What are the universal precautions for prosectors at high-risk autopsy?

Updated: May 20, 2019
  • Author: Jeffrey S Nine, MD; Chief Editor: Kim A Collins, MD, FCAP  more...
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Answer

Prosectors should limit their activities to the autopsy table and dissecting area. There should be only a single blade in the dissection field at any time. A "clean" circulating assistant should be available to obtain additional instruments, to take notes, and to answer the telephone. Specimens for microbiologic culture and cassettes of microscopic sections should be placed in a container; the outside of the container should be free of blood and body fluid(s) from the autopsy. These containers should be put into an impermeable bag for transport to the microbiology and histology laboratories. The paperwork needed to accompany the containers should be free of blood or body fluid(s). Paperwork that is contaminated by blood or fluid(s) should be replaced by uncontaminated copies of the paperwork before the paperwork leaves the autopsy room.

Needles should not be purposely bent, clipped, recapped, or otherwise manipulated by hand. A puncture-resistant container designed for the disposal of sharp instruments should be within easy reach of the prosector. Needles, syringes, and scalpel blades should be dropped into this container immediately after use. Needles should not be removed from syringes before disposal. Scalpel blades should be removed from their handles with the use of devices designed for this purpose or with a forceps; the tip of the blade should be aimed at the cutting board during removal. Some authorities advocate using one's hand to slip the blade off the scalpel handle; this decreases the possibility that someone struggling to remove a blade may inadvertently propel it into another person. Before leaving the autopsy table, the prosector should remove all scalpel blades from their handles and dispose of the blades immediately after completing the autopsy dissection and sectioning.

Additional measures enhance safety in the autopsy room even further. For most dissections, blunt-tipped scissors may be used instead of a scalpel. [7] Tissue may be held for dissection or sectioning with a forceps instead of with the noncutting hand. The ribs may be cut with a large gardening shears-type instrument. A plastic bag or tent may be placed around the mechanical saw while it is being used to cut the skull and spine. [8]

Surgical towels may be placed over the cut edges of the rib cage while the chest is being eviscerated and the thoracic spine and spinal cord cut. When slicing an organ, a sponge or stack of paper towels may be put on top of the organ between the organ and the noncutting hand holding the organ in place while it is being sliced. Scalpels may be placed on a flat surface for the prosector to pick up rather than handed to the prosector.

In general, anyone handling a scalpel or other sharp instrument should shut out distractions while cutting with it; the scalpel should then be set down in plain view in a cleared space. Before moving a sharp instrument, one should announce to all nearby persons that the instrument is being moved. Obtaining microscopic sections, which requires the use of a scalpel, may be done the day after an autopsy, after the tissue intended for sectioning has been fixed.

Additional suggestions for further enhancing safety in the autopsy room are not all practical. Some authors have suggested that the scrub suit worn while performing an autopsy should not be worn outside the autopsy room. This would require that the prosector strip down to his or her underwear before leaving the autopsy room.


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