Summary of commercial chlorine stockcard.

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.感染预防与控制是高质量医疗服务的核心要义。氯是医疗机构中广泛使用的消毒剂，但氯的供应稳定性与质量参差不齐，给医护人员带来了诸多挑战。现场制氯方案为解决这一难题提供了潜在路径。本研究针对加纳初级医疗保健机构中的Aqua Research STREAM消毒剂生成器（Aqua Research STREAM Disinfectant Generator），评估其可靠性、氯供应与质量的变化情况，以及总拥有成本。本横断面研究在阿哈福、中部以及沃尔塔地区的12家初级医疗保健机构中，对18台STREAM设备展开评估。研究采用平均故障间隔时间法对设备可靠性进行基准测试；将商用氯的历史库存记录与STREAM制氯量进行对比；通过氯质量评估，比对商用氯与STREAM氯样本中的游离余氯水平。此外，本研究构建了5年期成本模型，以估算STREAM设备的总拥有成本，以及每升氯的成本节约潜力。STREAM设备在研究周期内的正常运行率达94.8%，其中67%（n=12）的设备未发生任何故障。6台设备的首次故障平均间隔时长为60.8天（区间范围16~96天），且所有设备均未出现超过1次的部件故障。STREAM设备彻底解决了氯缺货问题——此前该地区年均氯缺货时长约为37天。研究发现，83%的医疗机构所使用的商用氯存在质量退化情况，而100%的STREAM氯样本均达到设备设定的目标浓度（0.5%±0.1% mg/L）。5年期总拥有成本区间为3700美元至7900美元。采用STREAM设备后，地区医院的年度氯供应成本降低17%，而卫生中心的年度氯供应成本则上升48%。STREAM设备在加纳医疗体系中展现出改善感染预防与控制实践的应用前景。本研究结果已助力加纳卫生服务局于2024年6月做出采购400台STREAM设备的决策。未来研究可探索优化运营模式，进一步提升医疗机构的氯供应稳定性并降低氯使用成本。