ABSTRACT

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 U.S. 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 M. 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 bloodborne 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.

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Author notes

Preliminary results from this study were presented at the National Association of Medical Examiners Annual Meeting; September 9, 2008, Louisville, KY, USA and the Centers for Disease Control and Prevention 11th International Symposium on Biosafety; January 26, 2010, Atlanta, GA, USA.