Mortuary design and hazards' · Post-mortem room Adequate space is essential: the committee feels that a poor standard of work is more often due to cramped conditions than to any

J. clin. Path. (1961), 14, 103

Mortuary design and hazards'A committee was set up in November 1959 to in-vestigate the conditions under which necropsy workis carried out, and to report to the Council on anydesirable improvements in these conditions.The committee has circulated questionnaires to

pathologists in a number of different areas of thecountry, and has collected information regardingexisting facilities for necropsy work in generalhospitals, teaching hospitals, and public mortuaries.Views have also been sought on the need for improv-ing mortuary facilities, and on desirable standardsfor these three types of mortuary unit. Members ofthe committee have discussed the subject withnumerous pathologists, with hospital architects, andwith other interested parties, including coroners andmedical officers of health. The present memorandumpresents the committee's conclusions and recom-mendations.

RESULT OF THE SURVEY

The committee was impressed by the extremelyvaried standards existing in different hospitaldepartments and public mortuaries throughout thecountry (Figs. 1 and 2). Some mortuary units arespacious and well-designed and are well-staffed andequipped with every facility for efficient work. Alarge number, however, are cramped and awkward,with few facilities, and the committee feels thatthere is a general need for improvement. As newhospitals are built, this improvement is graduallybeing effected by the provision of modern and well-designed mortuary units, but there is urgent andvery considerable scope for the improvement ofmortuary units in existing hospitals: the same istrue with regard to public mortuaries.The committee feels that information and general

guidance should be available for those pathologistswho have the opportunity either of designing newunits or of improving old ones: it hopes thatsuch information will stimulate many pathologiststo look afresh at their own mortuary facilities andsee what can be done to improve them.Many pathologists have expressed dissatisfaction

with staffing arrangements in mortuaries, and thecommittee has some comments to make on thissubject.'Report to the Council of the Association of Clinical Pathologistsof the Committee on Mortuary Design and Hazards (F. E. Camps,chairman, G. Stewart Smith, A. Dick, and H. H. Sissons, secretary).

The question of the joint use of mortuaries byhospital and coroners' pathologists is also con-sidered.

DESIGN AND EQUIPMENT OF MORTUARIESAND POST-MORTEM ROOMS

Although general considerations of design andequipment apply equally to various types of mor-tuary unit, both hospital and public, there aredifferences of emphasis and detail, and we havethought it best to set out our views under headingsrelating to the large general hospital, the smallerhospital, the teaching hospital, and the publicmortuary. It will be clear, however, that much ofwhat we have to say regarding hospital units appliesto public mortuaries.

LARGE GENERAL HOSPITAL In designing a newhospital it is desirable to incorporate the mortuaryunit, including the post-mortem room, in the mainstructure. Access to the unit is of great importance,and it should be sited so that there is ready andseparate access by the various groups of peopleconcerned (pathologists and other medical staff,staff transferring bodies from wards to mortuary,relatives coming to view bodies, undertakers, etc.).Sometimes there may be conflict between thesedifferent requirements, but in a modern hospitalblock good access is often most readily achieved bysiting the mortuary unit in the basement. There canbe separate routes of entry within the hospital forbodies, visiting relatives, and medical staff. Anexternal undertakers' entrance, screened from wardsand outside roads, can be provided.

In existing hospitals, the mortuary unit is usuallya separate building, and this may sometimes be anadvantage if it is to be used jointly by the hospitaland local authority (see page 107). Siting and accessare still important matters. A separate mortuaryunit should have pleasant and dignified surroundings,and should not-as is so often the case-be con-signed forever to some remote, inaccessible, anduntidy corner of the hospital grounds.

In addition to a general mortuary area equippedwith adequate refrigerated body storage, and asuitably sized and equipped post-mortem room, themortuary unit should include a room for themortuary attendant, facilities for viewing bodies,and a waitingroom and W.C. for visiting relatives.

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Mortuary design and hazards

FIG. 1

The mortuary area must be large enough to providespace for undertakers; adequate storage space isimportant. Facilities for washing and gowningshould be provided outside the actual post-mortemroom, and shower rooms and W.C.s should beavailable both for pathologists and post-mortemroom attendants. If the unit is at a distance fromthe pathology department, a doctors' room shouldbe provided where reports can be written or dictated.Some pathologists would like such a room, or thepathology department itself, to be linked to thepost-mortem room by a two-way inter-communica-tion system, so that reports can be dictated to asecretary or recorded on tape during the course ofa necropsy.An actual 'chapel' for the viewing of bodies is

regarded as unnecessary. A simple but quite ade-quate scheme can consist of a viewing room,separated from part of the mortuary area by acurtained window, the glass of which is tilted fromthe vertical to avoid reflections. The body to beviewed can be laid out in the mortuary, completely

separated from viewers by the window: it can beisolated from the rest of the mortuary area bysliding curtains hanging from the ceiling. A separateroom to house a body to be viewed is even better:again, a glass window should effect completeseparation between the body and the viewingrelatives.

There is abundant scope for individual planningin the arrangement of the rooms making up themortuary unit, and this should always be con-sidered with the hospital architect. Thought shouldbe given to the different routes by which bodies andvarious types of personnel move into and out of theunit: these should overlap as little as possible. Onno account should there be a common entrance orexit for bodies and visiting relatives. It is mostundesirable that relatives should have access by anyroute to the mortuary area itself or to the post-mortem room. The mortuary attendant's roomshould be sited so that he is available to visitingrelatives, as well as having ready access to themortuary area and the post-mortem room. Con-

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FIG. 2

sultation with the hospital architect and referenceto such works as Rosenfeld's 'Hospitals: IntegratedDesign' (2nd edition, Reinhold, New York, 1951),and 'Studies in the Function and Design of Hos-pitals', a report of an investigation sponsored bythe Nuffield Provincial Hospitals Trust and theUniversity ofBristol (Oxford University Press, 1955),are suggested for those concerned with the designof a new unit.Body storage Refrigerated body storage is of

course essential. It should be provided on a generousscale, particularly when a mortuary is to be usedfor both hospital and outside coroners' cases. Amortuary where 500 necropsies a year are carried outshould have storage space for at least 18 bodies:storage space for 24 to 30 is usually adequate for1,000 necropsies a year.Post-mortem room Adequate space is essential:

the committee feels that a poor standard of workis more often due to cramped conditions than toany other single factor. A post-mortem room deal-ing with 500 necropsies a year should, if possible,

have three post-mortem tables, and its floor areashould be not less than 500 sq. ft. A post-mortemroom with four tables should have a floor area ofapproximately 800 sq. ft. If air conditioning is notavailable, the post-mortem room should be ofgenerous height (12 to 15 ft.) and there should beadequate ventilation. In any case, the whole unitshould be fly proof.Air conditioning is highly desirable, and should

certainly be considered when any new unit is planned.It should provide a high rate of change of air, itshould not involve recirculation, and it is importantthat air extracted from the mortuary is not deliveredto other parts of the hospital, even indirectly. In thisconnexion, the mortuary unit should not be directlyin communication with a lift shaft or with any othershaft which has openings on other floors.

Lighting is extremely important. Good daylightis satisfactory, but the situation of the post-mortemroom may make it impossible to provide this.If the main sources of illumination is by artificiallighting this needs careful planning. The general level

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of illumination should be approximately 30 lumensper sq. ft., with additional lighting over post-mortem tables and dissecting benches. Provisionshould be made for some form of moveable lightingto examine cavities. The pros and cons of tungstenlighting and fluorescent lighting (natural colour)should be considered: it is difficult to recognizeimportant colour changes (such as that concerned incarbon monoxide poisoning) with some types ofartificial lighting. Roof lighting is often a feature ofolder mortuaries, but roof lights can interfere withthe maintenance of an even temperature and needshielding against brilliant sunshine: we feel they arebetter avoided.A smooth finish to walls and floors makes for

easy maintenance of a high standard of cleanliness.Terrazzo finish has been used in recent years butmay crack: modern materials such as polyvinylchloride (P.V.C.) sheeting can be used to give animpermeable and easily washable surface for bothwalls and floor with rounded surfaces in all corners.Conduits, pipes, etc. can be located behind flushremovable panels. Acoustically absorbent materialshould be used for the ceiling. Cupboards and otherfurniture should be plinth-mounted to facilitatewashing down.

Plenty of well-illuminated bench space (say 20 ft.)should be provided for dissection, weighing oforgans, etc., away from the post-mortem tables. Itshould include several large sink units, fitted withhot and cold water, and the bench top should be ofimpermeable material, preferably stainless steel. Thesurface actually used for dissection should be ofeasily cleaned material such as hard wood. Specimenswhich are to be preserved for museum mountingshould not come in contact with water: the provisionof running saline allows the washing of such speci-mens prior to their fixation. There should be adequatecupboard space (preferably built-in) for instruments,specimen jars, etc. Storage space for clean gowns,boots, aprons, gloves, etc. should be located outsidethe post-mortem room. A cleaners' cupboard forbrooms and other cleaning materials should beprovided in the mortuary area: there should also beadequate storage space for clothing of the deceased.Storage space (usually shelving) for fixed specimensshould be provided near the post-mortem room,but a mortuary store room is the best way to over-come this difficulty.

In the post-mortem room, balances, blackboard,wall-mounted x-ray viewing boxes, and electric saw(reciprocating type) should all be standard equip-ment: a bandsaw and a portable x-ray unit shouldbe available in a separate room, and the post-mortemattendant should be properly trained in the safe useof the latter. While porcelain post-mortem tables

are commonly used, stainless steel tables do notchip and can more readily be kept clean. Tablesshould be provided with running water and withdissecting tables if these are used. Drainage fromthe table should be by completely enclosed pipesunder the floor. If open floor channels cannot beavoided they should be covered by rust-proof metalgrids. There should be provision for sterilization ofinstruments from potentially infective cases; anelectrically heated instrument boiler is suitable, ifproperly used.

Hygiene With adequate space and proper plan-ning, the post-mortem room should be as clean andefficient as an operating theatre, and the likelihoodof bacterial contamination of staff during a necropsyshould be minimal. As in an operating theatre, theprovision of smooth washable surfaces and theavoidance of wall-mounted pipes and other obstruc-tions can eliminate the accumulation of potentiallyinfective dust and dirt. Strong emphasis shouldalways be placed on hygiene in necropsy work. Agood rule is that no one should enter the post-mortem room without donning gown and boots,and these must be discarded on leaving. A telephonecan be provided within the post-mortem room whichoperates without being touched by hand. Othercomparable measures can easily be instituted ina well-planned unit, but it is important to bereminded that in existing mortuary units a goodstandard of hygiene is often made impossible bybad arrangement of rooms and by cramped space.The precautions that should be taken to prevent

the dissemination of tubercle bacilli in the post-mortem room have been summarized in a reportto the Public Health Laboratory Service'. Thereport stresses general cleanliness, training of post-mortem attendants, and disinfection of instruments,dissecting surfaces, protective clothing, etc., afternecropsies on tuberculous subjects.

SMALLER HOSPITALS The general emphasis on accessand on good facilities and cleanliness, noted for thelarger unit should still apply; because a hospital issmall, there is no reason that the standards shouldbe lower. A post-mortem room with one table(adequate for about 100 necropsies per year) shouldhave a floor area of 300 sq. ft., and should have thesame standards of finish and equipment suggestedfor the larger unit. There should be facilities forwashing and gowning outside the post-mortem room.The unit should include refrigerated body storage.A hospital carrying out 100 necropsies per year needsspace for six bodies, and three is the minimum"Precautions against tuberculous infection in the diagnostic labora-tory', 1958. Bulletin of Ministry of Health and Public LaboratoryService. 17 January 1958.

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number for any unit where necropsies are performed.However small the unit, there should always befacilities for viewing bodies, together with a waiting-room and W.C. for visiting relatives. The separationof access for doctors, visiting relatives, and forbodies and undertakers is as important in the smallunit as in the large one.

TEACHING HOSPITAL The mortuary unit should besimilar to that in a large general hospital. Becauseof the greater number of people likely to be presentat necropsies, even more space is required in thepost-mortem room itself. For the same reason,considerations of hygiene are of outstandingimportance. Students and other onlookers shouldnot enter the actual post-mortem area unless theyare gowned and taking part in the examination: atiered gallery with separate entrance should beprovided for them, and this should be separatedfrom the dissecting bench by a low glass screen toavoid the dispersion of potentially infective materialduring dissection of organs. (The same separationof an 'observer area' should be applicable, on asmaller scale, in non-teaching hospitals. It can beof great value when numerous visitors enter thepost-mortem room and when the individuals con-cerned are reluctant to put on gowns and boots.)A room for the fixation and storage of post-

mortem specimens before their dissection and histo-logical study is always needed in a teaching unit, andis an asset in any department. It should be adequatelyventilated to avoid accumulation of formalinvapour. When it is desirable to store unfixedmaterial, either for teaching or research, the pro-vision of a cold room should also be considered.

PUBLIC MORTUARY These should be designed andequipped to at least the same standard and with thesame care as hospital mortuaries. A working partyhas reported on standards for space and generalarrangement for the Ministry of Housing and LocalGovernment.1 In this publication stress is laid uponthe siting of doors for the entrance of relatives andthe entry and removal of bodies. The proper sitingof the mortuary itself is important. A large amountof body storage is needed in a public mortuary(provision for at least 30 bodies is required in a unitwith 1,000 necropsies per year), and there should beproper facilities for viewing of bodies, x-ray examina-tion, preservation of material, and storage forclothing, together with waitingroom and W.C. forrelatives. The coroner's officer should be able tointerview relatives, and the needs of undertakers andpolice should be borne in mind. Adequate accom-"'The Planning of Mortuaries and Post Mortem Accommodation'.(1956) H.M.S.O.

modation with showers and W.C.s should be avail-able for pathologists and mortuary staff.

Special provision needs to be made for dealingwith decomposed and malodorous bodies. Aseparate refrigerator compartment should be re-served for this type of case, and a special metal ormetal-lined casket provided for body storage.Special fan-extraction of air should be provided overone post-mortem table where such bodies can beexamined. It is desirable to provide a separate roomfor this type of case, where possible, and such a roomis also useful for detailed and lengthy examinations.

STATUS AND SALARIES OF MORTUARYATTENDANTS

The work of the permanent mortuary staff, whetherin hospitals or in public mortuaries, is responsibleand exacting. There has been great difficulty inrecruiting suitable people for this work, and oursurvey leaves us in no doubt regarding thedissatisfaction of many pathologists with the statusand salary scales attached to the posts concerned.In many hospitals mortuary attendants are gradedas belonging to the unskilled 'porter' class, while inpublic mortuaries the status and salary are littlebetter. The committee feels strongly that this iswrong, and would like to see considerable improve-ment in the status of mortuary attendants, and in thesalary scales which apply to them. We suggest thattheir position in hospitals should be comparable withthat of laboratory technical staff. Similar changesare necessary in public mortuaries. The superin-tendent of a large public mortuary, to take oneexample, should be comparable in status and salarywith a public health inspector. Such changes, wefeel, would encourage the recruitment of suitablestaff, and so increase the efficiency of mortuarywork. It would also make the individuals concernedless dependent on the perquisites of their office-sums that come from a number of sources, not leastthe pocket of the pathologist whose job it is to carryout examinations in their particular post-mortemroom.

JOINT USE OF MORTUARIES BY HOSPITALAND CORONERS' PATHOLOGISTS

We have been impressed by what we regard asunnecessary duplication of mortuary facilities insome areas, and we feel that, in certain circumstances,there is scope for the joint use of mortuaries forhospital and coroners' necropsies. In big cities, thelarge number of coroners' necropsies makes itinevitable that these are carried out in special unitsand this is, in fact, desirable. But in smaller towns

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and in country areas it often appears uneconomicand inefficient to provide dual facilities for the sametype of work. In some areas, it is already thepractice for the hospital mortuary to be used for allcoroners' necropsies from the surrounding district;in many others, conditions would appear to justifythe adoption of similar units which could bedesigned to combine the functions of hospital andpublic mortuaries. Arrangements of this typeneed, of course, to be discussed and agreed by thecoroner, the hospital authorities, and the localauthority. Various administrative arrangements arein force, but the basic plan is for the local authorityto pay for the use of what is, in effect, the hospitalmortuary unit. This can be done either by an annualcontribution or by payment for each body admitted.

Apart from the added efficiency, such a scheme can

be financially attractive, as the local authority isunder a statutory obligation to provide, if requested,a public mortuary, and to do this properly as a

separate scheme can be very expensive. The size ofa shared unit, its architectural layout, and thedesignation of the facilities required in it, all needcareful planning by the parties concerned.

It appears to us, then, that hospitals and localauthorities might find it mutually advantageous tocollaborate more regarding the joint use of mortu-aries, and we feel that this topic should be thesubject of their joint discussion, following theapproval of the coroner, whenever the provision ofa new mortuary unit-either hospital or public-is considered.

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Mortuary design and hazards' · Post-mortem room Adequate space is essential: the committee feels that a poor standard of work is more often due to cramped conditions than to any