Abstract
There is a critical need for safe water in healthcare facilities (HCF) in low-income countries. HCF rely on water supplies that may require additional on-site treatment, and need sustainable technologies that can deliver sufficient quantities of water. Water treatment systems (WTS) that utilize ultrafiltration membranes for water treatment can be a useful technology in low-income countries, but studies have not systematically examined the feasibility of this technology in low-income settings. We monitored 22 months of operation of 10 WTS, including pre-filtration, membrane ultrafiltration, and chlorine residual disinfection that were donated to and operated by rural HCF in Rwanda. The systems were fully operational for 74% of the observation period. The most frequent reasons for interruption were water shortage (8%) and failure of the chlorination mechanism (7%). When systems were operational, 98% of water samples collected from the HCF taps met World Health Organization (WHO) guidelines for microbiological water quality. Water quality deteriorated during treatment interruptions and when water was stored in containers. Sustained performance of the systems depended primarily on organizational factors: the ability of the HCF technician to perform routine servicing and repairs, and environmental factors: water and power availability and procurement of materials, including chlorine and replacement parts in Rwanda.
Highlights
A reliable supply of safe water is essential in health care facilities (HCF) for infection control and hygiene [1,2]
Water treatment systems (WTS) utilizing membrane UF are a feasible on-site water treatment method for health care facilities and perhaps other institutions in low-income countries. These systems are capable of producing large volumes of high quality water; their application is limited to areas with robust access to water supply, and in most instances, electrical power
In settings where post-collection storage is common or even necessary, residual disinfection is essential for maintaining water quality
Summary
A reliable supply of safe water is essential in health care facilities (HCF) for infection control and hygiene [1,2]. Insufficient water supply and substandard infrastructure ( sanitary facilities) have been documented as deterrents to seeking care, and contributors to staff absenteeism [4,5,6]. A recent review by the World Health Organization (WHO) of 54 countries estimated that 42% of HCF in low-income countries do not have an improved water source within 500 m [7]. Where HCF do have connections to a piped water supply from an improved source (including protected wells and rainwater in rural areas), there is a risk of contamination because water flow is often intermittent and infrastructure is substandard [8,9,10]. Intermittent water supply, whether from a networked or non-networked source, necessitates storage of water in containers in order to have a reliable water supply, and this presents an additional risk of recontamination [11,12]
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