Embalmers fear TB, hope for the best
But masks won’t help, expert says
A recent report detailing how DNA fingerprinting by restriction-fragment-length polymorphism (RFLP) analysis was used to document transmission of TB from a cadaver to an embalmer doesn’t come as a big surprise to the people who toil in funeral-home "prep rooms" where bodies are embalmed.1 (For more information on RFLP analysis, see story, p. 27.)
Even though no federal regulations exist to protect them against TB, embalmers and other funeral industry workers say they believe they’re at higher-than-average risk for TB exposure and take precautions they hope will protect them. Unfortunately, experts say, those precautions probably are ineffectual.
"When I have a body I know has died from TB, I usually put a wet cloth over the [cadaver’s] mouth and nose," says Ed Williams, a longtime licensed Atlanta embalmer who says he apprenticed many years ago under the direction of a man who’d lost a lung to TB.
"I generally wear a mask," says Germaine Williams, another Atlanta embalmer (no relation to Ed). "Not everyone does, but I do, for the reason that one of the guys who works here is convinced he caught TB several years ago from a body he’d worked on."
OSHA requires regulation of formaldehyde
Exposure to formaldehyde, not TB, is one of the hazards the federal government does strive to protect industry workers against. For example, standards enforced by the Occupational Safety and Health Administration require mortuaries to monitor levels of formaldehyde in preparation rooms and funeral home workers to wear masks and other gear to protect them from fumes and splashes of the chemical, which is used in the embalming process.
Funeral homes are supposed to supply their embalmers with impermeable plastic shields, plastic face goggles, impermeable clothing coverings, and charcoal-filter respirators or masks. Wearing such gear, say some industry experts, offers good protection against not just fumes but other airborne hazards as well.
"The mask I wear is designed to protect against all airborne contaminants of all kinds," says David Patterson, a clinical preceptor at the Dallas Institute of Funeral Services.
Not so, says Bill Hofman, MBA, a physical scientist at the respirator branch of the National Institute for Occupational Safety and Health in Morgantown, WV. The trouble is that charcoal-filter masks and other respirators designed to protect against fumes offer no protection against particulates, just as particulate respirators don’t protect workers against fumes, he says. "There’s an awful lot of confusion around this issue. If you look inside one of these carbon-filter respirators, you’ll see there’s a filter there, but it’s really just a screen to keep the carbon in."
In any case, the accepted wisdom among many funeral home workers is that the real risk for TB exposure takes place during removal and transport of a cadaver, not during the embalming process itself. "You’re bending the body, you’re moving it around, and whatever [air] is in the lungs gets expelled right in your face," says Harvey Milner, a chemist at a mortuary supply company and former instructor at the Dallas Institute.
The potential for TB exposure is magnified when the body has been autopsied, he adds. "Think about it: Some of those bodies are cut to pieces when you go to pick them up." Patterson agrees. "That’s your biggest fear — moving the body from place to place," he says.
Even so, both men add, funeral home workers don’t always garb up for such occasions. "Some undertakers feel it offends the family to go into the home dressed like someone from outer space," Milner explains.
On the plus side, the funeral home workers interviewed say there’s only minimal potential for spills, splashes, and resulting aerosolizations during the embalming process. In the case of the recently published study of cadaver-to-embalmer transmission, the authors speculate that because the dead man suffered from HIV as well as TB, he may have had bacteremia, and a blood splash during the embalming process could have aero solized TB bugs into the air.
"Any splashing that occurs usually happens when the drain tube or arterial tube goes in or comes out," says Ed Williams. "You might get a drop splattered on you at that point, but no more than that." As embalming fluid, pumped into an artery under about five pounds of pressure, displaces blood in the body, effluents are directed by means of a catheter attached to rubber tubing into a sink and down a drain. Again, he says, it’s not a splashy affair.
As for the unnerving suggestion (posited in the recently published study) that cadavers may twitch or exhibit spasms, prompting effluents or exhalations, the embalmers interviewed snort in disbelief. "In years past we would get the bodies promptly when they died," says Ed Williams. "Sometimes, the cold embalming fluid could cause spasms and muscle twitches. These days, to be honest with you, they’ve usually been dead for quite a while by the time we receive them."
Unlike some of his co-workers, Ed Williams doesn’t bother with a mask in the prep room. "I have sinus problems, and wearing a mask seems like it makes it harder to breathe," he explains.
Plus, he adds, he’s skeptical when it comes to medical pronouncements. When he first took up the embalming trade many years ago, for example, his doctor advised him to get an annual chest X-ray. He did for three or four years, but then abandoned the practice. "So you see," he concludes, a note of triumph in his voice, "if we followed all the advice the doctors give us, I’d be dead by now."
Reference
1. Sterling TR, Pope DS, Bishai WR, et al. Transmission of Mycobacterium tuberculosis from a cadaver to an embalmer. N Engl J Med 2000; 342:246-248.
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