Refrigeration- Body should remain wrapped in plastic or body pouch while under refrigeration.

Viewing- Viewing the unembalmed intact remains does not present a particular hazard beyond that of any other disease.

Utilizing universal precautions, body can be sanitized (body surfaces) and features can be set.

To avoid unnecessary manipulation of the body and exposure to body fluids, body should remain wrapped in plastic and clothing should be draped over remains after casketing or placement on viewing table.

This may be an acceptable alternative for the family that desires a viewing.

If viewing is requested after cranial restoration, exposure to the prion is present, especially in the hair. A hairdresser would be exposed if the hair is to be done prior to viewing as would those who touch the body during viewing. Since the risks here are unknown, we strongly caution the funeral home against restoration or viewing of autopsied remains.

Cremation- Body should already be wrapped in plastic or placed in a body pouch. Body should also be in a rigid alternative cremation container or casket. With no direct contact with the body, no special precautions are required by crematory personnel.

While there have been no specific studies to definitively determine that the CJD prion is destroyed during the cremation process, it is normally destroyed by routine autoclave procedures (>130°for 15 minutes) which is done at a much lower temperature. Indeed the preheating of the retort alone is likely to be sufficient to destroy the prion.

Incineration at a temperature of 1000° is considered effective against the CJD prion.

Therefore we can safely assume that the prion is destroyed during the cremation process (1600 + degrees) and the handling of the cremated remains (ashes) poses no threat to crematory personnel.

Entombment- Body should already be placed in a body pouch. Using appropriate universal precautions, body should be treated with external embalming powder to minimize odors. Body should be placed in an inner sealer case or sealer-type casket. (Note: Mausoleum regulations may require embalming or have regulations concerning communicable diseases. Check mausoleum requirements prior to assuring family that entombment will be allowed).

Since the CJD prion can survive under normal conditions for up to a year, we assume that it will also survive for that long within the mausoleum. Assuming that the casket remains intact for at least a year, it should present no further health hazard if later removed. Even then, the casket should not be opened for any reason.

Burial- Body should already be wrapped in plastic or be in a body pouch prior to casketing. Body should be placed in an inner sealer case or sealer type casket.

Since the CJD prion can survive under normal conditions for up to a year, we assume that it will also survive for that long underground. To assure that the casket remains intact for at least a year, a vault or graveline should also be used.

Disinterment- Since the CJD prion can survive under normal conditions for up to a year, we assume that it will also survive for that long underground or in a mausoleum. We recommend that no disinterment be made for at least the first year following interment. Even prior to that time, if the casket is intact and sealed, the body should not present any appreciable risk. Even then, the casket and/or vault should not be reopened during the disinterment and reinterment.

Disposal of liquid waste (drainage)- If injection with drainage is attempted, it presents the additional problem of what to do with the drainage. Since formaldehyde has no effect on the prion, normal disposal into the sewer system means introducing an unknown quantity of the prion into the sewer system.

As an alternative, some have proposed treating the drainage with a chemical known to have some effectiveness against the prion, such as sodium hydroxide (lye) or sodium hypochlorite (bleach).

This presents further complications however.

Formaldehyde, which would also be in the drainage, should never be mixed with bleach.

Lye mixed with water produces heat and presents its own handling and disposal hazards.

Any attempts at treating the drainage, further exposes the embalmer to the prion as well as additional chemical hazards.

Therefore, although it may not seem to be an adequate solution, the most logical answer is to dispose of the drainage directly into the sewer system with a minimum of exposure to the embalmer.

This situation alone should be further justification for not attempting arterial injection of the body.

Disposal of solid waste (PPE, etc.)- All solid waste including gloves, gowns, sheets, etc. that have been used or which may have come into contact with the CJD case should be sealed in plastic and disposed of as hazardous waste.

Treatment of instruments- Disposable instruments should be used and also disposed of as hazardous waste or sharps. Non-disposable instruments should likewise be disposed of and not reused. Since the CJD prion has been shown to survive autoclaving if not done at proper temperature (and since most funeral homes do not have access to an autoclave), attempts at sterilization are not recommended.

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