Guidance on the use of hermetically sealed body bags

GQ1(c): Procedures on body storage prevent practices that disregard the dignity of the deceased.

PFE2(c): Storage for long-term storage of bodies and bariatric bodies is sufficient to meet needs. 

Guidance for standard PFE2(c) states: 

"There should be sufficient frozen storage for the long-term storage of bodies; the HTA advises that bodies should be moved into frozen storage after 30 days in refrigerated storage if there is no indication they are soon to be released or further examined, or before, depending on the condition of the body. Bodies in long-term storage should be checked regularly; this should include confirmation of their identity and the reason for their continued storage. Where there is insufficient freezer storage to meet needs, there should be arrangements with other establishments, or other contingency steps, to ensure that bodies can be stored appropriately. Where storage capacity is identified as an ongoing issue, this should be escalated to the relevant Trust, Health Board or Local Authority."

HTA licenced establishments in the post mortem sector are expected to ensure that bodies are stored in appropriate conditions and are fully shrouded, including the covering of heads and feet. It is a requirement for establishments to have sufficient freezer storage facilities for bodies, including bariatric bodies, to meet their needs. If long-term storage facilities are not available, alternative arrangements should be in place.  

Hermetically sealed body bags are used as a containment system option for infectious and decomposed bodies and are also often used on standby for mass fatality incidents. These body bag systems can be cut to any length and are made of a flexible three-ply material, including a metal foil barrier. Additional preservative-based sprays, which aid the inhibition of bacterial activity and support preservation, are available and may optionally be used prior to sealing. Once heat sealed, using a heat sealer, they become airtight, meaning gases and liquids become contained within the bag. 

It is important that HTA licenced establishments, currently using or considering using these systems, understand how they align with HTA standards. It is the HTA’s position that hermetically sealed body bags must not be used as a permanent solution in place of frozen storage. Although sealed body bags can be used where the establishment deem it necessary, for example for infectious or decomposed patients, DIs of HTA licenced premises have a responsibility to ensure HTA licensing standards are met. 
 

If hermetically sealed body bags are currently in use, or are soon to be introduced at a HTA licenced establishment, the HTA recommends DIs put in place the following steps:

• Establishments should have in place a risk assessment and a standard operational procedure (SOP). The SOP should include a stepwise guide on when hermetically sealed body bags can be used as well as the identification, transfer and sealing process. Mortuary staff should also be provided with appropriate training.
• Identification labels must be attached to the body. Body bags and shrouds must not be labelled in place of labels attached to the body.
• A minimum of three identifiers on the body should be checked against mortuary records before transferring a patient into a sealed body bag. Any discrepancies in the identifiers should be thoroughly investigated before proceeding.
• A minimum of three identifiers on the body should be checked against mortuary records before every transfer. This means, unsealing the hermetically sealed body bag before every transfer. This includes transferring between establishments or for internal short-term transfers.
• Checks should be made to ensure that identification bands on bodies are accessible and legible when bodies are transferred into freezer storage, including bodies in hermetically sealed body bags.
• Regular condition checks should be undertaken to ensure optimal preservation of bodies whilst in storage. Document dates of condition checks and record actions taken to prevent deterioration. Where regular condition checks are not carried out, for example in cases such as infectious or decomposed patients, the rationale for this should be recorded.
• Replace soiled shrouding, and clean bodies where possible (with agreement from the Coroner where required).
• If a hermetically sealed body bags become damaged, deceased patients should be transferred into a new body bag.
• In certain cases, such as forensic investigations or post-mortem examinations, the use of hermetically sealed bags may not be possible or require additional steps to ensure evidence preservation (contact the Coroner or the Police where required).
• Where it is not possible to transfer a body to frozen storage, document the reasons. This is particularly relevant where a body is showing signs of deterioration, or where a body has been in refrigerated storage for longer than 30 days. Conduct regular reviews of such cases, ensuring information is recorded and followed up appropriately. If it has not been possible to transfer a patient to frozen storage and deterioration of a body occurs, the establishment is required to report the incident to the HTA under the category accidental damage to a body.