title: Biosafety level 3 laboratory for autopsies of patients with severe acute respiratory syndrome: principles, practices, and prospects.
abstract: BACKGROUND
  During the outbreak of the emergent severe acute respiratory syndrome (SARS) infection, >30% of the approximately 8000 infected persons were health care workers. The highly infectious nature of SARS coronavirus (SARS-CoV) compelled our pathologists to consider biosafety issues in the autopsy room and for tissue processing procedures.
  
  
  METHODS
  A specially designed biosafety level 3 (BSL-3) autopsy laboratory was constructed and divided into a clean area, a semicontaminated area, a contaminated area, and 2 buffer zones. High-efficiency particulate air filters were placed in the air supply and exhaust systems. Laminar air flow was from the clean areas to the less clean areas. The negative pressures of the contaminated, semicontaminated, and clean areas were approximately -50 pa, -25 pa, and -5 pa, respectively. Personal protective equipment, including gas mask, impermeable protective clothing, and 3 layers of gloves worn during autopsies; the equipment was decontaminated before it was allowed to exit the facility. Strict BSL-3 practices were followed.
  
  
  RESULTS
  When a given concentration of particulate sarin simulant was introduced into the contaminated area, it could not be detected in either the semicontaminated area or clean area, and particles >0.3 microm in size were not detected in the exhaust air. A total of 16 complete postmortem examinations for probable and suspected SARS were performed during a 2-month period. Of these, 7 reported confirmed cases of SARS. None of the 23 pathologists and technicians who participated in these autopsies was infected with SARS-CoV.
  
  
  CONCLUSIONS
  Our experience suggests that BSL-3 laboratory operating principles should be among the special requirements for performing autopsies of contaminated bodies and that they can safeguard the clinicians and the environment involved in these procedures.
authors.affiliation: Department of Pathology, Health Science Center, School of Basic Medical Sciences, Peking University, Beijing, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Jiang
authors.initials: J
authors.lastname: Gu
authors.forename: Xicheng
authors.initials: X
authors.lastname: Shi
authors.forename: Encong
authors.initials: E
authors.lastname: Gong
authors.forename: Xingwang
authors.initials: X
authors.lastname: Li
authors.forename: Hongquan
authors.initials: H
authors.lastname: Shao
authors.forename: Xueying
authors.initials: X
authors.lastname: Shi
authors.forename: Huijun
authors.initials: H
authors.lastname: Jiang
authors.forename: Xiaoqiang
authors.initials: X
authors.lastname: Gao
authors.forename: Daiyun
authors.initials: D
authors.lastname: Cheng
authors.forename: Lizhu
authors.initials: L
authors.lastname: Guo
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Shi
authors.forename: Peizhi
authors.initials: P
authors.lastname: Wang
authors.forename: Qianying
authors.initials: Q
authors.lastname: Zhang
authors.forename: Bing
authors.initials: B
authors.lastname: Shen
mesh_terms: D001344:Autopsy / Q000592:standards*; D003264:Containment of Biohazards / Q000592:standards*; D004780:Environment, Controlled; D006801:Humans; D017053:Infection Control / Q000295:instrumentation* / Q000592:standards*; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control; D019570:Inhalation Exposure / Q000517:prevention & control; D007753:Laboratories / Q000592:standards*; D016273:Occupational Exposure / Q000517:prevention & control*; D010338:Pathology, Clinical / Q000295:instrumentation / Q000592:standards; D011481:Protective Clothing; D011482:Protective Devices; D012307:Risk Factors; D012449:Safety; D045169:Severe Acute Respiratory Syndrome / Q000473:pathology / Q000517:prevention & control* / Q000635:transmission; D013048:Specimen Handling