Sterilization techniques in underground surgical units in Afghanistan.

Sterilization equipment and techniques available to forward surgical units in modern conflicts past and present are sophisticated and generally taken for granted. Underground surgical units operating in rural Afghanistan must function without electricity or petroleum-powered generators and, with few exceptions, are unable to use sterilization equipment that produces intense heat for prolonged periods. We discuss the equipment and techniques developed for use by the IMC to sterilize surgical instruments, gowns, gloves, rubber goods, and sutures in the 42 clinics operating in resistance-held Afghanistan. These techniques may have application to other similar primitive conditions.