Making Surgery Affordable: Design of a Surgical Drill Cover System for Scale in Low-Resource Settings

Many surgeons in low-resource settings do not have access to safe, affordable, or reliable surgical drilling tools. Surgeons often resort to non-sterile hardware drills because they are affordable, robust, and efficient, however impossible to sterilize. A promising alternative is to use a Drill Cover system (a sterilizable fabric bag plus surgical chuck adapter) so that a non-sterile hardware drill can be used safely for surgical bone drilling. Our objective was to design a safe, effective, affordable Drill Cover system for scale in low-resource settings. We designed our device based on feedback from users at Mulago Hospital (Kampala, Uganda) and focused on three main aspects. The first key aspect of our design was a sealed barrier between the surgical field and hardware drill that withstands pressurized fluid. The second feature was the selection of a hardware drill with maximum speed of 1050 RPM, a speed that matches common surgical drills and reduces risk of necrosis. The third key feature was a fabric cover optimized for ease of assembly while maintaining sterile technique. Furthermore, with the Drill Cover approach, multiple Drill Covers can be provided with a single battery-powered drill in a ‘kit’, so that the drill can be used in backto-back surgeries without requiring immediate sterilization. Our Drill Cover design provides a proof-of-concept for a product that can be commercialized and produced at scale. By designing a system that meets the needs of end-users, the Drill Cover has the potential to scale globally.