Purpose: A third of the global disease burden requires surgical therapy, yet in disaster-affected areas and lower-middle income countries, 5 billion people have little or no access to safe surgical care. We develop, evaluate, and aim to deploy a new technology to help increase access to safe surgery. Methods: We conducted a needs assessment, then used iterative prototyping to incorporate stakeholder feedback and testing of all components. Proof-of-concept testing of the prototype entailed setup over a mannequin and using a particle counter to evaluate ability to provide a contaminant-free sterile field. Results: Our prototype shrinks the scope of the sterility challenge from the room to the critical space immediately over the incision. Users seal the modular system of sterile clear containers over the patient and operate via ports. An integrated airflow system controls enclosure conditions. Everything folds for rapid deployment. Testing demonstrates superior environmental control compared to standard operating rooms, including setup time, time to surgical site sterility, resistance to active contamination, and air changes per hour. Conclusions: Our results indicate that it is possible to provide state-of-the-art levels of sterility during surgeries even in austere settings, by using a low-cost, ultraportable, modular system codeveloped with key stakeholders.

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Vaccines need to be continuously stored between 2°C to 8°C, from their production to administration to beneficiaries. Every year, more than 25% of vaccines are wasted. One of the main reasons for this wastage is the lack of cold chain continuity in low-income settings, where electricity is scarce. Recently, several advances have been made in cooling technologies to store and transport vaccines. The current paper presents a review of refrigeration technologies based on scientific publications, industry white papers and other grey literature. For each refrigeration method, we describe its working principle, the best performing devices available as well as the remaining research challenges in order to obtain a very high degree of performance enhancement. Finally, we comment on their applicability for vaccine transport and storage.