiratory protection if any procedures will generate aerosols or if required for chemicals used in accordance with the manufacturer’s label. Wear heavy-duty gloves over nitrile disposable gloves if there is a risk of cuts, puncture wounds, or other injuries that break the skin. Additional information on how to safely conduct aerosol-generating procedures is in the CDC’s Postmortem Guidance. Cleaning should be conducted in accordance with manufacturer’s instructions. Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).

After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water is not available. Soap and water should be used if the hands are visibly soiled.

Decedents with COVID-19 can be buried or cremated, but check for any additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.

When a US citizen dies outside the United States, the deceased person’s next of kin or legal representative should notify US consular officials at the Department of State. Consular personnel are available 24 hours a day, 7 days a week, to provide assistance to US citizens for overseas emergencies. If a family member, domestic partner, or legal representative is in a different country from the deceased person, he or she should call the Department of State’s Office of Overseas Citizens Services in Washington, DC, from 8 am to 5 pm Eastern time, Monday through Friday, at 888-407-4747 (toll-free) or 202-501-4444. For emergency assistance after working hours or on weekends and holidays, call the Department of State switchboard at 202-647-4000 and ask to speak with the Overseas Citizens Services duty officer. In addition, the US embassyexternal icon closest to or in the country where the US citizen died can provide assistance.

CDC does not require an autopsy before the remains of a person who died overseas are returned to the United States. Depending on the circumstances surrounding the death, some countries may require an autopsy. Sources of support to the family include the local consulate or embassy, travel insurance provider, tour operator, faith-based and aid organizations, and the deceased’s employer. There likely will need to be an official identification of the body and official documents issued by the consular office.

CDC requirements for importing human remains depend upon if the body has been embalmed, cremated, or if the person died from a quarantinable communicable disease.

At this time, COVID-19 is a quarantinable communicable disease in the United States and the remains must meet the standards for importation found in 42 Code of Federal Regulations Part 71.55 and may be cleared, released, and authorized for entry into the United States only under the following conditions:

The remains are cremated; OR
The remains are properly embalmed and placed in a hermetically sealed casket; OR
The remains are accompanied by a permit issued by the CDC Director. The CDC permit (if applicable) must accompany the human remains at all times during shipment.
Permits for the importation of the remains of a person known or suspected to have died from a quarantinable communicable disease may be obtained through the CDC Division of Global Migration and Quarantine by calling the CDC Emergency Operations Center at 770-488-7100 or emailing dgmqpolicyoffice@cdc.gov.
Please see CDC’s guidance for additional information.

https://www.cdc.gov/coronavirus/2019-ncov/faq.html#funerals

GESTIÓN DE CADÁVERES EN SITUACIONES DE DESASTRES: Guía practica para equipos de respuesta 
https://emssolutionsint.blogspot.com/2014/10/gestion-de-cadaveres-en-situaciones-de.html

Manejo de cadaveres en situaciones de desastre OPS gratis pdf  https://emssolutionsint.blogspot.com/2019/05/manejo-de-cadaveres-en-situaciones-de.html


Documento técnico Procedimiento para el manejo de cadáveres de casos de COVID-19 Versión del 13 de marzo de 2020

https://emssolutionsint.blogspot.com/2020/03/documento-tecnico-procedimiento-para-el.html

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