Achieving Biosafety Level 3 through the Use of Biosafety Level 2 Facilities and Biosafety Level 3 Practices: A Prevalence Survey of Medical Research and Academic Institutions

Heightened interest in pathogens with the potential for aerosol transmission and for which prevention and medical treatment is not readily available has resulted in a need for more work environments that meet Biosafety Level 3 (BSL 3) criteria. Recognizing that the facility-based criteria for BSL 3 cannot be achieved by some existing laboratories, the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) biological safety guidelines provide an option for attaining BSL 3 status through the use of Biosafety Level 2 (BSL 2) facilities and strict adherence to BSL 3 practices (BSL 2/3). Inherent to this provision is a greater emphasis on safe work practices. Since the extent to which this approach is actually used in practice is not known, a nationwide mail survey of medical academic and research institutions was conducted to provide an objective indication of the proportion of BSL 3 operations actually being carried out in the BSL 2/3 mode. The results obtained indicate that 2% of activities designated as BSL 3 in the study population actually achieve this level of protection using the BSL 2/3 approach. The findings quantitatively estimate for the first time the proportion of BSL 3 activities being carried out in this fashion, and can serve as a reference point for future studies to evaluate usage trends. The results also demonstrate the utility of flexible, performance-based health and safety guidelines, as a significant amount of clinical and research work is being accommodated with the BSL 2/3 provision.