Dental Hygiene Clinical Waste Audit Feedback and Infection-Control Compliance in Ghanaian Health Centres: A Stepped-Wedge Implementation Trial

Clinical waste audit feedback is widely promoted as a low-cost lever for improving infection-control compliance in resource-limited dental settings, yet the stepped-wedge designs used to evaluate such programmes are rarely powered with explicit attention to the variance structure they will encounter. Power was estimated across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The analysis indicates that 54 clusters are required to detect a 5-percentage-point improvement at 80% power, a requirement that exceeds the largest cluster count examined and that has direct consequences for the feasibility of the planned trial. Minimum detectable effects at 80% power are reported for each cluster count, and the implications for the design of audit-and-feedback evaluations in African dental hygiene settings are discussed.