Médico

The American Journal of Forensic Medicine and Pathology

23(2):107–122, 2002.

©2002 by Lippincott Williams & Wilkins, Inc., Philadelphia

Biosafety Considerations for Autopsy
Kurt B. Nolte,
M.D.,

David G. Taylor,

Ph.D.,

and Jonathan Y. Richmond,

Ph.D.

An autopsy may subject prosectors and others to a wide variety of infectious agents, including bloodborne and aerosolizedpathogens such as human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. Other hazards include toxic chemicals (e.g., formalin, cyanide, and organophosphates) and radiation from radionuclides used for patient therapy and diagnosis. These risks can be substantially mitigated through proper assessment, personal protective equipment, appropriate autopsy procedures,and facility design. Key Words: Autopsy—Biohazards—Chemical hazards— Toxichazards.

“. . .What kind of a cut is it? Where is it?” “Right here, on my finger. I rode over to the village today—you know, the one they brought that mouzhik with typhus from. For some reason or other they were getting ready to do an autopsy on him, and it’s been a long time since I’ve had any practice of that sort.” “. ..Old timer,” Bazarov began in a hoarse, slow voice, “my goose is cooked; I’ve been infected and in a few days you’ll be burying me.” Ivan S. Turgenev, Fathers and Sons, 1862 Autopsies can be performed with the consent of the next-of-kin of persons who die of natural causes in hospitals, or they can be performed under legislated authority (forensic or medicolegal autopsies) on persons who die ofviolent, unnatural, suspicious, sudden, or unexplained causes. The frequency of consent autopsies has declined substantially over the previous several decades, from approximately 50% of all hospital deaths in 1950 to less than 10% in 1995 (1). One reason for this decline is the potential increased risk of occupational exposure of pathologists to dangerous pathogens (2). With decreased hospitalautopsy rates, the proportion of medicolegal postmortem examinations has increased. Medicolegal autopsies constituted a large proportion, and in some jurisdictions the majority, of the total number performed in 1981 (3). Since then, national hospital autopsy rates have continued to decline, and medicolegal autopsies likely represent the majority of these procedures performed in almost all areas of theUnited States. AUTOPSY HAZARDS Infectious Agents The risk of infectious disease transmission has long been recognized for prosectors, observers, and other persons in close proximity to an autopsy. Retrospective surveys of British clinical laboratories between 1970 and 1989 demonstrated that the highest rates of laboratoryacquired infections were in autopsy workers (4 – 8). Autopsy-transmittedinfections may occur after direct cuta107

Manuscript received January 20, 2002; accepted January 20, 2002. From the Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, New Mexico, the Medical Examiner/Coroner Information Sharing Program, Division of Public Health Surveillance and Informatics, Epidemiology Program Office, and Infectious Disease PathologyActivity, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (K.B.N.) and the Office of Health and Safety (D.G.T., J.Y.R.), Centers for Disease Control and Prevention, Atlanta, Georgia, U.S.A. Address correspondence and reprint requests to Kurt B. Nolte, M.D., Office of the Medical Investigator, University of New Mexico School of Medicine, Albuquerque, NM 87131-5091,U.S.A.; e-mail: knolte@ salud.unm.edu

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K. NOLTE ET AL. per exposure (31); and for HCV, an average of 1.8% per exposure but may be as high as 10% (38,46). Although the viability of HIV in cadaveric blood appears to decrease over time, this organism has been isolated from specimens from deceased persons with postmortem intervals of 6, 11, and 16 days (47–50). HIV-infected bodies should...