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Abstract

Introduction:

Biosafety Level 2 (BSL-2) training programs were benchmarked at institutions of higher learning in the United States by surveying Biosafety Officers (BSOs). The goal of this survey was to not only compare Institutional Biosafety Committee (IBC) requirements for BSL-2 training but also compare delivery format, length of training, inclusion of a hands-on or interactive component, and requirement for refresher training.

Methods:

Survey subjects were drawn from the National Institutes of Health (NIH) registry of BSOs and were limited to BSOs at institutions of higher learning in the United States. Twelve survey questions were developed in this study. The survey was sent to 324 BSOs, of which 108 responded with sufficient data to be included in the analysis.

Results:

The survey found that BSL-2 training is required by the institutional and/or IBC policy at 88% of institutions, is optional at 5.6%, and not offered at 6.5%. More than half of the respondents (60.4%) offered BSL-2 training in an on-demand manner. Some institutions (34.5%) include a component of training that is in person. However, this training does not always include hands-on exercises or interactive activities. The survey indicated that most (96.6%) institutions offered BSL-2 training less than three hours in length, and many (58%) institutions required refresher training.

Conclusions:

Most institutions of higher learning in the United States, which are registered with the NIH, require BSL-2 training for laboratory personnel involved in research and teaching.

Introduction

Laboratory personnel working with biological materials should receive appropriate training to perform their work safely and ensure compliance with biological safety regulations and guidelines. Biosafety Level 2 (BSL-2) training covers the basic principles and practices for working with biohazardous materials, including infectious agents that cause human disease, microbial toxins, and other hazardous biological materials that pose a moderate risk to personnel and the environment, as outlined in the Biosafety in Microbiological and Biomedical Laboratories, 6th Ed. (BMBL).¹ The Guidelines for Biosafety Laboratory Competency outlines the expectations for skills, knowledge, and ability to work safely at BSL-2.² The BMBL recommends that laboratory personnel receive specific training in handling pathogenic agents.¹ It is the expectation that research personnel receive training in handling the specific pathogens and toxins they work with, the procedures they will use to manipulate the organisms, and the use of engineering controls to protect the research, the workers, and the environment. The BMBL BSL-2 training recommendation includes annual updates.¹ The National Institutes of Health (NIH) Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines) recommend “laboratory personnel have specific training in handling pathogenic agents.”³

There is no regulatory requirement for institutions to provide BSL-2 training.¹ This is different from the training requirements for work with other hazards, including work with chemical hazards as mandated by the Hazard Communication Standard,⁴ work with materials that may contain microorganisms infectious to humans present in blood as mandated by the Bloodborne Pathogen Standard,⁵ and work with biological agents and toxins that pose a severe threat to human, animal, and/or plant health as mandated by the Select Agent and Toxins regulations⁶ Although many institutions offer BSL-2 training, the individual principal investigator (PI) who leads the research is responsible for training their personnel and students on how to work safely with biohazardous materials at BSL-2 instead of the institution.

Biosafety training helps ensure that laboratory personnel know how to work safely with biohazardous materials. Higher education institutions may have personnel who lack experience working with the unique hazards found in a biological laboratory. Lack of hazard awareness and inadequate safety knowledge have led to unsafe actions,⁷ leading to over 90% of safety incidents in biology laboratories.⁸ When hazards are unrecognized or underestimated, risk perception is influenced, which has been shown to impact safety-related decision-making.⁹ Familiarity with biosafety training and knowledge of agents studied have correlated with reduced laboratory-acquired infections.¹⁰ BSL-2 training offered at an institutional level promotes a foundation of knowledge of laboratory hazards and safety work practices for working with human pathogens or other biohazardous materials. As an institution, we have completed a high-level risk assessment based on the Institutional Biosafety Committee protocols submitted, the Iowa State University (ISU) policies, and the types of facilities and equipment we have. Based on this risk assessment, we developed a general BSL-2 training that can be used as an introductory overview of what researchers may expect. It is the responsibility of the individual PIs and/or supervisors to provide laboratory-specific training based on the hazards and risks in their respective workspaces. Laboratory-specific training must be provided by competent laboratory staff to ensure proficiency in handling biohazardous materials and safely performing associated procedures.

As outlined in published biosafety guidelines from the Centers for Disease Control and Prevention^1,2 and NIH Guidelines,³ content covered as part of BSL-2 training builds upon the basics of working with noninfectious biohazardous materials. Based on these guidelines, BSL-2 training programs include topics such as identifying potential hazards, hazard control measures, administrative control measures, and emergency preparedness and response. This training should consist of the essential elements of BSL-2 criteria outlined by the BMBL:¹ safe work practices, safety equipment, and laboratory facilities. Hands-on training complements information covered in presentations or online modules, including job shadowing experienced personnel, working through scenario-based risk assessments, practicing laboratory techniques with noninfectious surrogate organisms, or other interactive activities such as handwashing, sorting waste for disposal, and autoclaving. BSL-2 training intends to give a fundamental understanding of safety considerations and requirements for working with biohazardous materials that require BSL-2 containment to provide a foundation for laboratory-specific training.

ISU offers BSL-2 training to students, staff, and faculty working with biohazardous materials that require BSL-2. This training is not required by institutional policy or the Institutional Biosafety Committee (IBC). Historically, the training consisted of an in-person classroom presentation covering the principles of biosafety, the procedures and practices necessary to work safely with biohazardous materials, and a hands-on component that included identification of improperly prepared biohazardous waste and utilizing provided resources to determine the proper disinfectant for a given infectious agent. The course was offered several times a year and open to a maximum of 20 participants (i.e., faculty, staff, students, and postdocs).

The authors discussed implementing an online on-demand BSL-2 course, as low enrollment in the in-person course has resulted in numerous cancelations of the offered sessions (i.e., a minimum of six participants are required for training to occur). There is perceived value for in-person BSL-2 training, which may be lost by providing training in an online format. It is presumed that enrollment in the in-person course would be much higher if there were a requirement to take this course at the institutional level or by the IBC. However, a requirement for BSL-2 training may increase enrollment to a level in which additional course sessions would be necessary, requiring extra support by biosafety professionals.

The discussions regarding transitioning from in-person to online training included benchmarking the training format and the requirement for training at other academic institutions. A previous survey of biosafety professionals found that 85% of the institutions required biosafety training at BSL-2.¹¹ However, this publication did not differentiate this training requirement for academic institutions from other institutions, including private companies, government agencies, and nonprofit organizations.¹¹ In addition to the delivery format and requirement for BSL-2 training, the length of training, the inclusion of a hands-on component, and available refresher BSL-2 training were crucial areas of focus. A survey was created and distributed to biosafety professionals at other academic institutions of higher education to benchmark other BSL-2 training programs.

Materials and Methods

The cohort for this study was chosen from a list of IBC contacts and Biosafety Officers (BSOs) of record at the NIH. A Freedom of Information Act request was filed with the NIH in October 2022 to list all BSOs and IBC contacts, including email addresses. The original list from the NIH included IBC contacts and BSOs from educational institutions (i.e., emails ending .edu), commercial entity BSOs (e.g., emails ending .com or .org), and international institutions (e.g., email addresses ending .uk, .au, .ca, etc.). The list also included duplicate entries for BSOs whose responsibilities included multiple departments, sections, or institutes within a larger organization and various contacts for a single institution or IBC. Duplicate and multiple contact email addresses (313), such as email addresses ending .com (530), .org (171), .gov (66), .mil (6), .bio (2), .us (2), .inf (1), and international email addresses (81), were excluded from the survey cohort. From an original list of 1519 IBC contacts and BSOs, this resulted in a survey sample size of 324 BSOs and IBC contacts, who were emailed invitations to the survey.

The survey consisted of 10 multiple-choice questions and two free-text entry questions. It was determined through preview testing (unpublished data) that the average length of time it would take a respondent to complete the survey was 10 min. The survey queried training format, length, and frequency of training, but did not delve into the specific knowledge included in the training. In addition, the survey did not include a definition of BSL-2 training because the BMBL¹ and NIH Guidelines³ define the training for the survey cohort.

The survey and prospective respondents’ information was submitted to the ISU Institutional Review Board (IRB). The IRB determined that approval for this survey was not required because it does not include human subjects (as they are federally defined). The survey was sent to the final list of email addresses using Qualtrics^®, and a reminder email was subsequently sent to the BSOs that had not participated initially.

Pearson’s chi-squared test using two degrees of freedom was performed to analyze if there was a correlation between select survey responses using R software (https://www.r-project.org/). A p value less than 0.05 was considered statistically significant.

Results

Survey Response

Of the original 324 NIH-registered BSOs, 111 responded, representing a 34.3% response rate. Since three did not respond to all survey questions (≤2 responses), 108 respondents’ answers were used for the analysis. The geographic distribution of the respondents was limited to the United States of America (USA) and represented all regions of the United States.

Requirement for BSL-2 Training

Respondents indicated that BSL-2 training was required by their institution, 83.3% (n = 90/108) (Figure 1A), whereas 80.8% (n = 80/99) indicated that BSL-2 training was required by their IBC (Figure 1B). Aggregating the responses from BSOs to these questions further supports that requiring BSL-2 training is a best practice, as 88% of study respondents (n = 95/108) indicated that BSL-2 training was required by the institution, the IBC, or both (Figure 1C). Statistical analysis determined a relationship between the requirement for training at the institutional level and the requirement for training by the IBC (p < 0.001), which supports the finding that for most institutions, BSL-2 training is required by both the institution and the IBC.

Figure 1.

Requirement for BSL-2 training. (A) Requirement for training at the institutional level. (B) Requirement for training by the IBC. (C) Requirement for training by the institution and/or IBC. BSL-2, Biosafety Level 2; IBC, Institutional Biosafety Committee.

Based on Carnegie Classification’s definitions for institution size,¹² respondents to this survey were fairly evenly distributed between small (20%), medium (19%), large (27%), and huge (34%) institutions based on student enrollment.

All respondents from medium institutions (n = 15/15) indicated that training was required. Respondents from small and large institutions indicated training was provided at most institutions (n = 14/16 and n = 21/24, respectively), and the training was required (n = 13/16 and n = 20/24, respectively). All respondents from huge institutions indicated training was provided (n = 28/28), and most require (n = 25/28) the training. Additional evaluation of survey responses indicated that there was no relationship between the number of PIs at an institution and whether BSL-2 training was offered or required [data not shown].

Format of BSL-2 Training

The next set of survey questions related to the format or delivery method of the training was only offered to respondents who indicated BSL-2 training was provided. The majority of respondents (60.4%, n = 58/96) indicated that on-demand (e.g., online course, pre-recorded lecture, or video) BSL-2 training was offered. The remaining respondents stated training was offered in person (15.6%), through a blended experience that included in-person training (19.8%) or live remote (4.2%) (e.g., zoom lecture, webinar, round table) (Figure 2A).

Figure 2.

Format and length of BSL-2 training. (A) Delivery format of BSL-2 training. (B) Length of BSL-2 training. (C) Relationship between delivery format and length of training.

For respondents who indicated training was required, the most utilized delivery format was on-demand, 61.5% (n = 56/91). Other training formats utilized were in-person (14.3%), a blended experience that included in-person (19.8%), and live remote (4.4%). Statistical analysis strongly suggested a relationship between the responses for the requirement for training and on-demand delivery format (p = 0.0568), which supports that institutions that require BSL-2 training provide training in an on-demand format.

When there was no training requirement, the most utilized delivery format was split between on-demand, 40% (n = 2/5), and in-person, 40% (n = 2/5). A blended experience was indicated for one respondent (20%), and live remote training was not indicated.

On-demand training is the most popular training format regardless of institution size based on survey responses provided by 75 respondents, accounting for 50% (n = 7/14) of training at small institutions, 60% (n = 9/15) of training at medium institutions, 63% (n = 12/19) of training at large institutions, and 59% (n = 16/27) of training at huge institutions. Small institutions provide in-person training more often than other institutions based on survey responses, accounting for 36% (n = 5/14) of training at small institutions, but only 6% (n = 1/15) of training at medium institutions, 11% (n = 12/19) of training at large institutions, and 15% (n = 2/27) of training at huge institutions.

Length of BSL-2 Training and Relationship to Delivery Format

When asked about the length of BSL-2 training offered, more than half of the respondents, 52.9% (n = 46/87), indicated that the training was for one hour or less. The other respondents stated the training was for 1–3 h (43.7%), and a few respondents indicated the training lasted for 1 workday (3.4%) (Figure 2B). No respondent indicated the training lasted for one work week or more than one work week.

There was no significant difference in BSL-2 training formats when the training was offered for ≤1 h or 1–3 h. Aggregating the format and length of training, respondents stated that on-demand format for 1 hour or less and 1–3 h was the most common combination. On-demand training was offered by 100% (n = 3/3) of respondents who indicated the training lasted 1 workday (Figure 2C).

Hands-on Component Included in BSL-2 Training

BSOs who indicated that the BSL-2 training format was either in-person or a blended experience, including in-person, were asked to categorize the type(s) of hands-on exercises or interactive activities included in the BSL-2 training. A total of 30 respondents answered this question, of which 11 said the training was offered in-person, and 19 said the training was a blended experience, including in-person. Of these, 4 and 8 respondents, respectively, or 40% total (n = 12/30), indicated the training did not include a hands-on component. The remaining respondents, 7 and 11, respectively, or 60% in total (n = 18/30) identified categories of hands-on exercises or interactive activities that were included as part of their in-person training (Figure 3A).

Figure 3.

Type(s) of hands-on exercises or interactive activities that were reported by respondents who said that their BSL-2 training format was either in person or a blended experience that includes in-person training. (A) Responses regarding the inclusion of a hands-on component in training. (B) Responses regarding type(s) of hands-on exercises.

Of the 18 respondents who identified that a hands-on component was included as part of the training, 50% (n = 9/18) indicated training included BSL-2 laboratory procedures with no organisms, 16.6% (n = 3/18) indicated training included BSL-2 laboratory procedures with noninfectious organisms, 27.7% (n = 5/18) indicated training included shadowing personnel working in a BSL-2 laboratory, and 61.1% (n = 11/18) indicated training included interactive activities related to BSL-2 safe work practices, principles of biosafety, and/or safety equipment (Figure 3B).

Respondents who selected at least one type of hands-on exercise or interactive activity were asked to describe the hands-on exercises or interactive activities included in the training. Of applicable respondents, 61% (n = 11/18) described training activities. Responses included hands-on laboratory-specific training provided by the lab manager or PI, shadowing experienced laboratory personnel, training on the use of a biosafety cabinet, cleaning up biological spills, donning and doffing personal protective equipment (PPE), handling biohazardous waste, handwashing, aerosol-generating procedures, and disinfection of work areas. Many of the respondents suggested or stated the hands-on training was not provided as part of the BSL-2 training course, but rather as a requirement by the institution to include site-specific training by the PI or supervisor (Table 1).

Table 1.

Descriptions of hands-on exercises or interactive activities

Individual responses
The PI or lab manager in the laboratory that they will work in must do laboratory-specific BSL-2 training, in addition to virtual training.
Personnel shadow experienced researcher: Personnel then demonstrates techniques and is allowed to work independently if the trainer is satisfied.
How to work in a Biosafety Cabinet (BSC).
How to clean up a biological spill.
In-person training specific to the type of research.
Use of biosafety cabinets, spill cleanup, PPE donning and doffing, and hand washing.
Practice spill clean-up with noninfectious materials. Shadowing/observing more experienced laboratorians.
Researchers are required to complete site-specific training and follow a checklist.
BSC training
Hands-on training is the responsibility of the PI leading the project. The need and extent of training are based upon risk associated with the laboratory and the specific procedures that will be performed by the person being trained.
Use of BSC, biohazard waste handling, aerosol generating procedures, and disinfection of work area.
Hand-on training is provided by the specific laboratory where the staff will be working. It is generally provided by the PI or lab manager.

PI, principal investigator; BSC, biosafety cabinet; PPE, personal protective equipment; BSL, biosafety level.

Refresher BSL-2 Training

Many respondents, 58% (n = 54/93), indicated their institution provides BSL-2 refresher training and the training is required. The remaining respondents indicated their institution provides BSL-2 refresher training, but it is optional (26%) or their institution does not provide refresher BSL-2 training (16%).

Format of Refresher BSL-2 Training

The majority of respondents, 78.9% (n = 56/71), indicated that refresher training was provided using on-demand format. The remaining indicated training was conducted in person (7.0%), through a blended experience that included in-person training (9.9%), or as a live remote format (4.2%) (Figure 4b).

Figure 4.

Training format for respondents who said that their institution offers both initial and refresher BSL-2 training. (A) Initial BSL-2 training. (B) Refresher BSL-2 training.

Length of Refresher BSL-2 Training

When asked about the length of refresher BSL-2 training, over half of the respondents, 60.6% (n = 43/71), indicated the training was for 1 h or less. Other respondents indicated the training lasted for 1–3 h (35.2%) or lasted for 1 workday (2.8%). No respondent indicated the training lasted for 1 workweek. One respondent (1.4%) indicated that the refresher training was more than 1 workweek.

Respondents who indicated their institutions did not currently offer BSL-2 training were asked whether there was a plan to develop BSL-2 training in the future. About half of the 44.4% (n = 4/9) planned to develop BSL-2 training in the future, while the other half, 55.5% (5/9), do not plan to develop BSL-2 training.

Discussion

This survey found that most institutions of higher learning in the United States, which are registered with the NIH, require BSL-2 training either as a policy of the Institution and/or IBC, although it is not specifically required by the NIH Guidelines³ or BMBL.¹ However, other agencies such as the U.S. Occupational Safety and Health Administration (OSHA) require employers to provide training to employees who will encounter hazards on the job.¹³ Because OSHA applies only to employees, the requirement may not apply to graduate students, teaching assistants, and postdocs who are not considered employees at most higher education institutions.¹⁴ This disparity in requirement may leave some individuals without a comprehensive requirement.

The survey found that 61.5% of institutions that require training offer this training on-demand. A portion of the respondents indicated that training is provided through a blended experience that includes in-person (19.7%), which may have an on-demand training component. Therefore, an on-demand format may be offered at up to 81% of institutions requiring BSL-2 training, although this could not be confirmed using the survey data acquired. This result is consistent with the increased prevalence of online training, which has become the fastest-growing market in the education industry, with a 900% growth rate globally since the year 2000.¹⁵ The COVID-19 pandemic further contributed to the utilization of this teaching format as a majority of higher education institutions developed online curriculums to fulfill traditional in-person lectures such as laboratory, field, and studio components.¹⁶ Although several credentialing organizations, such as ABSA International, allowed for an extension of the certification period due to the COVID-19 pandemic,¹⁷ other professions moved their continuing education and refreshers to asynchronous online training.

The survey found that BSL-2 refresher training is required at most institutions, even though this is not a requirement outlined by published biosafety guidelines^1–3 or specific occupational safety regulations.¹³ Recurrent training aligns with several public health regulations, which require annual refresher training for individuals who work with bloodborne pathogens⁵ and select agents and toxins.⁶ Many professions require continuous educational training to provide awareness, introduce new techniques, and reinforce skills and knowledge that may have been forgotten.^18–20

Only a small contingent of respondents (<10%) indicated that a hands-on training component was included, regardless of delivery format. Online training formats offer a convenient and cost-effective method for training delivery as individuals can take the training on-demand. A study that investigated the use of virtual simulations for laboratory exercises showed that students trained either virtually or through live demonstration tutor showed similar knowledge in the microbiological practice of streaking plates.²¹ A study on the effectiveness of online cardiopulmonary resuscitation recertification training versus in-person training found online training was as effective or better than in-person recertification training and produced better learning outcomes when the training has user-controlled interactions and prompts for learner reflection.^22,23 It is important to note these studies were on recurrent training and did not study the effectiveness of presenting initial training in an online format.

Online learning offers the ability to incorporate features that appeal to multiple learning styles. For example, some learners prefer reading text to comprehend information, whereas audio learners benefit most from listening to information, and visual learners benefit from images and animations.²⁴ Online training also offers the opportunity to employ learner engagement strategies, such as games and other interactive features.²⁵ Training modules can be purposefully abbreviated to reflect the students’ attention span to learn new material while allowing the learner to review the material in the course at any time.²⁶

Limitations

The survey’s focus was to benchmark the BSL-2 training programs offered by other academic institutions of higher education, which included the requirement for training, delivery method, length of training, and if the training included a hands-on component. There are several areas of focus that this survey did not inquire about. For example, this survey did not evaluate which personnel at the institution the BSL-2 training was provided to (students, faculty, or staff). The survey did not capture the BSL-2 training programs at nonacademic institutions such as private companies, government agencies, or nonprofit organizations. All responses were from individuals at institutions of higher learning listed on the NIH registry of BSOs; however, no additional characteristics, such as job role or specific institution type, were captured as part of the survey, As the content of BSL-2 training is covered in biosafety guidance publications, the content of training offered at academic institutions was not included as part of the survey inquiry. Word selection, the format, or presentation style of the provided training were not included, nor was an evaluation of the delivery method concerning learning engagement and information retention. The survey did not inquire about compliance or effectiveness of institutions’ training programs, which may be impacted by aspects of the training program, such as delivery method. In addition, this survey was not utilized to compare the BSL-2 training programs found in different geographic regions or used by other cultures.

The survey question regarding the types of hands-on exercises or interactive activities included in the training elicited many responses, referencing laboratory-provided training (Table 1). It was determined that this question could have been written more clearly to capture only responses related to hands-on training provided directly by the institution. However, only 18 of 108 respondents indicated that hands-on training was included as part of their BSL-2 training program, so it is indicated that few institutions include hands-on training or interactive activities as part of the offered BSL-2 training. Furthermore, the survey did not include a question regarding hands-on or interactive training for work at ABSL-2.

Conclusions

A survey of BSOs was used to benchmark BSL-2 training programs offered by institutions of higher learning in the United States. Based on survey responses, most institutions that conduct research or teach at BSL-2 require laboratory personnel to complete BSL-2 training. Most respondents also indicated the requirement was the policy of both the IBC and the institution. The format or delivery method used to provide the BSL-2 training was predominantly provided using an on-demand format, with a small contingent of respondents (<10%) indicating a hands-on training component was included, regardless of delivery format. Most institutions offer BSL-2 training that is less than three hours long. Most institutions that indicated they require BSL-2 training for personnel also provide refresher BSL-2 training, with on-demand being the predominant format. The results of this survey can serve as an opportunity for institutions to benchmark their BSL-2 training programs and provides evidence that most institutions have a mandatory BSL-2 training requirement as part of their IBC requirements.

Footnotes

Acknowledgments

The authors would like to thank the Iowa State University Center for Survey Statistics and Methodology (ISU CSSM), which was consulted to help formulate questions. The authors would also like to thank the Iowa State University Statistical Consulting Group, which performed the statistical analyses for this article.

Authors’ Contributions

K.H. and S.Z. contributed to the design and implementation of the research, K.H. contributed to the analysis of results, and all authors contributed to the writing of the article. B.M. conceived the original concept and supervised the project.

Data Access Statement

Research data supporting this publication are available from the corresponding author.

Authors’ Disclosure Statement

No competing financial interests exist.

Funding Information

No funding was received for this article.

References

Centers for Disease Control and Prevention . Biosafety in Microbiological and Biomedical Laboratories, 6th ed. Revised. 2020. Available from: https://www.cdc.gov/labs/pdf/SF__19_308133-A_BMBL6_00-BOOK-WEB-final-3.pdf [Last accessed: March 18, 2024].

Centers for Disease Control and Prevention. Guidelines for Biosafety Laboratory Competency. MMWR Suppl. 2011; 60(02):1–23. Available from: https://www.cdc.gov/mmwr/pdf/other/su6002.pdf [Last accessed: March 18, 2024].

National Institutes of Health. NIH Guidelines for research involving Recombinant or Synthetic Nucleic Acid Molecules (NIH Guidelines), Revised 3. 2019. Available from: https://osp.od.nih.gov/wp-content/uploads/NIH_Guidelines.pdf [Last accessed: March 18, 2024].

United States of America. Code of Federal Regulations. Occupational Exposure to Hazardous Chemicals in Laboratories, 29 CFR Part 1910. 1450. Available from: https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XVII/part-1910/subpart-Z/section-1910.1450 [Last accessed: March 18, 2024].

United States of America. Code of Federal Regulations. Bloodborne Pathogens, 29 CFR Part 1910. 1030. Available from: https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XVII/part-1910/subpart-Z/section-1910.1030 [Last accessed: March 18, 2024].

United States of America. Code of Federal Regulations. Select Agents and Toxins, 42 CFR Part 73. Available from: https://www.ecfr.gov/current/title-42/chapter-I/subchapter-F/part-73?toc=1 [Last accessed: March 18, 2024].

, Guo

, Wang

, et al. Current challenges of university laboratory: Characteristics of human factors and safety management system deficiencies based on accident statistics. J Safety Res, 2023; 86:318–335; doi: 10.1016/j.jsr.2023.07.010

. Discussion on safety and environmental protection management of biology laboratory. Res. Explor. Lab, 2011; 30:176–178.

Wirth

, Foreman

, Friedel

, et al. Two discrete choice experiments on laboratory safety decisions and practices. J Safety Res, 2020; 75:99–110; doi: 10.1016/j.jsr.2020.08.005

10.

Harding

, Byers

. Epidemiology of laboratory-associated infections. In: Biological safety: principles and practices 4th ed. ( Fleming

, Hunt

. eds.): ASM Press; Washington, DC. 2006:53–77, doi: 10.1128/9781555815899.ch4

11.

Chamberlain

, Burnett

, King

, et al. Biosafety Training and Incident-reporting Practices in the United States: A 2008 Survey of Biosafety Professionals. Appl Biosaf, 2009; 14(3):135–143; doi: 10.1177/153567600901400305

12.

National Association for College Admissions Counseling. College sizes: small, medium, or large? Available from: https://www.collegedata.com/resources/the-facts-on-fit/college-size-small-medium-or-large [Last accessed: May 18, 2024].

13.

United States Department of Labor. Training Requirements in OSHA Standards, 2020, Lulu Press Incorporated. Available from: https://www.osha.gov/sites/default/files/publications/osha2254.pdf.

14.

Ménard

, Trant

. A review and critique of academic lab safety research. Nat Chem, 2020; 12(1):17–25; doi: 10.1038/s41557-019-0375-x

15.

Oxford Learning College. Online Education and E-Learning Statistics UK. Available from: https://www.oxfordcollege.ac/news/online-education-statistics/ [Last accessed: March 18, 2024].

16.

Sarvary

, Castelli

, Asgari

, et al. Undergraduates’ experiences with online and in-person courses provide opportunities for improving student-centered biology laboratory instruction. J Microbiol Biol Educ, 2022; 23(1); doi: 10.1128/jmbe.00289-21

17.

ABSA International. Credentialing Maintenance Program Guide. Available from: https://absa.org/wp-content/uploads/2022/11/ABSA-CM-Program-Guide.pdf [Last accessed: March 18, 2024].

18.

Ahuja

, DeSena

, Lio

. Continuing medical education in dermatology: The possible use of artificial intelligence. Clin Dermatol, 2024; 42(1):79–81; doi: 10.1016/j.clindermatol.2023.10.016

19.

Colligan

, Cohen

. The role of training in promoting workplace safety and health. Psychol Workplace Safety, 2004:223–248; doi: 10.1037/10662-011

20.

Tran

, Tofade

, Thakkar

, et al. U.S. and international health professions’ requirements for continuing professional development. Am J Pharm Educ, 2014; 78(6):129; doi: 10.5688/ajpe786129

21.

Makransky

, Thisgaard

, Gadegaard

. Virtual simulations as preparation for lab exercises: Assessing learning of key laboratory skills in microbiology and improvement of essential non-cognitive skills. PLoS One, 2016; 11(6):e0155895; doi: 10.1371/journal.pone.0155895

22.

Means

, Toyama

, et al. Evaluation of evidence-based practices in online learning: A meta-analysis and review of online learning studies. U.S. Department of Education. 2010. Available from: http//www.2.ed.gov/rschastat/eval/tech/evidence-based-practices/finalreport.pdf.

23.

Rogers

. A study in the effectiveness of online CPR recertification training for rural and remote nurses in Canada. Fielding Graduate University. 2013. Available from: https://www.proquest.com/dissertations-theses/study-effectiveness-online-cpr-recertification/docview/1352752456/se-2?accountid=10906.

24.

Pinchot

, Paullet

. Different keystrokes for different folks: Addressing learning styles in online education. Information Systems Education Journal, 2014; 12(2):29–37. Available from: https://files.eric.ed.gov/fulltext/EJ1140787.pdf

25.

Dewan

MAA

, Murshed

, Lin

, et al. Engagement detection in online learning: A review. Smart Learn Environ, 2019; 6(1):1–20; doi: 10.1186/s40561-018-0080-z

26.

Al Rawashdeh

, Mohammed

, Al Arab

, et al. Advantages and Disadvantages of using e-learning in university education: Analyzing students’ perspectives. Ejel, 2021; 19(3):107–117. Available from: https://files.eric.ed.gov/fulltext/EJ1296879.pdf

Biosafety Level 2 Training Programs at Institutions of Higher Learning in the United States