January 11, 2021

Re: MC on Procedures on Interment at MP sites without Crematorium as per DOH

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On Wed, Jan 6, 2021 at 7:15 PM Jorge Saguinsin <jorge.holygardens@gmail.com> wrote:
To:         All SBUs without crematorium who will handle interments at the Memorial Park

              Holy Gardens Oton
              Holy Gardens Calapan
              Holy  Gardens Calamba
              Holy Angels Memorial park
              Holy Gardens La Union

Subject:    MC on procedures to be followed for Covid19 dead at the  Memorial Park and Crematorium

Date:     January 7, 2021

Objectives:

      1.  To ensure safety of the memorial park for the  public at large and our staff
      2.  To prevent spread from our memorial park
      3.   To serve the memorial need of the population for covid19 while observing #1 and #2

Reality

     1.  Our interment last January 6 2021 belies our total understanding of the whole issue resulting in:

         1.  Losses from the discount on the covid premium charge
         2.  Unnecessary use of the lowering device which need not be used;

    2.  Our staff could not produce the procedures needed for the covid19 interment

General Principles:

     1. Recognition the main mode of transmission which is via the  drop infection;
     2.  That the most amount of viral load is in the person who died from covid19
     3.  That the  infection is deadly and is resurging due to lapses in enforcement of protocols
     4.  That there is premium charged for the covid 19 due to use of PPE and disinfectants
     5.  That covid19 being a communicable disease need disposal within 12 hours as per book xx1 and the IATF guidelines
     6.   Somebody must shoulder the cost of health protocol:  the govt, or the customer.  (No tawad shall be allowed.)  Health care is burden of every one.

Coverage

    1.  Transport and pick up
    2.  Transport
    3    At the funeral homes
    4.   At the crematorium
    5   At the cemetery and memorial park



Guidelines:

     A.   Pick up from the health care facility  (copy pasted)

          
               1. All healthcare personnel, support staff, and funeral parlor workers, among others, shall wear appropriate PPE before handling the human remains. 
               2. All tubes, drains, and catheters shall be removed with extreme caution and disposed of properly.
               3. Implants (e.g. pacemaker, orthopedic implants) in the cadaver   shall not be removed to minimize exposure of personnel handling the body. In this case, the body                        shall be buried instead of cremated. 
               4, Wound drainage and needle puncture holes shall be disinfected and dressed with impermeable material. 
               5. Wrap the body with cloth and place it in the airtight cadaver bag that is leak-proof and zip or close tightly with tapes and bandage strips. 
                 For patients with Islamic faith, double cadaver bag with thickness of not less than 150 pm shall be used. 
               6. Decontaminate surface of the bag with hypochlorite solution (50-100 ppm) or one-in-four diluted household bleach (mixing | part of 5.25% bleach with 4 parts of                              water).  (Zonrox)
              7. If the family of the patient wishes to view the body after removal from the isolation room or area, they may be allowed for as long as standard precautions are strictly                      followed.
              8. Ensure that the body is  fully sealed in an impermeable airtight cadaver bag before being removed from the isolation room or area and before transfer to mortuary or                    crematorium, to avoid leakage of body fluid. 
              9. Properly dispose the PPE used and wash hands  

2.   Transport to funeral home/crematorium


          1, The accredited/identified funeral establishment/crematorium shall provide proper transport. Otherwise, the concerned Local Government Unit (LGU)shall assist in                          securing the services of a funeral establishment which will transport the remains to the burial site/crematorium. 

          2.   The body shall be fully sealed in a cadaver bag and decontaminated as not to pose additional risk to the staff transporting the dead body. At no instance shall unzipping the cadaver bag of the body and removal of the body be permitted. 

          3.   Embalming and hygienic preparation, such as cleaning of the body, tidying of hair, trimming of nails and shaving shall not be allowed.

          4.    The personnel handling the body shall wear at the minimum a mask, gloves, water-resistant gown/apron, and goggles as protection if there be splashes. 

          5.   The vehicle used for transport shall be disinfected immediately following proper disinfection protocol. Dispose properly the PPE used and wash hands with liquid soap                    and water immediately.  

3.   Procedure at the Memorial Park cemetery 
        1, The procedures for burial and cremation shall be done within 12 hours after death. However, burial of remains should be in accordance with the person's religion and                    culturally-acceptable norms, to the most possible extent (e.g. in Islamic rites, cremation is forbidden or "haram"). 

         2.   The staff should practice hand hygiene, use of masks, gloves, goggles and water-resistant gown/apron as standard precautions. Transportation shall be provided by                   the  funeral home to the buria site.

         3,   Large gathering at the crematorium/ burial ground should be avoided.

        4.    For those that will be buried: 

             a. Only adult members of the family of the deceased may be permitted to attend the funeral;  (not more than 10;  walking processions not allowed

             b. Remains shall be placed in a durable, airtight and sealed metal casket. For patients with Islamic faith, as stated above, remains shall alternatively
                  be placed in double cadaver bag with thickness of not less than 150 um. 

            c. Remains shall not be taken to any place of public assembly and viewing of the deceased shall not be permitted.

           d.  Lowering device shall not be used for interment but rather linen cloth to be manually used by ISG in lowering the casket;  
                No member of the family should be withiin 100 meters of the interment site.

          e.  Interment should be conducted at night;

          f.   Use of apog - calcium carbonate.   (at least two bags)   https://en.wikipedia.org/wiki/Calcium_carbonate

             To help neutralize the microbes:

            1.  Pour on the casket inside the vault.  Place inside the vault.  Use one bag for the vault
            2.  Use the other bag to be mixed with soil being backfilled


         5.    Fort hose that will be cremated: 

            a. Cremains shall be reduced to the size of fine sand or ashes and packed in a cremains container before they are turned over to the relatives of the deceased; and

            b. Cremains shall be placed in a container with a minimum capacity of 0.0049 cubic meter and made of polyethylene provided with a liner bag (preformed 5 ml plastic),                      locking tie.

     4.  General protocol

        1.  Wear face mask and face shield
        2.  Physical distancing.   At least one meter    Not more than 10 in funeral wake and in procession. No walking in funeral procession
            a.   Do virtual mass or necrological services
            b.   Send flowers via delivery
           c.    Have on line obituaries and tributes.
        3.  PPE for the funeral cemetery  and crematorium.   Two PPE for cremation:   one in pick up and one in cremation
        4.  Hand washing.
        5.  Avoid contact with the cadaver.
        6.  Only authorized personnel inside the cremation room.  
        7.  Disinfect the hearse, the the pick up vehicle, every time 
        8  Regular antigen testing of the FS, cremation, and ISG staff 

   5.  What to have at SBU

      1.  Stocks of disposable PPE
      2.  Alcohol for hand washing
      3.  Potassium cholate (zonrox) 1:10 for disinfecting hearse, pick up vehicle, the crematorium  every after use.  
      4.  LInen cloth for lowering casket
      5.  At least 4 plastic waterproof cadaver bags.
      6.  Calcium carbonate (apog) for interment of covid19





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