Improving infection prevention and control in Ghana primary health care facilities: Evaluation of the STREAM disinfectant generator

Infection prevention and control is essential for high-quality health care. Chlorine is a widely used disinfectant in health care facilities; however, inconsistent availability and quality pose challenges for health staff. On-site chlorine production offers a potential solution. This study evaluates the reliability, change in chlorine availability and quality, and total cost of ownership of the Aqua Research STREAM Disinfectant Generator in primary health care facilities in Ghana. Our cross-sectional study evaluated 18 STREAM devices across 12 primary health care facilities in Ahafo, Central, and Volta Regions. A mean time between failures approach was used to benchmark device reliability. Historical commercial chlorine stock records were compared with STREAM chlorine production volumes. Chlorine quality assessments compared free residual chlorine levels in commercial and STEAM chlorine samples. A 5-year cost model estimated the total cost of STREAM ownership and per-liter cost savings potential. STREAM units remained functional for 94.8% of the study; 67% (n = 12) functioned without failure. Six devices averaged 60.8 days before their first failure (range 16–96 days). No device recorded more than one component failure. STREAM devices eliminated chlorine stock outs, previously occurring 37 days per year on average. In all, 83% of health facilities were found to have degraded commercial chlorine, whereas 100% of STREAM samples met the device’s target concentration (0.5% ± 0.1% mg/L). The 5-year total cost of ownership ranged from $3,700 to $7,900. District hospitals saw a 17% reduction in annual chlorine supply costs with STREAM units, while health centers experienced an increase of 48%. The STREAM shows promise for improving infection prevention and control practices in Ghana’s health system. Study results informed the Ghana Health Service’s decision to purchase 400 STREAM devices (June 2024). Future research should explore operational models that expand chlorine availability and lower chlorine costs in health facilities.