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"Moon Suit" Trains Biosafety Lab Researchers

Three wrinkled white rubber body suits hang side by side from ceiling hooks inside a room at Rocky Mountain Laboratories (RML), a distant research component of NIAID located in Hamilton, Montana.

This Hamilton Middle School student wriggles her fingers into gloves attached to the positive pressure training suit.
This Hamilton Middle School student wriggles her fingers into gloves attached to the positive pressure training suit. Paul Carlson, the occupational safety and health officer at RML, provides instruction.
Credit: NIAID
Technically known as positive pressure suits, informally called “moon suits,” the body suits are required gear for researchers who work with disease-causing microbes in maximum containment, or biosafety level 4 (BSL-4), laboratories. They are on display because they will be worn by some researchers who will work in RML’s new Integrated Research Facility, expected to be operational by the end of 2007. But for now, they are being used by laboratory staff for training purposes, and occasionally to teach RML visitors—in this case a group of middle schoolers—about the suits.

Inside the training room, RML’s Occupational Safety and Health Manager Paul Carlson fastens a connector to a valve on one of the suits, allowing purified air to flow in from one of six coiled yellow hoses hanging from the ceiling. Arms and legs inflate and slowly take shape; then a torso and head emerge. Soon the suit loosely resembles the Michelin Man or the Pillsbury Dough Boy.

Mr. Carlson then leads a visiting student from Hamilton Middle School to the suit and, with classmates looking on, they complete a visual integrity test—one of the first critical lessons that scientists learn when training to conduct BSL-4 research.

Suited for the Work?

Few rooms in the world match the purpose of this training room. It is a place where scientists, in a relaxed but realistic setting, can learn and practice safe techniques for conducting research in laboratories where such suits are required gear. Inside the training suit, they experience what it is like to communicate through a wireless headset and to work with limited hand dexterity because of the three pairs of gloves they must wear. They learn about claustrophobia, about the mental and physical challenges to their concentration and … their bladders. Because of the added bulk surrounding their body, they even re-train themselves to sit and stand.

The positive pressure suit acts as a protective barrier between scientists and their laboratory environment.

“Each time before entering the lab in their suit, scientists must check for cracks, flaws, and leaks,” RML Biosafety Officer Nancy Hoe, Ph.D., tells the group of students during their tour. “They inflate the suit, visually examine it, and use soapy water to make sure it is airtight.” Any soap bubbles that appear on the suit signify a leak and need for repair. The wide-eyed students clearly understand, and one boy steps inside and zips himself into the suit.

In a real BSL-4 laboratory, other items the scientists must check daily before starting BSL-4 work include room security features, autoclaves, air pressure, disinfectants, and breathing air.

Coming Soon

The training room is a near duplicate of the BSL-4 laboratory suites that are anticipated to open during 2007 inside RML’s new Integrated Research Facility. The facility is part of an effort by NIAID, part of the National Institutes of Health (NIH), to boost research into emerging and re-emerging infectious diseases, such as forms of viral hemorrhagic fever and encephalitis.

The training room provides RML scientists, emergency responders, visiting researchers, maintenance personnel, and other staff an authentic training environment—right down to the sounds, equipment, and physical space. Along with learning proper use of positive pressure suits, training includes discussion about

  • Primary laboratory infection controls, such as biological safety cabinets and fume hoods and other types of personal protective equipment, such as gloves, coats, gowns, and even shoe covers
  • Secondary controls, such as airlocks and specialized ventilation systems, and the box-within-a-box laboratory construction
  • Standard laboratory equipment, such as centrifuges, down-draft tables, and microscopes

“This room is a serious place that is vital to our scientific education and training,” says RML Associate Director Marshall Bloom, M.D. “But it also can be a fun place where we can show students and other visitors what happens in our laboratories—that these suits are not scary, and neither is the science.”

Or in the words of recent RML visitor U.S. Senator Max Baucus of Montana: “Putting on the suit is just like putting on a pair of fishing waders.”

This illustration shows the typical process of entering and exiting a BSL-4 laboratory, though specifics might vary from facility to facility.

This illustration shows the typical process of entering and exiting a BSL-4 laboratory, though specifics might vary from facility to facility.
Credit: CUH2A, Atlanta
View larger version of the illustrtaion


Best Practices

The training room is one of several ideas gleaned from a best-practices approach to developing the RML Integrated Research Facility, according to Dr. Bloom. While the RML facility was still in the planning stages, NIH consulted experts who had been involved with BSL-4 construction in Winnipeg, Manitoba, Canada; Atlanta, Georgia; and Galveston, Texas.

Among their many suggestions, “All of them said, ‘We wish we had built an external training area.’ So we made sure we did,” Dr. Bloom says.

Lee H. Thompson is the biocontainment consultant at RML. He has previously worked on construction and commissioning of BSL-4 laboratories in Texas, Canada, Sweden, and India.

“Historically this type of training takes place in a BSL-4 lab that is ‘hot,’ [meaning it is being used for research], which poses an array of challenges,” notes Mr. Thompson. “Many places don’t want to commit the resources for a separate training room, but that mindset is changing as people start to see the benefits. The RML training facility is the first to be completed for this new generation of high containment labs.”

Attention to Details

Back with the middle school visitors, Dr. Hoe and Mr. Carlson use simple illustrated charts to outline the sequential steps scientists must take to gain access to a BSL-4 laboratory: Those who are authorized enter the facility and gradually work their way toward the BSL-4 laboratory, passing through multiple layers of security features along the way. Then they enter a small room with a set of lockers, where they disrobe and dress in surgical clothing. The adjoining room is the suit room, where they inspect and test the positive pressure suit. Once scientists are wearing the suit, they will proceed through air pressure-resistant (APR) doors and into the laboratory. Thereafter, they must connect to a breathing air hose in every room they occupy. APR doors, similar to those used in submarines, contain an air bladder that expands between the door and doorframe to create an air-tight seal.

To exit the laboratory, an individual reverses the entry steps, and takes a lengthy decontamination shower—similar to a car wash—after leaving the laboratory but before removing the positive pressure suit. The chemical shower disinfects the suit before its next use. Scientists also take a personal shower before returning to the locker room to dress in their street clothes.

The training that scientists undergo before first conducting research in the BSL-4 laboratory involves months of preparation.

People like Dr. Hoe, Mr. Carlson, Mr. Thompson, and a few others at RML will closely evaluate the trainees’ skills. They will know the trainees’ full history and experience of working in BSL-2 and BSL-3 laboratories; test their practical skills and knowledge of BSL-4; and assign them to a BSL-4 training mentor.

“It’s a team approach … and it’s comprehensive,” says Dr. Hoe, reflecting on the extensive paper documentation and background review required before laboratory training can begin.

Lengthy theoretical and practical exercises form the heart of the training. The theoretical phase ensures that trainees are knowledgeable in biosafety containment principles, personal protective equipment, biological safety cabinets, aerosols, biological exposure, emergency procedures, disinfection, autoclaves, and waste handling. The practical, or hands-on, phase covers organizing laboratory materials, proper handling techniques, preventing creation of aerosols, disposing of wastes, decontamination, suit checking and suit maintenance, entering and exiting the suit, connecting and disconnecting from air lines, and moving inside the laboratory.

There’s no guarantee that every trainee will be fit for BSL-4 work, notes Dr. Hoe. “The standards are high and the evaluations are rigorous, as they should be,” she says. “If someone is deficient, they will be coached and given the opportunity to improve, but they won’t be able to work at BSL-4 until they are proficient.”

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Last Updated May 02, 2007