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This publication describes the implementation and integration of a biosafety level 3 laboratory (BSL-3) unit within a drug discovery environment into a public multi-tenant and multi-user complex of buildings. The manuscript is intended to be used as guidance for any owners/users willing to build a laboratory unit of this type, including all steps from design to registration and certification. The goal of integrating a BSL-3 laboratory, according to international standards, with a drug development unit and an animal facility for infection studies, in a mixed multi-user and multi-tenant building, under circumstances where biosafety legislation is still under development, can lead to a complex situation with conflicting demands and expectations of the involved parties and the public. To solve the potential conflicts, an innovative approach was chosen to optimize the design of the laboratory (basing the safety concept on user requirements and qualifications criteria, and developing technical solutions in compliance with a consensus of the most relevant international biosafety regulations).We describe here the BSL-3 unit set-up, built for the Novartis Institute for Tropical Diseases (NITD), which moved in April 2004 to Biopolis in Singapore, where new laboratories compliant with international biosafety standards had to be set up. The project ran in six phases; after 14 months of construction and build-up, installation approval, commissioning and certification, the laboratory could be made available to users. After evaluation and approval of all Standard Operating Procedures (SOPs) with non-infectious agents, the laboratory could be used as a so-called "hot operation" with infectious agents.

Objective: The aim was to assess the impact of operating room (OR) ventilation quality on surgical site infections (SSIs) using a novel ventilation index. Background: Previous studies compared laminar air flow with conventional ventilation, thereby ignoring many parameters that influence air flow properties. Methods: In this cohort study, we surveyed hospitals participating in the Swiss SSI surveillance and calculated a ventilation index for their ORs, with higher values reflecting less turbulent air displacement. For procedures captured between January 2017 and December 2019, we studied the association between ventilation index and SSI rates using linear regression (hospital-level analysis) and with the individual SSI risk using generalized linear mixed-effects models (patient-level analysis). Results: We included 47 hospitals (182 ORs). Among the 163,740 included procedures, 6791 SSIs were identified. In hospital-level analyses, a 5-unit increase in the ventilation index was associated with lower SSI rates for knee and hip arthroplasty (−0.41 infections per 100 procedures, 95% confidence interval: −0.69 to −0.13), cardiac (−0.89, −1.91 to 0.12), and spine surgeries (−1.15, −2.56 to 0.26). Similarly, patient-level analyses showed a lower SSI risk with each 5-unit increase in ventilation index (adjusted odds ratio 0.71, confidence interval: 0.58-0.87 for knee and hip; 0.72, 0.49-1.06 for spine; 0.82, 0.69-0.98 for cardiac surgery). Higher index values were mainly associated with a lower risk for superficial and deep incisional SSIs. Conclusions: Better ventilation properties, assessed with our ventilation index, are associated with lower rates of superficial and deep incisional SSIs in orthopedic and cardiac procedures. OR ventilation quality appeared to be less relevant for other surgery types.

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