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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 62-64

Perspectives on the construction of forensic autopsy laboratories designed to handle infectious diseases


1 Department of Forensic Pathology, Guangzhou Forensic Science Institute and Key Laboratory of Forensic Pathology, Ministry of Public Security, Guangzhou, China
2 Department of Forensic Science, Criminal Investigation Department, Ministry of Public Security, Beijing, China

Date of Submission12-Mar-2020
Date of Decision28-May-2020
Date of Acceptance05-Jun-2020
Date of Web Publication09-Jul-2020

Correspondence Address:
Yong Niu
Criminal Investigation Department, Ministry of Public Security, Beijing 100741
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_31_20

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  Abstract 


Coronavirus disease 2019 has already infected tens of thousands of people in China. The existing autopsy laboratories are not qualified to perform autopsies on individuals confirmed or suspected to have died from an infectious disease. When dealing with corpses with uncertain health conditions or unknown contact with a pathogen, the forensic medical practitioners face severe risks of being infected. To meet the requirements of performing autopsies on such bodies, ensure the health and safety of forensic medical practitioners, and study the pathophysiological changes of infected patients, it is necessary to improve the construction requirements and regulations for forensic autopsy laboratories.

Keywords: Autopsy laboratory, COVID-19, forensic pathology, infectious diseases


How to cite this article:
Zhao J, Niu Y. Perspectives on the construction of forensic autopsy laboratories designed to handle infectious diseases. J Forensic Sci Med 2020;6:62-4

How to cite this URL:
Zhao J, Niu Y. Perspectives on the construction of forensic autopsy laboratories designed to handle infectious diseases. J Forensic Sci Med [serial online] 2020 [cited 2020 Aug 10];6:62-4. Available from: http://www.jfsmonline.com/text.asp?2020/6/2/62/289282




  Introduction Top


Since the outbreak of the novel coronavirus (coronavirus disease 2019 [COVID-19]) at the end of 2019, more than 80,000 people have been diagnosed in China.[1] On January 20, 2020, the National Health Commission categorized COVID-19 as a highly contagious infectious disease and required application of the highest prevention standards. In addition to the long incubation period, which ranges from 1.3 to 11.3 days, and high infectivity of the novel coronavirus, the presence of many contagious patients with mild to no symptoms makes COVID-19 difficult to manage and control.[2],[3],[4]

Since death frequently occurs in COVID-19 patients, forensic practitioners of public security departments are currently facing severe risks of being infected while conducting body examinations and autopsies. This is of particular concern with unidentified bodies, as accurate health evaluations and contact history with possibly infected people remain unclear.[5] Corpses may also carry various infectious pathogens, including 2019-nCoV (severe acute respiratory syndrome [SARS]-CoV-2), HIV, Mycobacterium tuberculosis, plague bacillus, and many new infectious diseases such as SARS, Middle East respiratory syndrome, Ebola hemorrhagic fever, highly pathogenic avian influenza, and others.

The existing forensic autopsy laboratories of public security departments do not have the qualifications necessary for performing autopsies on bodies with confirmed or suspected infectious diseases, causing forensic practitioners to face a high risk of being infected. To ensure the safety of these practitioners, it is necessary to improve the conditions of forensic autopsy laboratories. In this article, we summarize the problems of the current autopsy laboratory design that have arisen since the start of the COVID-19 pandemic, review the relevant laws and laboratory biosafety level (BSL) requirements, and give some perspectives for future autopsy laboratory construction.


  Deficiencies of the Existing Autopsy Laboratory Design in the Public Security System of China Top


Recently, the public security departments around China have made some progress on increasing funding to improve forensic autopsies. Multiple autopsy laboratories have been constructed that qualify to hold activities of certain biological safety levels (P1-P4) according to local environmental and economic circumstances.[6] The work environment of forensic practitioners in these departments has been significantly improved, as have autopsy standards. However, the COVID-19 pandemic has exposed some remaining deficiencies. This public health crisis has not only prevented autopsy proceedings in both death and crime scene investigations but also obstructed pathological autopsies of infected bodies and interfered with the in-depth study of the pathological changes induced by possible future infectious diseases.[7],[8]

The COVID-19 pandemic has revealed the following deficiencies of the currently existing forensic autopsy laboratory model:

The partition setting is unable to effectively isolate the pathogens that cause infectious diseases

Most of the autopsy laboratories were designed with one autopsy table per room. Only some of the autopsy laboratories built within the past 10 years have a contaminated area with maintained negative pressure, a buffer zone, and a clean area, which are biosafety requirements for autopsies of bodies with an infectious disease. However, this is not sufficient to effectively isolate pathogens of infectious diseases from forensic practitioners during the autopsy.

Disinfection facilities are not qualified for elimination of the pathogens that cause infectious diseases

The existing autopsy laboratories are only equipped with ultraviolet disinfecting lamps, ultraviolet sterilization systems, disinfection cabinets, or other basic disinfection equipment. These are insufficient and incomplete for disinfection and removal of these pathogens. There are no standardized disinfection methods specifically designed to protect the forensic practitioners conducting the autopsies or to decontaminate the liquids and/or gases that are generated during autopsies on bodies with (or suspected to have) an infectious disease.

Design deficiencies of ventilation equipment could cause long-distance transmission of the pathogens that cause infectious diseases

The existing ventilation equipment in the current forensic laboratories is mainly designed to process gases, such as ammonia and hydrogen sulfide, which are produced by corpse putrefaction. The ventilation system adjusts the air volume according to the degree of indoor gas discharge to ensure indoor and outdoor air exchange. However, this system allows polluted gas to be directly discharged into the atmosphere. Moreover, all functional areas, including the contaminated area, buffer zone, and clean area, are lacking independent ventilation and air purification systems. This design deficiency could result in spreading of infectious pathogens through the ventilation ducts to the outside environment during the autopsy and even cause cross-contamination between functional areas.

Insufficient negative pressure in the laboratory could lead to infection of forensic practitioners

Most of the autopsy laboratories of public security departments do not have negative pressure. In fact, only a few newly built autopsy laboratories have negative pressure (−20 Pa), but this value is still higher than that suggested by the biological safety protection standards of highly infectious pathogens protection.[9] Actions performed during the autopsy, such as cutting, shearing, lifting, turning, sawing, and others, could lead to pathogenic microorganism aerosol formation and potentially infect the forensic practitioners.


  Prospects for Construction of Autopsy Laboratories during the Coronavirus Disease Pandemic Top


Laboratory construction requirements

Currently, there are no standards for the construction of autopsy laboratories that can sufficiently handle bodies of individuals who died of an infectious disease. To ensure the safety of forensic practitioners performing autopsies during the COVID-19 pandemic and to prevent any infection by a pathogenic microorganism, it is necessary to meet the biosafety requirements of infectious disease protection by constructing appropriate autopsy laboratories.[9]

To address the hazards associated with infectivity, public security departments should construct P2 level autopsy laboratories that are equivalent to P3 level laboratories (BSL-3). These laboratories should meet the autopsy requirements for the most highly contagious infectious diseases and suspected infected cases. P2 level autopsy laboratories have special requirements for floor layout, maintenance structure, ventilation and air conditioning systems, water and air supply systems, sewage disposal, and disinfection systems.[10] The personal safety of the forensic practitioners and quality of the autopsy work need to be ensured by preventing the spread of any pathogens. Each functional area of the laboratory must maintain a specific negative pressure and suction gradient to ensure no leakage or reflux of contaminated air, which should only be discharged after being decontaminated.

Management requirements

A reasonable scientific management system needs to be established to guarantee the laboratory safety. It is necessary to formulate a biological safety management system for autopsy laboratories that conform to the typical habits of forensic practitioners from public security departments. Operations in P2 level autopsy laboratories should be regulated by a standardized process that is strictly followed by forensic practitioners to minimize their risk of occupational exposure. Occupational protection rules and risk prevention monitoring systems must be integrated into regular employee training procedures to reduce potential hazards.[11]

In addition, a biosafety response emergency plan should be included in the management system. The emergency response plan should provide an efficient guidance for the control and prevention of any biological safety accidents such as the leak of an infectious microorganism.

Laboratory construction mode

Construction of P2 level autopsy laboratories will play a critical role in the development of forensic medicine in China. All cities in China develop different construction plans based on their own specific needs. If no autopsy laboratory currently exists, the city should consider adding P2 level autopsy laboratory equipment to the new construction plan. In addition, a reconstruction plan should be considered if the existing autopsy laboratory has sufficient space and functional areas.

Most importantly, autopsy laboratory construction should be associated with hospitals, medical schools, and research institutions. An autopsy of a patient who has died from a confirmed or suspected infectious disease is not only an important task for the public security department but also is of great significance to the in-depth study of unfamiliar infectious diseases, especially related to the discovery of pathological and physiological changes induced by diseases.[12] Hospitals, medical schools, and research institutions should share the construction costs and use these facilities to perform autopsies and/or research on infectious diseases. Since the bodies of patients with a confirmed or suspected infectious disease cannot be transported over long distances, cities should coordinate their construction plans to make full use of limited resources.


  Conclusions Top


Forensic examinations play a critical role in fighting crime and ensuring justice in public security. The pathological and physiological changes of new infectious diseases also provide a scientific basis for the clinical diagnosis and treatment of these diseases through autopsies. When facing a new infectious disease, such as COVID-19, autopsies can also be used to assess the pathophysiological changes that occur in patients infected by pathogens. Autopsies of patients who died from an infectious disease have been a key part of the response to outbreaks such as SARS and COVID-19.[7],[8]

Although the regulations of autopsies of patients with a confirmed or suspected infectious disease (Order No. 43 of the Ministry of Public Health) have been implemented since 2005,[13] no fully qualified infectious disease autopsy laboratory currently exists in China. Because of an equipment deficiency, forensic practitioners cannot carry out their work in a timely or effective manner when encountering an infected case. This is already not only an obstruction for death investigations by public security departments but also for the diagnosis and treatment of patients with infectious diseases by clinical medical practitioners.

Therefore, because of the continual emergence of new infectious diseases such as COVID-19, it is extremely necessary to establish an autopsy laboratory that meets the requirements of the examination of patients with a confirmed or suspected infectious disease in accordance with the relevant BSL.

Acknowledgments

The authors gratefully thank Ms. Ye Xue for their assistance in preparing the manuscript. Funding support came from Grant-in Aids for Scientific Research from Ministry of Public Security of the People's Republic of China (2019SSGG0403) and a grant from the Guangzhou Municipal Science and Technology Project (2019030001; 2019030012). This article was released in Chinese language in Chinese Journal of Forensic Medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
COVID-19 Pandemic Real-Time Report. Available from: http://fms.news.cn/swf/2020_sjxw/2_1_xgyq/index.html. [Last accessed on 2020 Mar 08].  Back to cited text no. 1
    
2.
COVID-19 Prevention Expert Group of Chinese Preventive Medicine Association. An update on the epidemiological characteristics of novel coronavirus pneumonia. Chin J Epidenmiol 2020;41:139-44.  Back to cited text no. 2
    
3.
General Office of National Health Commission of the People's epublic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of corona virus disease-19 (7th trial edition). China Med 2020;15:801-5.  Back to cited text no. 3
    
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Yu P, Zhu J, Zhang Z, Han Y. A familial cluster of infection associated with the 2019 novel corona-virus indicating potential person-to-person transmission during the incubation period. J Infect Dis 2020;221:1757-61.  Back to cited text no. 4
    
5.
Pang HB, Xu LM, Niu Y. Protection of forensic practitioners in crime scene investigation during the COVID-19 epidemic. Chin J Forensic Med 2020;36:29-34.  Back to cited text no. 5
    
6.
The Ministry of Public Security of the People's Republic of China. GA/T 830-2009, Construction Standard for Autopsy Laboratory. Beijing: Standards Press of China; 2009.  Back to cited text no. 6
    
7.
Wang H, Ding Y, Li X, Yang L, Zhang W, Kang W. Fatal aspergillosis in a patient with SARS who was treated with corticosteroids. N Engl J Med 2003;349:507-8.  Back to cited text no. 7
    
8.
Liu Q, Wang RS, Qu RS, Wang YY, Liu P, Zhu YZ, et al. Case report: Forensic examination of COVID-19 induced death.[J]. Chinese Journal of Forensic Medicine 2020,36:19-21.  Back to cited text no. 8
    
9.
National Health and Family Planning Commission of PRC. WS 233-2017, General Standard for Causative Bacteria Laboratories. Beijing: Standards Press of China; 2017.  Back to cited text no. 9
    
10.
Zhao HQ, Sun QY, Sun XM, Jiao HX. Principles, requirements and quality control of P3 level laboratory construction. Chinese Journal of Public Health Management 2002;18:561-2.  Back to cited text no. 10
    
11.
Zhang YF, Fang XX, Zhao RL. The hidden dangers and countermeasures of Medical Graduate Laboratories in University. Med Edu Res Pract 2019;27:593-6.  Back to cited text no. 11
    
12.
Cong B. Academician Bin Cong: Novel coronavirus infection id needed to strengthen autopsy. Chin J Forensic Med 2020;36:4-5.  Back to cited text no. 12
    
13.
Regulations of autopsies of patients with a confirmed or suspected infectious disease (Order No. 43 of the Ministry of Public Health). The Journal of Law and Medicine 2005;04:240.  Back to cited text no. 13
    




 

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