Effectiveness and Sustainability of Water Chlorination in Public Healthcare Services in Guatemala

Healthcare-associated infections are a significant public health challenge, particularly in resource-limited settings. While hand hygiene is critical for infection prevention, contaminated water from hand hygiene stations (HHSs) in healthcare facilities (HCFs) may undermine infection control efforts. Chlorination can reduce microbial contamination in HHSs, ensuring that water intended for hygiene does not become an infection source.

Water quality was monitored before and after the installation of on-site chlorine dispensers (CDs) in water tanks and HHSs of HCFs in Quetzaltenango, Guatemala, to evaluate their effectiveness in improving water quality. Focus groups were conducted to develop action plan proposals to ensure the intervention's sustainability.

Before the intervention, 75% of HHS water samples tested positive for total coliforms, with 50% testing positive for presumptive extended-spectrum beta-lactamase (ESBL)-producing total coliforms, while 20% were E. coli-positive, with 50% presumptive ESBL-producing E. coli. After installing CD, 1% of samples were coliform-positive over a six-month period. Focus groups identified resource limitations and political barriers and proposed solutions such as developing operational manuals, strengthening inter-institutional relationships, and forming alliances with external organizations.

Localized chlorination was successfully implemented using a community participatory approach to improve water quality in resource-limited HCFs. These findings have important implications for infection prevention and control.