Formaldehyde. It’s not a four-letter word, but it is certainly can be toxic. It is also necessary in a prep room. But with good operational protocols and properly-designed prep rooms, formaldehyde and other hazardous chemicals are quite manageable. Let’s take a closer look at prep room safety and why every funeral home owner, manager, embalmer and even employees not normally in a prep room must be cognizant of it.

First, to understand the gravity of protection when working with formaldehyde and other hazardous chemicals, various studies link such chemicals to diseases if proper protection is not used in the prep room. This article outlines several good safety practices that minimize exposure.
The three areas of concern are:
1) Air Quality – important with regards to cancer
2) Personal Protective Equipment (PPE) – important to prevent infection and disease
3) Disinfection – important in prevention of infection

Effective ventilation is critical in reducing exposure to vapors in the prep room. With the average exposure per embalming of 9 parts per million (ppm), it is critical for every funeral home to have a respiratory protection plan in place. Short-term exposures to formaldehyde gas can cause eye, nose and throat irritation at levels up to 5 ppm. At levels from 10 to 20 ppm, it causes coughing, chest tightness, and unusual heartbeat. From 50 to 100 ppm, fluid on the lungs precedes death. A protection protocol absolutely must include periodic testing of air quality. Among the factors that might accelerate air quality testing are an increase in the number of embalmed cases or renovation of the funeral home.

Personal protective equipment absolutes are gloves, gowns, eye protection, and face masks/respirators. There are several options with gloves and depending on the task, it is good to have different types of gloves and sizes. Types include latex, vinyl and nitrile, with nitrile being the best option for embalming based on its ability to better resist chemicals and be less prone to breakage and needle sticks. Also, be sure that all staff members double-glove during embalming.

Eye protection seems to be ignored by some embalmers, which is really asking for trouble…for them and for the funeral home management. If during embalming you ever had a hose blow off the cannula or had an aspirator backup, you know that your hands will not be able to completely stop the spray. I have personally observed embalmers raising vessels with their face extremely close – they are just asking for a blood spray. Bottom-line: everyone should wear safety eye shields.

When is a face mask not a face mask? When it is dangling around a chin or shoved on top of a head…another reality that is commonly observed. Face masks need to be on the embalmer’s face – period. There are several different types, but not all are similarly effective. The dust mask, or filtering face piece, is a simple, two-strap disposable mask that is designed only for dust. While not as protective as respirators, they at least are adequate in many cases, but not if the dust is really toxic. Half-face air-purifying respirators cover just the nose and mouth and have removable cartridges that filter out either dust, chemicals, or both. Selecting the correct cartridge is essential since they are designed for particular types of chemicals or dust. A reputable respirator vendor can assist in selecting the correct cartridges. A full-face air-purifying respirator may be desirable when the air contaminant irritates the eyes. These respirators also provide somewhat higher protection to the lungs since they tend to fit tighter and are less prone to leakage. Just like the half-face respirators, full-face respirators have replaceable cartridges that must be changed on a regular basis.

My best PPE advice? Treat every person as if they were infectious. Too many embalmers are only using PPE when they think the individual is infectious but you really never know. We see PPE sales spike during times such as the Ebola outbreak but proper PPE should always be used. The suggested minimum PPE is:

• Gloves (double glove)
• Face Shield
• Face Mask
• Full Gown
• Shoe Covers

Earlier I stated that all staff should be cognizant of safety protocol and using personal protective equipment is a great example of application beyond the embalmers. For example, gloves should be used when casketing or dressing the body, since you never know what small micro-organisms could be alive on the table or the back of the person. Face shields are a simple way to protect against unknown chemicals or unexpected blood sprays. Shoe covers prevent tracking of toxins across the carpet or even bringing them into employees’ homes, inadvertently endangering family members and pets.

There are other sometimes-ignored paths to toxic exposure in a funeral home, but all can be addressed with simple measures:
• Always add embalming fluid to water instead of the other way around. Adding water to embalming fluid activates the fluid and releases micro air particles that significantly spikes the amount of formaldehyde in the air.

• Always use drain tubes, an inexpensive way to reduce potential exposure to blood.

• Always be careful when carrying fluid bottles, especially when gloves are wet – dropped bottles are both messy and release a very high level of formaldehyde.

• Slow down when removing diapers from a deceased as pulling one off too quickly can risk exposure of small, potentially infectious air particles.

It may go without saying, but I’ll say it anyway because it is so important: keep the prep room clean and safe. Here are some keys to a safe work space:

• Shapes containers

• No eating or drinking in prep room

• Clean the prep room often, using proper products

• Use drain tubes

• Use safe lifting methods and always ask for help

• Treat all body fluids as infectious

• Use PPE

• Treat all laundry as infectious

• Wash hands often

• Have proper and legible signage and labels

• Avoid needle sticks and cuts (needle sticks are the
number one on-the-job injury)

• Make sure employees are vaccinated for Hepatitis B

Speaking of Hepatitis B, other infectious diseases to be aware of include Hepatitis C, Ebola, HIV and Tuberculosis (which can live up to 36 days after death). One small precaution is ensuring your disinfectants are quality products designed to kill bacteria.

Finally, be sure that all employees are aware of and practice safe lifting. A number of challenges face funeral home employees, from morgue removals to cremations, and even shortage of staff and an aging staff. There are many potential areas that could lead to heavy or awkward lifting, including removals from high shelves and pushing or pulling bodies. Overhead lifts are a wise investment, particularly as many are short-staffed.

Whether in the prep room or outside of it, safety is everyone’s concern. But it begins – and ends – with ownership. FBA

Lance Ray is Chief Operating Officer and Executive Vice President for Pierce Chemical, a Wilbert Group organization based in Dallas, Texas. His experience as a licensed funeral director and embalmer provides Ray with a user’s perspective of the products offered by Pierce, including fluids, embalming machines, instruments, cosmetics and other prep room supplies. Prior to joining Pierce in 2014, Ray had spent twenty years in funeral service and working within the Wilbert Funeral Services organization. Lance Ray can be reached at [email protected]