7.8 Management of deaths

7.8.1 Investigation of deaths

A death in a CTC or CTU must be recorded by the ward or on-call doctor or the facility coordinator as soon as possible.

All deaths must be investigated. This consists of a brief analysis of the individual patient file, treatment conditions and circumstances of death. This investigation should determine the probable cause of death and whether the death was avoidable or not (Section 8.4.8).

7.8.2 Registration of deaths

Anyone who arrives alive but dies in a treatment facility, even if the death occurs within minutes after arrival, even if the patient dies of a co-morbid condition (e.g. malaria), must be registered both as a case and as a death.
Individuals who die before having been brought to the treatment facility must not be registered as a death in the facility. They are reported separately as “community deaths”.
The CTC coordinator should check the number of deaths every day.

7.8.3 Preparation of corpses

Once the death has been recorded, the corpse should be transported to the morgue as quickly as possible. The corpse should not be prepared on the ward (and in all events, never in view of other patients).

The corpse should be washed with 2% chlorine solution, using a sponge. Sprayers should not be used to “disinfect” a corpse.

The corpse should be placed in a non-porous body bag with two disposable underpads (one placed under the head, the other under the buttocks) to absorb possible leaks through the mouth and anus. The bag is closed until burial or cremation that should be held as soon as possible.

If the corpse cannot be buried within 24 hours, natural orifices (i.e. mouth and anus5) can be plugged with cotton. This technique can limit the leak of excreta but should not be routinely used. The plugging of orifices should be carried out by health staff (usually auxiliary nurses) or specifically trained staff. It should be avoided if it is not essential or acceptable to the population or if staff has not been trained in this practice.

Staff preparing corpses should wear personal protective equipment (Section 7.5.3) and carefully wash their hands after this operation.