A tiny laboratory capable of doing big things is what Barry Kosloff, working with the London School of Hygiene and Tropical medicine, has created - a new type of high-tech, low-cost, tuberculosis (TB) lab in a shipping container. He walked IRIN/PlusNews through what it takes to build one.
“I don’t know if this is normal but it’s almost like I had a photograph of it in my head,” said Kosloff, who designed such a lab for the national reference laboratory in the capital, Lusaka. It is part of efforts by the Zambia AIDS-Related TB Project, a local NGO, to expand the country’s diagnostic capacity.
The facility is the first in Zambia to be equipped with infection controls that make it safe for staff to grow the TB cultures needed to diagnose HIV-positive patients, and to determine whether TB patients have successfully completed treatment.
Communicate with your suppliers
Based on his experience in designing container labs, Kosloff said it was important to get suppliers talking and listening.
“[Suppliers] didn’t really understand what we were trying to do, and we didn’t understand what the capabilities were,” he told IRIN/PlusNews. “It came with very small sinks, and it used US-style air conditioners - the ones where you have to make a big hole in the wall [to mount it], and that brought in a lot of dust.”
This time Kosloff made sure that suppliers installed bigger sinks and mounted air conditioners internally to avoid letting in dust that could damage equipment and contaminate TB cultures.
“We wanted bigger sinks because in TB labs you make smears or stain slides, so we needed sinks you could actually work in,” he said.
The space race
The lab can handle 100 sputum samples a day, using four technicians.
Kosloff said many people were surprised that a lab this small could be so efficient. He said a container lab’s size could improve efficiency if you utilized the space to best advantage.
“In most container labs I’ve seen they tend to just have counters and equipment along one wall - they don’t make use of both sides …[like] I did,” he told IRIN/PlusNews.
“It’s like a [ship’s] galley kitchen, where you have equipment on both sides and all you have to do is turn around and there’s more equipment,” he said. “The layout is very efficient - when you sit down everything is close by. You’re not having to get up every five minutes and get something from down the hall.”
The efficient use of space also allows more room for storing supplies, which is important because the lab could be stationed in a remote location for a period of time.
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Go with the flow
The possibility of spilled specimens that could send a spray of infectious TB bacteria into the air and into a technician’s respiratory tract makes working in a TB lab dangerous. Well-designed ventilation and exhaust systems are critical.
In Kosloff’s lab, air is drawn into the container and filtered, then moves in a one-directional flow from the least dangerous part of the lab to the room where cultures and sputum are handled, which has negative pressure. If an accident occurred, the direction of the air flow would prevent dangerous bacteria from being carried out of the negative pressure zone and reaching technicians in other rooms.
“This also works better when you have a long, narrow room. If you have a big room, the air is getting stirred around in all different directions, and that doesn’t protect you very well,” Kosloff commented.
The doors are self-closing but the air flow also helps make sure they stay shut - a standard infection-control measure. In more expensive labs the doors are also fitted with electromagnetic locks to ensure that they do not stay open, and that no two doors are open at the same time. In the space-constrained container, Kosloff placed doors between rooms close together, which makes opening any two at the same time very awkward.
The ventilation and air filtration systems also help keep the lab clean. In Zambia’s dusty climate, the filters in lab equipment typically have to be replaced every year but Kosloff estimated that those in the container lab could last up to four years, making maintenance cheaper and easier.
Kosloff looked for regional expertise to fit out the lab and used Air Filtration Maintenance Services (AFMS), a South African company, to design and install the ventilation and exhaust systems. Although AFMS had not worked on a container before, their knowledge of resource-poor settings like Zambia meant the company used as many locally obtainable parts as possible, making it easier to find replacements and do small repairs in Lusaka.
“In the US, when you have a problem you call someone and they’re there in an hour. Here, if something breaks we have to fly people in from South Africa because there’s no one in the country that can do the work,” Kosloff told IRIN/PlusNews. “The fancier the system, the more you need highly skilled people to fix it.”
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions