The Virginia Department of Health (VDH) holds monthly zoom calls to discuss state readiness and preparedness. This begin during the 2022, U.S. Health Advisory for the Ebola outbreak in Uganda and has continued after the advisory was receded due to the need to continued bio emergency preparedness. The VDH first recognized the gap between the hospitals and funerals homes and invited a local leading funeral home to one of the monthly state Ebola calls. Our institution volunteered to work with the funeral homes to initiate the creation of a safe SOP, the handoff transfer of a highly infectious decedent from hospital to funeral home. Over the course of August 2023 to January 2024, sequential meetings occurred to develop the new SOP. All parties involved in the development of the SOP should participate and develop questions to support the protocol (see Table 1). Developing an SOP for Hospital to Funeral Home involves many departments within the healthcare facility and members of our community including the funeral homes, state and government officials.

Table 1 Questions for collaborating teams The First Meeting

The first meeting expanded the knowledge and plan of the goal to build the SOP and prepared for the development of the SOP internally. A virtual internal hospital meeting was held with the Unique Pathogens Unit (UPU), Risk Management, Decedent Affairs, Infection Prevention and Control, & Emergency Management (EM) departments to notify all parties of the need to build the SOP. Initiating supporting internal conversations assist with ensuring all hospital policies, procedures and departments directly related would have a say in how the new SOP would be developed. Members from all departments were asked to have representatives at the first in person meeting with the funeral homes.

The Second Meeting

The second meeting was the first in person meeting and included internal representation from all departments from the first meeting and external representation with the local funeral homes, VDH, and officials from the OCME. The meeting began with a tour of the free-standing biocontainment unit for our external partners. A review of the step-by-step process to prepare a special pathogen decedent was conducted to educate on the Infection Prevention standards carried out in the preceding preparation SOP and how it follows CDC guidance. During this meeting we concluded with discussions of how the protocol should be written.

Current information on decedent management was collected from CDC, NETEC, funeral homes, and was reviewed. Limited research was found within the literature on a handoff procedure. Most of the literature referred to countries in Africa with different settings than those within the states. A SOP draft created, and the next steps were to present the SOP to the region and NETEC for review and follow up consultation.

The Third Meeting

A virtual consultation with the National Emerging Special Pathogens Training and Education Center (NETEC) was requested through the NETEC website. The virtual consultation included representatives from three Regional Emerging Special Pathogen Treatment Centers (RESPECTC), including our region 3 RESPECT and one of the RESPECTs who were able to provide supportive and insightful knowledge based upon their previous experiences. One of the two institutions that had an Ebola decedent in 2014–2015 was representative on the call. Reaching out to an experienced facility that have had to do this was key to utilizing their lessons learned. A decedent lift was one of the key takeaways from the call to enable safe handling and exposure risk reduction.

The Fourth Meeting

The fourth meeting was an in-person meeting at the funeral homes. Participants included the funeral home representatives, VDH, OCME, and the UPU. Review of process and continued further discussions to perfect the protocol based upon state and hospital guidelines and the feedback from NETEC. This meeting solidified additional need to run a collaborative drill of the SOP created to find additional areas of improvement.

The Fifth Meeting

A decedent UPU Emergency Management drill was conducted of the draft SOP. VCUHS attendees included members of: UPU, EM, Security, Risk, Infection Prevention, Decedent Management. Community members included: VDH, officials from the OCME, Funeral Homes, Central Virginia Coalition and the other state treatment center (Fig. 1).

Fig. 1

Meetings and participants in the development of the SOP