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Radiation dose and diagnostic image quality associated with iterative reconstruction in coronary CT angiography: A systematic review

Abdullah KA, McEntee MF, Reed W, Kench PL

J Med Imaging Radiat Oncol, 2016 Aug;60(4):459-68.
PMID: 27241506 DOI: 10.1111/1754-9485.12473

The aim of this systematic review is to evaluate the radiation dose reduction achieved using iterative reconstruction (IR) compared to filtered back projection (FBP) in coronary CT angiography (CCTA) and assess the impact on diagnostic image quality. A systematic search of seven electronic databases was performed to identify all studies using a developed keywords strategy. A total of 14 studies met the criteria and were included in a review analysis. The results showed that there was a significant reduction in radiation dose when using IR compared to FBP (P 0.05). The mean ± SD difference of image noise, signal-noise ratio (SNR) and contrast-noise ratio (CNR) were 1.05 ± 1.29 HU, 0.88 ± 0.56 and 0.63 ± 1.83 respectively. The mean ± SD percentages of overall image quality scores were 71.79 ± 12.29% (FBP) and 67.31 ± 22.96% (IR). The mean ± SD percentages of coronary segment analysis were 95.43 ± 2.57% (FBP) and 97.19 ± 2.62% (IR). In conclusion, this review analysis shows that CCTA with the use of IR leads to a significant reduction in radiation dose as compared to the use of FBP. Diagnostic image quality of IR at reduced dose (30-41%) is comparable to FBP at standard dose in the diagnosis of CAD.

Matched MeSH terms: Occupational Exposure/prevention & control
Use of asbestos building materials in Malaysia: legislative measures, the management, and recommendations for a ban on use

Safitri Zen I, Ahamad R, Gopal Rampal K, Omar W

Int J Occup Environ Health, 2013 Jul-Sep;19(3):169-78.
PMID: 23885771 DOI: 10.1179/2049396713Y.0000000028

Malaysia has partially banned the use of asbestos. The prohibition of asbestos building materials in schools, clinics, and hospitals built by government started in 1999. Since 2005, prohibition has also been applied to all government buildings. However, asbestos construction materials such as roof and ceiling tiles are still sold in the market. There are no acts or regulations prohibiting the use of asbestos in private buildings in Malaysia. Asbestos was first used for industrial purposes in Malaysia in the 1960s and the first regulations related to asbestos have been around since the 1980s. Non-governmental organizations have been pushing the government to impose a total ban since the 1980s. Asbestos is still used in the manufacturing sector under the "control use" concept. The study found difficulties in established and validated medical record data on asbestos-related diseases. This paper reviews existing asbestos-related regulations and guidelines in Malaysia and discusses the urgency for a total ban in the use of asbestos in building materials in the country. In the meanwhile, stricter enforcement of occupational safety and health regulations related to the use and exposure of asbestos among workers in the manufacturing, construction, maintenance, and demolition sectors has been in place.

Matched MeSH terms: Occupational Exposure/prevention & control*
Gaining competitive advantage in personal dosimetry services through ISO 9001 certification

Noriah MA

Radiat Prot Dosimetry, 2007;125(1-4):101-4.
PMID: 17145724

This paper discusses the advantage of certification process in the quality assurance of individual dose monitoring in Malaysia. The demand by customers and the regulatory authority for a higher degree of quality service requires a switch in emphasis from a technically focused quality assurance program to a comprehensive quality management for service provision. Achieving the ISO 9001:2000 certification by an accredited third party demonstrates acceptable recognition and documents the fact that the methods used are capable of generating results that satisfy the performance criteria of the certification program. It also offers a proof of the commitment to quality and, as a benchmark, allows measurement of the progress for continual improvement of service performance.

Matched MeSH terms: Occupational Exposure/prevention & control
Fulltext Farmers and formulations--rural health perspective

Rathinam X, Kota R, Thiyagar N

Med J Malaysia, 2005 Mar;60(1):118-24; quiz 125.
PMID: 16250298

Conventional farming demands excessive use of chemicals in the form of synthetic fertilizers and pesticides, confirming to the norms of Green Revolution. Farmers in general, specifically in the developing countries resort to injudicious and excessive use of pesticides which is linked to the illiteracy and poverty of the rural farming community. Their overriding concern for profitable agriculture, has rendered the health of the farmers at a greater risk of developing dreadful maladies including various type of cancers, reproductive disorders, respiratory, dermal, and neuropsychological problems etc. The possible means of reducing the health risks are discussed, including the global effort to regulate the manufacture, transport and use of highly toxic pesticides. Slow and programmed transition to alternative agriculture and strengthening of farmers' knowledge on health, ecosystem and environment will prove effective.

Matched MeSH terms: Occupational Exposure/prevention & control
Fulltext Supporting Role of Society and Firms to COVID-19 Management among Medical Practitioners

Zandi G, Shahzad I, Farrukh M, Kot S

Int J Environ Res Public Health, 2020 10 29;17(21).
PMID: 33138254 DOI: 10.3390/ijerph17217961

Measurement of job stress and employees' commitment are few of the admired topics in the corporate world amongst business writers. With a principal aim to trial the blow of exposure to COVID-19 patients on doctors' job stress and commitment, in Pakistan; data have been collected through 7-10 min telephonic interview from voluntary participants and a sample of 129 responses were analyzed by Structure Equation Modeling-Partial Least Square (SEM-PLS) path modeling through Smart PLS 3.2. The results of the study indicated; direct positive & significant impact of Extent of Exposure on Job Stress while direct negative, significant association with Commitment. Job Stress also observed having direct negative impact on commitment. The Extent of Exposure-Job Stress relationship was also found stronger among group of doctors having Low level of Perceived Organizational Support and weaker among group of doctors having High level of Perceive Organizational support. Perceived Organizational Support showed a moderating effect on the Extent of Exposure-Job Stress relationship; while, Social Support showed no moderation. Researchers are required to investigate more and management of the medical services providers (both hospitals and government) needs to focus on doctors' perception about Organizational Support, as doctors show no concern about the support from society as long as their well-being is cared for by respective hospitals. This study is an effort to stimulate more empirical evidence towards the treating and handling of COVID-19 patients and the psychological well-being of doctors.

Matched MeSH terms: Occupational Exposure/prevention & control
The handling of safety concerns among anaesthetists when restarting full surgical lists during the COVID-19 pandemic

Loh PS, Shariffuddin II, Chaw SH, Mansor M

Med J Malaysia, 2021 01;76(1):98-100.
PMID: 33510117

Around June 2020, many institutions restarted full operating schedules to clear the backlog of postponed surgeries because of the first wave in the COVID-19 pandemic. In an online survey distributed among anaesthestists in Asian countries at that time, most of them described their safety concerns and recommendations related to the supply of personal protective equipment and its usage. The second concern was related to pre-operative screening for all elective surgical cases and its related issues. The new norm in practice was found to be non-standardized and involved untested devices or workflow that have since been phased out with growing evidence. Subsequent months after reinstating full elective surgeries tested the ability of many hospitals in handling the workload of non-COVID surgical cases together with rising COVID-19 positive cases in the second and third waves when stay-at-home orders eased.

Matched MeSH terms: Occupational Exposure/prevention & control*
Fulltext Organophosphorus pesticide exposure in agriculture: effects of temperature, ultraviolet light and abrasion on PVC gloves

Ismail I, Gaskin S, Pisaniello D, Edwards JW

Ind Health, 2018 Apr 07;56(2):166-170.
PMID: 29199264 DOI: 10.2486/indhealth.2017-0157

Elbow length PVC gloves are often recommended for protection against organophosphorus pesticide (OP) exposure in agriculture. However, performance may be reduced due to high temperature, UV exposure and abrasion. We sought to assess these impacts for two OPs under normal use and reasonable worst-case scenarios. Glove permeation tests were conducted using ASTM cells with two PVC glove brands at 23°C and 45°C for up to 8 h. Technical grade dichlorvos and formulated diazinon were used undiluted and at application strength. Breakthough of undiluted dichlorvos occurred at both 23°C and 45°C, but only at 45°C for application strength. Breakthrough of diazinon was not achieved, except when undiluted at 45°C. UV-exposed and abraded gloves showed reduced performance, with the effect being approximately two-fold for dichlorvos. Only small differences were noted between glove brands. Extra precautions should be taken when handling concentrated OPs at high temperature, or when using abraded or sunlight-exposed gloves.

Matched MeSH terms: Occupational Exposure/prevention & control
RESULTS OF THE JOINT IAEA/ARPANSA INTERCOMPARISON EXERCISE ON WHOLE BODY DOSEMETERS FOR PHOTONS IN ASIA AND THE PACIFIC REGION

Rizk C, Long S, Okyar HB, Baradaran S, Al Fares E, Sangau JK, et al.

Radiat Prot Dosimetry, 2019 Dec 31;187(4):418-425.
PMID: 31605130 DOI: 10.1093/rpd/ncz182

An intercomparison exercise (IC) on whole body dosemeters to determine the quantity personal dose equivalent Hp (10) in photon radiation fields was jointly organised and conducted by the International Atomic Energy Agency (IAEA) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) for individual monitoring services (IMS) in Asia and the Pacific region. This was arranged to help the IMS in the region to achieve a more accurate dosimetry service and to improve their performance. Twenty-four IMS participated in this IC. Four sets of dosemeters were irradiated using X-ray and gamma radiation qualities at 0° and 20° angle of incidence, respectively. All the IMS provided results that were within the acceptable limits defined by the IAEA. However, only a minority of participants reported confidence intervals that included the reference dose, for each exposure scenario. For few systems, the overall performance could be significantly improved by reviewing calibration procedures.

Matched MeSH terms: Occupational Exposure/prevention & control
Fulltext Management of accidental laboratory exposure to Burkholderia pseudomallei and B. mallei

Peacock SJ, Schweizer HP, Dance DA, Smith TL, Gee JE, Wuthiekanun V, et al.

Emerg Infect Dis, 2008 Jul;14(7):e2.
PMID: 18598617 DOI: 10.3201/eid1407.071501

The gram-negative bacillus Burkholderia pseudomallei is a saprophyte and the cause of melioidosis. Natural infection is most commonly reported in northeast Thailand and northern Australia but also occurs in other parts of Asia, South America, and the Caribbean. Melioidosis develops after bacterial inoculation or inhalation, often in relation to occupational exposure in areas where the disease is endemic. Clinical infection has a peak incidence between the fourth and fifth decades; with diabetes mellitus, excess alcohol consumption, chronic renal failure, and chronic lung disease acting as independent risk factors. Most affected adults ( approximately 80%) in northeast Thailand, northern Australia, and Malaysia have >/=1 underlying diseases. Symptoms of melioidosis may be exhibited many years after exposure, commonly in association with an alteration in immune status. Manifestations of disease are extremely broad ranging and form a spectrum from rapidly life-threatening sepsis to chronic low-grade infection. A common clinical picture is that of sepsis associated with bacterial dissemination to distant sites, frequently causing concomitant pneumonia and liver and splenic abscesses. Infection may also occur in bone, joints, skin, soft tissue, or the prostate. The clinical symptoms of melioidosis mimic those of many other diseases; thus, differentiating between melioidosis and other acute and chronic bacterial infections, including tuberculosis, is often impossible. Confirmation of the diagnosis relies on good practices for specimen collection, laboratory culture, and isolation of B. pseudomallei. The overall mortality rate of infected persons is 50% in northeast Thailand (35% in children) and 19% in Australia.

Matched MeSH terms: Occupational Exposure/prevention & control*
Interventional cardiologists and risk of radiation-induced cataract: results of a French multicenter observational study

Jacob S, Boveda S, Bar O, Brézin A, Maccia C, Laurier D, et al.

Int J Cardiol, 2013 Sep 1;167(5):1843-7.
PMID: 22608271 DOI: 10.1016/j.ijcard.2012.04.124

Interventional cardiologists (ICs) are exposed to X-rays and may be at risk to develop cataract earlier than common senile cataract. Excess risk of posterior subcapsular cataract, known as radiation-induced, was previously observed in samples of ICs from Malaysia, and Latin America. The O'CLOC study (Occupational Cataracts and Lens Opacities in interventional Cardiology) was performed to quantify the risk at the scale of France.

Matched MeSH terms: Occupational Exposure/prevention & control*
Occupational disease among non-governmental employees in Malaysia: 2002-2006

Abas AB, Said AR, Mohammed MA, Sathiakumar N

Int J Occup Environ Health, 2008 Oct-Dec;14(4):263-71.
PMID: 19043913

In the absence of systematic occupational disease surveillance, other data collected by governmental agencies or industry is useful in the identification of occupational diseases and their control. We examined data on occupational diseases reported by non-governmental employees to the national workers' social security organization in Malaysia, 2002-2006. The overall incidence rate of occupational disease was 2.8 per 100,000 workers. There was an increase in the annual number and rates of occupational disease over time. The most frequently reported conditions were hearing impairment (32%) and musculoskeletal disorders (28%). Workers in the non-metallic manufacturing industry had the highest average incidence rate of hearing impairment (12.7 per 100,000 workers) and musculoskeletal disorders (3.5 per 100,000 workers), compared to all other industries. Preventive measures should focus on safety education, engineering control and workplace ergonomics. Enforcing workplace standards and incorporating an ongoing surveillance system will facilitate the control and reduction of occupational disease.

Matched MeSH terms: Occupational Exposure/prevention & control
Fulltext Hepatitis B immunisation status among health care workers in two Kuala Lumpur hospitals

Hesham R, Zamberi S, Tajunisah ME, Ariza A, Ilina I

Med J Malaysia, 2005 Oct;60(4):407-10.
PMID: 16570700

Health care workers (HCW) are at higher risk of acquiring blood borne infections such as hepatitis B virus, hepatitis C virus and human immunodeficiency virus from patients. To minimise exposure, Universal Precautions Policy guidelines were introduced. This study looked into one of the aspects of hepatitis B prevention among HCW in the Malaysian context. The objective of this study was to assess hepatitis B vaccine coverage among HCW. A cross sectional study involving pre-tested questionnaires was undertaken from February 2001 to August 2001. Hospital staff in Hospital Kuala Lumpur and Hospital Universiti Kebangsaan Malaysia as well as undergraduate students undergoing clinical attachments were randomly chosen. A total of 625 subjects were enrolled. Only 58.4% had taken a complete hepatitis B vaccination. However, 82.2% have taken at least one dose of the hepatitis B vaccine and were supposed to complete the schedule in due course. Not all HCW were protected against hepatitis B. Preventing hepatitis B in HCW should be one of the priorities of the hospital management as it is definitely cheaper than managing chronic hepatitis B cases.

Matched MeSH terms: Occupational Exposure/prevention & control*
Fulltext The prevalence of, and factors related to, compliance with glove utilization among nurses in Hospital Universiti Sains Malaysia

Naing L, Nordin R, Musa R

Southeast Asian J. Trop. Med. Public Health, 2001 Sep;32(3):636-42.
PMID: 11944730

Increasing risk of HIV infections among health care workers has been a continuing concern. The study was designed to identify the compliance of glove utilization, and factors related to non-compliance. A sample of 150 staff nurses were recruited from the study population of 550 nurses in Hospital Universiti Sains Malaysia. Data were collected by using a structured self-administered questionnaires. The response rate was 98.4%. The study revealed a low compliance (13.5%) of glove utilization (for all 9 procedures), which varied among different procedures (27-97%). Younger nurses and those with shorter duration of working experience had better knowledge of Universal Precautions. Nurses in intensive care unit and operation theatre were better in both knowledge and compliance of glove utilization. The three commonest misconceptions were identified as "selective use of gloves for high risk groups and suspected cases", and "tendency to depend on HIV prevalence". Nurses reported practical problems including administrative and personal related such as "stock irregularity" (46%), "glove not available at the emergency sites" (44%), and "reduction of tactile sensation" (39%). It was concluded that poor knowledge and practical problems were possible responsible factors for the low compliance. A good training for nurses comprising principle and practice of Universal Precautions, updated knowledge of blood and body fluid borne infections and risk and its management, will probably improve the compliance.

Matched MeSH terms: Occupational Exposure/prevention & control
Fulltext Cross-continental comparison of safety and protection measures amongst urologists during COVID-19

de la Rosette J, Laguna P, Álvarez-Maestro M, Eto M, Mochtar CA, Albayrak S, et al.

Int J Urol, 2020 11;27(11):981-989.
PMID: 32772434 DOI: 10.1111/iju.14340

OBJECTIVES: To determine the well-being of urologists worldwide during the coronavirus disease 2019 pandemic, and whether they have adequate personal protective equipment knowledge and supplies appropriate to their clinical setting.
METHODS: Urologists worldwide completed a Société Internationale d'Urologie online survey from 16 April 2020 until 1 May 2020. Analysis was carried out to evaluate their knowledge about protecting themselves and others in the workplace, including their confidence in their ability to remain safe at work, and any regional differences.
RESULTS: There were 3488 respondents from 109 countries. Urologists who stated they were moderately comfortable that their work environment offers good protection against coronavirus disease 2019 showed a total mean satisfaction level of 5.99 (on a "0 = not at all" to "10 = very" scale). A large majority (86.33%) were confident about protecting themselves from coronavirus disease 2019 at work. However, only about one-third reported their institution provided the required personal protective equipment (35.78%), and nearly half indicated their hospital has or had limited personal protective equipment availability (48.08%). Worldwide, a large majority of respondents answered affirmatively for testing the healthcare team (83.09%). Approximately half of the respondents (52.85%) across all regions indicated that all surgical team members face an equal risk of contracting coronavirus disease 2019 (52.85%). Nearly one-third of respondents reported that they had experienced social avoidance (28.97%).
CONCLUSIONS: Our results show that urologists lack up-to-date knowledge of preferred protocols for personal protective equipment selection and use, social distancing, and coronavirus disease 2019 testing. These data can provide insights into functional domains from which other specialties could also benefit.

Matched MeSH terms: Occupational Exposure/prevention & control*
Fulltext COVID-19 in Malaysia: exposure assessment and prevention practices among healthcare workers at a teaching hospital

Muhammad Azami NA, Abdul Murad NA, Mohammed Nawi A, Salleh SA, Periyasamy P, Kori N, et al.

J Infect Dev Ctries, 2021 12 31;15(12):1816-1824.
PMID: 35044938 DOI: 10.3855/jidc.15277

INTRODUCTION: During the second wave of the coronavirus disease 19 (COVID-19) pandemic, Malaysia reported several COVID-19 clusters related to healthcare workers. Thus, addressing and understanding the risk of exposure in healthcare workers is important to prevent future infection and reduce secondary COVID-19 transmission within the healthcare settings. In this study, we aim to assess exposure and prevention practices against COVID-19 among healthcare workers at the Hospital Canselor Tuanku Muhriz, a university teaching hospital based in Kuala Lumpur, Malaysia.
METHODOLOGY: A total of 571 healthcare workers at COVID-19 and non-COVID-19 wards as well as the emergency department and laboratory staff at COVID-19 testing labs were recruited. The presence of novel human coronavirus (SARS-CoV-2) and IgM/IgG antibodies were confirmed in all healthcare workers. The healthcare workers responded to an online Google Forms questionnaire that evaluates demographic information and comorbidities, exposure and adherence to infection prevention and control measures against COVID-19. Descriptive analysis was performed using Statistical Package for the Social Sciences 24.0.
RESULTS: Three healthcare workers (0.5%) tested positive for SARS-CoV-2, while the remaining 568 (99.5%) were negative. All were negative for IgM and IgG antibodies during recruitment (day 1) and follow-up (day 15). More than 90% of the healthcare workers followed infection prevention and control practices recommendations regardless of whether they have been exposed to occupational risk for COVID-19.
CONCLUSIONS: The healthcare workers' high level of adherence to infection prevention practices at this hospital helped reduce and minimize their occupational exposure to COVID-19.

Matched MeSH terms: Occupational Exposure/prevention & control*
Fulltext Recommendations for Essential Esophageal Physiologic Testing During the COVID-19 Pandemic

Lee YY, Bredenoord AJ, Gyawali CP

Clin Gastroenterol Hepatol, 2020 Aug;18(9):1906-1908.
PMID: 32371164 DOI: 10.1016/j.cgh.2020.04.075
Matched MeSH terms: Occupational Exposure/prevention & control
Improving safety-related knowledge, attitude and practices of nurses handling cytotoxic anticancer drug: pharmacists' experience in a general hospital, Malaysia

Keat CH, Sooaid NS, Yun CY, Sriraman M

Asian Pac J Cancer Prev, 2013;14(1):69-73.
PMID: 23534806

BACKGROUND: An increasing trend of cytotoxic drug use, mainly in cancer treatment, has increased the occupational exposure among the nurses. This study aimed to assess the change of nurses' safety-related knowledge as well as attitude levels and subsequently to assess the change of cytotoxic drug handling practices in wards after a series of pharmacist-based interventions.
MATERIALS AND METHODS: This prospective interventional study with a before and after design requested a single group of 96 nurses in 15 wards actively providing chemotherapy to answer a self-administered questionnaire. A performance checklist was then used to determine the compliance of all these wards with the recommended safety measures. The first and second assessments took 2 months respectively with a 9-month intervention period. Pharmacist-based interventions included a series of technical, educational and administrative support measures consisting of the initiation of closed-system cytotoxic drug reconstitution (CDR) services, courses, training workshops and guideline updates.
RESULTS: The mean age of nurses was 32.2∓6.19 years. Most of them were female (93.8%) and married (72.9%). The mean knowledge score of nurses was significantly increased from 45.5∓10.52 to 73.4∓8.88 out of 100 (p<0.001) at the end of the second assessment. Overall, the mean practice score among the wards was improved from 7.6∓5.51 to 15.3∓2.55 out of 20 (p<0.001).
CONCLUSIONS: The pharmacist-based interventions improved the knowledge, attitude and safe practices of nurses in cytotoxic drug handling. Further assessment may help to confirm the sustainability of the improved practices.

Matched MeSH terms: Occupational Exposure/prevention & control*
Analysis of the comprehensibility of chemical hazard communication tools at the industrial workplace

Ta GC, Mokhtar MB, Mohd Mokhtar HA, Ismail AB, Abu Yazid MF

Ind Health, 2010;48(6):835-44.
PMID: 20616463

Chemical classification and labelling systems may be roughly similar from one country to another but there are significant differences too. In order to harmonize various chemical classification systems and ultimately provide consistent chemical hazard communication tools worldwide, the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) was endorsed by the United Nations Economic and Social Council (ECOSOC). Several countries, including Japan, Taiwan, Korea and Malaysia, are now in the process of implementing GHS. It is essential to ascertain the comprehensibility of chemical hazard communication tools that are described in the GHS documents, namely the chemical labels and Safety Data Sheets (SDS). Comprehensibility Testing (CT) was carried out with a mixed group of industrial workers in Malaysia (n=150) and factors that influence the comprehensibility were analysed using one-way ANOVA. The ability of the respondents to retrieve information from the SDS was also tested in this study. The findings show that almost all the GHS pictograms meet the ISO comprehension criteria and it is concluded that the underlying core elements that enhance comprehension of GHS pictograms and which are also essential in developing competent persons in the use of SDS are training and education.

Matched MeSH terms: Occupational Exposure/prevention & control
A study on compliance to hearing conservation programme among industries in Negeri Sembilan, Malaysia

Nor Saleha IT, Noor Hassim I

Ind Health, 2006 Oct;44(4):584-91.
PMID: 17085919

Noise is one of the hazards faced by workers. A cross-sectional study was conducted among industries in Negeri Sembilan with the objective to assess their compliance to Hearing Conservation Programme (HCP). The other objectives of this study were to determine the factors influencing it and to show the industries' compliance to each element of the programme. It was also to identify the association between compliance to HCP and the prevalence of hearing impairment and standard threshold shift. Data for this study were collected using questionnaires sent by mail and also the results of the latest audiometric tests. A total of 167 industries were analysed for this study. It was found that 41.3% of these industries fully complied to the programme. It was also found that the industries preferred to provide hearing protection device (92.8%) and least complied to noise control (61.1%). There were significant associations (p<0.05) between compliance and number of employees, status of ownership and the presence of officer in charge of hearing conservation programme. Having at least 150 employees actually raised the compliance to HCP in two folds (beta = 0.717, OR = 2.048, C.I 95% = 1.063 to 3.944). The prevalences of hearing impairment and standard threshold shift were 23.9% and 5.2% respectively. There was no significant association between the prevalence for hearing impairment and compliance to HCP. The prevalence for standard threshold shift was inversely related to compliance. This study showed that compliance percentage need to be improved as an effort to prevent the hearing problems among workers exposed to noise.

Matched MeSH terms: Occupational Exposure/prevention & control*
Fulltext The craniotomy box: an innovative method of containing hazardous aerosols generated during skull saw use in autopsy on a COVID-19 body

Hasmi AH, Khoo LS, Koo ZP, Suriani MUA, Hamdan AN, Yaro SWM, et al.

Forensic Sci Med Pathol, 2020 09;16(3):477-480.
PMID: 32500339 DOI: 10.1007/s12024-020-00270-z

During a disease pandemic, there is still a requirement to perform postmortem examinations within the context of legal considerations. The management of the dead from COVID-19 should not impede the medicolegal investigation of the death where required by the authorities and legislation but additional health and safety precautions should be adopted for the necessary postmortem procedures. The authors have therefore used the craniotomy box in an innovative way to enable a safe alternative for skull and brain removal procedures on suspected or confirmed COVID-19 bodies. The craniotomy box technique was tested on a confirmed COVID-19 positive body where a full postmortem examination was performed by a team of highly trained personnel in a negative pressure Biosafety Level 3 (BSL-3) autopsy suite in the National Institute of Forensic Medicine (IPFN) Malaysia. This craniotomy box is a custom-made transparent plastic box with five walls but without a floor. Two circular holes were made in one wall for the placement of arms in order to perform the skull opening procedure. A swab to detect the presence of the SARS-CoV-2 virus was taken from the interior surface of the craniotomy box after the procedure. The result from the test using real-time reverse transcriptase polymerase chain reaction (rRT-PCR) proved that an additional barrier provided respiratory protection by containing the aerosols generated from the skull opening procedure. This innovation ensures procedures performed inside this craniotomy box are safe for postmortem personnel performing high risk autopsies during pandemics.

Matched MeSH terms: Occupational Exposure/prevention & control*

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