Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda.

BACKGROUND: Effective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda. METHODS: We installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device). RESULTS: Chlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products. CONCLUSION: The STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.

Factors associated with adherence to safe water chain practices among refugees in Pagirinya refugee settlement, Northern Uganda.

Poor adherence to safe water chain practices is a major obstacle to consumption of safe drinking water. In refugee settings, adherence to safe water chain is critical in minimizing water-related diseases. Despite this, little is known about the level of adherence to safe water chain and associated factors, especially in emergency settings. In this study, we interviewed 400 household heads in Pagrinya refugee camp in Northern Uganda and assessed household level adherence to safe water chain practice and associated factors. Modified Poisson regression was used to model the association between adherence to safe water chain and independent variables. All households utilized improved water sources and 74.0% had high adherence to safe water chain. Having post-primary education and high level of knowledge about the safe water chain were positive predictors of high adherence to the safe water chain while round travel time exceeding 1 hour during water collection was negatively associated with high adherence. There is a need for awareness campaigns on safe water chain maintenance among refugees without any formal education. Constructing more water sources would also minimize round travel time during water collection and enable households to collect sufficient water that enables hygienic water storage and use.