Poor outcomes for patients in developing areas, such as surgical site infections, longer hospital stays, and deaths, can be attributed to lack of access to surgical tool sterilization equipment, unreliable power supplies, and inadequate quality control over sterilization processes. Engineers at Rice University in Texas designed the Sterile Box, an autonomous, shipping-container-based sterile processing unit, to address these deficiencies.

The mobile container is designed to sterilize surgical instruments in low-resource settings. Image source: Rice University.A standard 20-foot steel shipping container houses the equipment required to prepare surgical instruments for safe reuse, including a water system for decontamination and a solar-powered autoclave for steam sterilization. Autoclaves are standard in modern hospitals but remain badly needed in low-resource settings. The Sterile Box, a nearly complete drop-in system, is largely self-sufficient in power and water.

The container includes solar panels and electrical storage as well as water distribution from two tanks, one on the ground that has a hand pump to move water to a 50-gallon tank on the roof. The interior has two rooms: a foyer that separates the sterile processing area from outsiders and the elements and a main area with al window to pass instruments in and out.

Processing is divided into four stations. At the first station technicians decontaminate instruments in a three-basin sink, removing debris and then soaking them in an enzymatic detergent and scrubbing with nylon brushes before a final rinse. At the second station an electric hotplate heats the steam autoclave that sterilizes the instruments. At the third, the instruments are dried on wire racks and then moved to the fourth stage, a storage cabinet where they await the next surgery (see video).

The next step will be to test the Sterile Box in a clinical setting. Baylor Global Initiatives at Baylor College of Medicine in Texas will incorporate the system into the planned deployment of its Smart Pod -- a mobile surgical suite also to be housed in a modified shipping container. Baylor expects to test its unit near the Malawi capital of Lilongwe in 2017.