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Published on: October 3, 2016
Design and Construction of a Biosafety Level 3 Autopsy Laboratory
Kurt B Nolte1, Timothy B Muller2, Adam M Denmark3
1From the Office of the Medical Investigator and Departments of Pathology and Radiology (Nolte [https://orcid.org/0000-0003-0257-6284]), University of New Mexico Health Science Center, Albuquerque.
Context.—:
Autopsy pathologists, including medical examiners, provide valuable public health support for infectious disease deaths through surveillance for deaths of public health concern including emerging infections, identifying causative organisms for unexplained deaths, and providing insights into the pathology and pathogenesis of novel or unusual infections. However, autopsy poses biosafety risks to workers within and outside the laboratory. The highest rates of laboratory-acquired infections occur in autopsy workers.
Objective.—:
To design and construct an appropriately biosafe autopsy laboratory.
Design.—:
We conducted a biosafety risk assessment for autopsy workers using the process developed by the US Centers for Disease Control and Prevention and National Institutes of Health and applied these findings as the basis of laboratory design and construction.
Results.—:
Autopsy workers are unpredictably exposed to a variety of infectious organisms, including hepatitis C virus, HIV, and Mycobacterium tuberculosis. Hazardous autopsy procedures include using and encountering sharp objects and the generation of aerosols from dissection, fluid aspiration, rinsing tissues, and dividing bone with an oscillating saw.
Conclusions.—:
Exposure to blood-borne and airborne pathogens from procedures that can cause cutaneous inoculation and inhalation of aerosols indicates that human autopsies should be performed at biosafety level 3. We designed a large, entirely biosafety level 3 medical examiner autopsy laboratory using design principles and characteristics that can be scaled to accommodate smaller academic or other hospital-based autopsy spaces. Containment was achieved through a concentric ring design, with access control at interface zones. As new autopsy laboratories are planned, we strongly recommend that they be designed to function uniformly at biosafety level 3.
Insights
Autopsy workers face high infection risks. Designing autopsy laboratories at biosafety level 3 is crucial for worker safety and public health, especially with emerging infectious diseases.
Area of Science:
- Public Health
- Infectious Diseases
- Pathology
Background:
- Autopsy pathologists play a vital role in public health surveillance, identifying causes of death and understanding novel infections.
- Autopsy procedures present significant biosafety risks, with autopsy workers experiencing the highest rates of laboratory-acquired infections.
- Exposure to blood-borne pathogens (e.g., HIV, Hepatitis C) and airborne agents (e.g., Mycobacterium tuberculosis) is a constant hazard.
Purpose of the Study:
- To design and construct an autopsy laboratory that ensures an appropriate level of biosafety for personnel.
- To mitigate the risks associated with handling infectious agents during post-mortem examinations.
Main Methods:
- A biosafety risk assessment was conducted for autopsy workers, following established guidelines from the US Centers for Disease Control and Prevention and National Institutes of Health.
- The findings from the risk assessment informed the design and construction of the autopsy laboratory.
Main Results:
- Hazardous autopsy procedures, including dissection and aerosol-generating activities, increase exposure risks.
- The study indicates that human autopsies should be conducted at Biosafety Level 3 (BSL-3) due to potential exposure to blood-borne and airborne pathogens.
- A large, fully BSL-3 medical examiner autopsy laboratory was designed using a concentric ring containment strategy with controlled access zones.
Conclusions:
- Human autopsies should be performed at Biosafety Level 3 to protect workers from infectious agents.
- New autopsy laboratories should be uniformly designed to operate at BSL-3, incorporating scalable principles for various settings.
- Implementing BSL-3 standards in autopsy laboratory design is essential for safeguarding public health and laboratory personnel.
