1. High Risk Autopsy Randal R. Nixon, MD PhD Oregon Health & Sciences Univ. Dept. of Pathology, Portland, OR Cleveland, OH - 6/23/04

2. Source Material

3. High Risk Autopsies Case Selection Permissions –Local –NPDSU (required for genetic testing) Precautions –Autopsy - BSL 2 –Tissue- BSL 3 Equipment Procedure Tissue Handling Shipping

4. High Risk Autopsies - Goals Limit Exposure –Respirator –Vacuum –Limited personnel Limit Contamination –Disposables –Shroud –Coverings –Dissection container –Dedicated tool set. Obtain diagnostic tissue

5. High Risk Autopsies - Equipment HEPA Respirator suit(Enviro-Safety Products) http://envirosafetyproducts.com HEPA Vacuum(Mar-Med Inc.) 1-440-572-5175 Disposables(Mopec) –Cutting board, large –Brain Knife –Headrest Plastic Tub Biohazard Bags

13. High Risk Autopsies - Decontamination Stainless steel –Autoclavable 1M NaOH 30’ –Non-autoclavable Immersible –1-2M NaOH, 1hr, RT Non-Immersible –1-2M Aluminum –Sodium hypochlorite (2% free chlorine) DO NOT AUTOCLAVE Liquid waste –1M NaOH –Autoclave 132°, 4.5hr Dry waste –Incineration –Autoclave 132°, 4.5hr

14. Tissue Processing Post-fixation Formic Acid –>95%, 1hr, RT with post-treatment formalin 48hr. Process as usual –Discard waste as biohazardous waste

15. Shipping Infectious substance,6.2UN1 fiberboard box602 Affecting humans2814X 10g (Prions, PrP-Sc) Dry Ice 9UN III10kg904 1845 OVERPACK USED Emergency contact: NAME / PHONE NUMBER Prior arrangements as required by the IATA Dangerous Goods Regulations 1.3.3.1 have been made.

16. Useful Websites CDC CJD –http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s7d.htm WHO TSE –http://www.who.int/emc-documents/tse/whocdscsraph2003c.html WHO Shipping –www.who.int/emc/pdfs/emc97_3.pdf HEPA Respirator –http://envirosafetyproducts.com