World Health Organization · 1st edition, 2025 · 78 pages
Evidence-based recommendations for governments and practitioners to promote hand hygiene in households, schools, workplaces and public spaces
- Issuer
- World Health Organization
- Edition
- 1st edition, 2025
- Audience
- Government ministries (health, water/sanitation, education, labour) leading hand hygiene efforts; local government; international organizations; NGOs; civil society; service providers; public health and WASH practitioners
- Evidence
- GRADE-rated systematic reviews with moderate to high certainty evidence for materials and technique, low certainty for key times; WHO-INTEGRATE evidence-to-decision framework; strong recommendations based on clear balance of benefits over harms
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
These guidelines provide evidence-based recommendations for promoting hand hygiene in non-healthcare settings (households, schools, workplaces, public spaces) to reduce diarrhoeal diseases and acute respiratory infections. They establish that governments bear responsibility for implementing policy, legal, regulatory and fiscal measures to promote hand hygiene as a critical public health intervention.
The guidelines define three core requirements for changing and sustaining hand hygiene practice: (1) access to minimum material needs (reliable water and soap or alcohol-based hand rub, ABHR), (2) information on why, when and how to clean hands, and (3) a conducive physical and social environment. Effective hand hygiene should be practised with plain soap and water at five key times: before preparing food, before eating or feeding others, after using the toilet or handling faeces, after coughing/sneezing/nose blowing, and when hands are visibly dirty.
Implementation guidance emphasizes moving beyond project-based approaches toward government-led strengthening of national and local systems for hand hygiene, with clear delineation of roles across national government, local government, service providers and local facility administration.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Handwashing with soap and water can reduce risk of diarrhoea by 30% and acute respiratory infections by 17%, preventing 740,000 deaths annually
- Five key times for hand hygiene: before preparing food, before eating/feeding others, after toilet use/handling faeces, after coughing/sneezing/nose blowing, when hands visibly dirty
- Effective technique requires plain soap and water for enough time to cover both hands entirely with soap and thoroughly rub; ABHR (≥60% alcohol) is effective alternative when hands not visibly dirty
- Minimum water requirement: 0.5–2.0 L per handwashing session to enable wetting entire hand surface and thorough rinsing
- Minimum soap requirement: 1–3 mL liquid soap (1–3 g), 0.5–1 g bar soap, or 200 mL soapy water per event; 3–5 mL ABHR per event
- Hand hygiene facilities must provide reliable access to sufficient running/poured water and soap, with safe wastewater disposal, and be accessible to all users including children and those with limited mobility
- Antimicrobial soap not recommended; plain soap equally effective and avoids health/environmental harms from triclosan and triclocarban
- 1.7 billion people lacked basic hand hygiene services at home in 2024; 611 million had no handwashing facility at all
Core requirements for changing and sustaining hand hygiene practice
Table extracted from the guideline
| Core requirement | Definition | Key elements |
|---|---|---|
| (a) Minimum material needs | Hand hygiene facilities with reliable access for all to sufficient running/poured water and soap, or ABHR, with safe wastewater disposal | 0.5–2.0 L water per event; 1–3 mL liquid soap or 0.5–1 g bar soap or 200 mL soapy water or 3–5 mL ABHR; facilities accessible, affordable, durable, regularly maintained |
| (b) Information | Access to information on why, when, how and where to clean hands | Importance of handwashing (why); key times (when); technique (how); accessible, actionable, credible, relevant, timely, understandable |
| (c) Conducive environment | Physical and social environment that encourages consistent and sustained practice | Physical: convenient location, attractive design, easy to use; Social: visibility/role modelling, positive reinforcement, collective routines, community engagement |
Source: World Health Organization, Guidelines on hand hygiene in community settings. Reproduced in summary form.
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, Iise that hand hygiene remains amongst our most cost-effective public health interventions, yet 1.7 billion people worldwide still lack basic services at home. For Georgian clinicians, particularly those in primary care and paediatrics, I would stress the five key times for hand hygiene and the evidence that plain soap performs as well as antimicrobial formulations whilst avoiding environmental harm. The critical implementation challenge in our region will be sustaining government commitment beyond initial projects, especially in rural areas where reliable water access and winterised facilities require substantial infrastructure investment that must compete with other health priorities.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
These guidelines are highly relevant for Georgia and the South Caucasus region, where hand hygiene infrastructure varies significantly between urban and rural areas. National programmes should assess current coverage gaps (household facilities, schools, public spaces), establish a lead ministry for coordination across health, education, water/sanitation and municipal sectors, and develop costed implementation plans with clear targets. In rural and mountainous areas where piped water access is limited, programmes should prioritize interim solutions such as protected water sources with storage containers, foot-pump handwashing stations, and locally-produced soapy water solutions. Integration with existing maternal-child health, school health, infectious disease control and emergency preparedness programmes will be essential, as will ensuring facilities are winterized for cold-climate durability. Regional coordination across Armenia, Azerbaijan and Georgia could strengthen capacity development and enable shared procurement of hand hygiene products.
Questions this guideline answers
Quick answers
What is the minimum amount of water and soap needed for effective handwashing?
Each handwashing event requires 0.5–2.0 litres of water to enable wetting the entire hand surface and thorough rinsing. For soap, use 1–3 mL of liquid soap (about 1–3 grams), 0.5–1 gram of bar soap, or 200 mL of soapy water solution (made with 5 g powdered soap or 5 mL liquid soap per litre of water). The key is using enough to cover both hands entirely with soap.
When must ABHR contain at least 60% alcohol and when can it be used instead of soap and water?
ABHR must contain at least 60% alcohol to ensure disinfectant efficacy. It is an effective alternative to soap and water when hands are not visibly dirty and is particularly useful in public settings with high population density where water access is difficult. Use approximately 3–5 mL (a palmful) and rub hands until dry. However, soap and water remain the preferred option in households and most institutional settings where they are available.
Why is antimicrobial soap not recommended for community settings?
Plain soap is equally effective at removing pathogens as antimicrobial soap, but antimicrobial soaps containing triclosan and triclocarban may be harmful to health (endocrine disruption, skin irritation) and the environment (aquatic toxicity, antimicrobial resistance). Plain soap is defined as detergent containing no added antimicrobial agents or containing these only as preservatives. Liquid, bar or powdered forms of plain soap are all acceptable.
What is the minimum quantity of alcohol-based hand rub needed per application?
The guidelines recommend 3–5 mL of alcohol-based hand rub (containing ≥60% alcohol) per event, applied until hands are completely dry. ABHR is an effective alternative when hands are not visibly dirty.
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- ASF Hospital — Standard 18 — Sustainable Care
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 1st edition, 2025
- Status
- Current
- Published
- 2025-12-02
- Languages
- English
- Scope
- Community settings (households, public spaces, institutional settings excluding healthcare facilities) globally; applicable in low, middle and high resource contexts; relevant for routine public health and health emergency contexts
- Audience
- Government ministries (health, water/sanitation, education, labour) leading hand hygiene efforts; local government; international organizations; NGOs; civil society; service providers; public health and WASH practitioners
- Pages
- 78
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789240116559
- Evidence
- GRADE-rated systematic reviews with moderate to high certainty evidence for materials and technique, low certainty for key times; WHO-INTEGRATE evidence-to-decision framework; strong recommendations based on clear balance of benefits over harms
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
World Health Organization, United Nations Children's Fund (UNICEF). Guidelines on hand hygiene in community settings. Geneva: WHO and UNICEF; 2025. Licence: CC BY-NC-SA 3.0 IGO.GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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