What’s good for odors is good for TB, too
Basking in state-of-the-art coroner’s office
When Diane Franklin, assistant health and safety officer at the Los Angeles coroner’s office, thinks about state-of-the-art coroner’s facilities, there’s a particular building she has in mind. Flanked by palm trees, warmed by the tropical sun, and christened with the proud, if slightly fanciful, address of "Number One on Bob Hope Road," the Dade County coroner’s office is the facility that most often animates Franklin’s daydreams.The secret to a state-of-the-art coroner’s office? Plain good housekeeping, says Joseph H. Davis, MD, former director of Dade County’s medical examiner’s department and still a strong presence at the facility (in retirement, he bears the title of "visiting professor"). "Better to start off right upfront with the idea that you’ll be careful and clean," he counsels.
That means, first off, a properly designed work space, with plenty of storage rooms and wall cabinets, something Davis says he discovered the need for the hard way. "The old autopsy room was forced to be a hallway, a storeroom, a supply room . . . there was no space at all," he says.
Less chance for crud to collect
Now, with tools and supplies stashed neatly out of sight, "there’s less chance for crud to collect," Davis says. Even the tops of wall cabinets are stationed at eye level and constructed to slant upward, so cleaning personnel see them — and dust accordingly.Good lighting is another prerequisite, and here Davis has a simple rule of thumb: Take the standard industrial specs for good lighting, and double them.
Most important of all, however, is good odor control. Features that keep down bad smells make for good TB control, too, Davis says.
To keep odors and TB bacilli at bay, autopsy suites are maintained under negative air pressure. Badly decomposed bodies, along with cases known to have had TB or other communicable diseases, are routed to a special facility known as the "decomp area," a third building that is separate both from the administrative building and the regular autopsy building.
When TB is discovered after the fact, in the regular autopsy room, the body stays put; but everyone is immediately cleared from the floor, except for the necessary personnel, says Scott Hanks, overseer of morgue operations.
Routing air away from noses
Improving further on ventilation and borrowing an idea from the San Francisco coroner’s office, Davis routed airflow in such a way as to carry odors and bugs away from workers’ noses by placing the supply vent in the ceiling and putting the exhaust below on the floor.Between floors of the building, there are no perforations at all but instead an inch-thick impervious membrane in the crawl space that divides the forensic laboratory from the autopsy suites. Elevator shafts, often a haven for germs and odors, are placed on the exterior of the building.
What Davis considers his crowning touch, ventilation-wise, is an array of expensive Cosa-Tron filters, the same devices enlisted to scrub the air in smoky bingo parlors and fumey airport terminals. "They coalesce the molecules that cause odors by ionizing the air that flows through," he explains. The clumps of molecules are then amenable to being trapped in a special box filter, which is changed, in accordance with the maker’s instructions, on a monthly basis. Errant TB bacilli are caught and trapped by the same method, Davis says.
In place of the Stryker saws routinely used in such facilities, the Dade County facility has a stock of saws outfitted with vacuums and HEPA filters. Hoses that wash down surfaces of dissecting tables have wide-bore nozzles, which are better for supplying plenty of low-pressure water, and, thus, avoiding generating a spray.
Autopsy room workers don the requisite jumpsuits, goggles, masks, and N-95 respirators. All gear is put on and doffed in a shower room adjacent to the autopsy suites.
But Davis is skeptical about the ultimate value of too many fancy devices. "Every time you modify the system to build in safety, you create unforeseen hazards," he says. "People who don heavy gloves and safety glasses lose their sense of smell and their tactile sensation. Their vision is obscured and they’re uncomfortable. That means they’re more error-prone."
That’s why, even on the busiest day, a visitor to the Dade County facility won’t see any telltale splatters on the floor, says Hanks.
With a caseload of about 3,400 bodies per year, of which 2,900 are processed in-house, the Dade County facility boasts a good track record so far, Hanks says. Of 11 doctors and seven techs, only a couple test positive for TB infection, he figures.
On the other hand, the facility was constructed in 1982; to build it today would cost upwards of $40 million, Hanks says — not the kind of money county governments typically like to throw around for autopsies. "Let’s face it," Hanks says, "this isn’t like a hospital where you can bill someone for your services. Here, you’re sort of on the negative end of things."
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