World Health Organization · 1st edition, 2019 (published 2020) · 55 pages
Starting-point standards for IPC programme implementation at national and health facility levels to protect patients and healthcare workers.
- Issuer
- World Health Organization
- Edition
- 1st edition, 2019 (published 2020)
- Audience
- IPC and AMR focal points, policy-makers, senior managers, facility directors, IPC teams and committees, quality and patient safety leads
- Evidence
- Expert consensus (>70% agreement threshold) based on systematic review of IPC minimum standards literature and global inventory of IPC guidance
- Reviewed
- 23 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO technical document establishes the minimum requirements for infection prevention and control (IPC) programmes based on the eight core components framework. It defines the essential starting point for countries and facilities to build effective IPC programmes through a stepwise approach, recognizing that full implementation takes time but minimum protection must be in place immediately.
The minimum requirements cover all eight core components: IPC programmes (dedicated focal points and budget), IPC guidelines (evidence-based SOPs for hand hygiene, environmental cleaning, waste management, and standard precautions), education and training (orientation for all new staff), HAI surveillance (technical groups at national level, active surveillance in tertiary care), multimodal strategies (for priority interventions), monitoring and feedback (hand hygiene as essential indicator), workload and staffing (bed occupancy not exceeding capacity, adequate staff ratios), and built environment (improved water sources on premises, functional sanitation, hand hygiene facilities at points of care, waste segregation, adequate ventilation and lighting).
The document differentiates requirements across primary, secondary, and tertiary care levels, with progressively more stringent standards reflecting increasing complexity and risk. It emphasizes that minimum requirements are the foundation, not the goal—all countries should progress toward full implementation of WHO core components to effectively reduce healthcare-associated infections and antimicrobial resistance.
Key points
For clinicians — doses and thresholds as stated in the guideline
- National level: at least one full-time trained IPC focal point and dedicated budget for implementing IPC strategies
- Primary care: trained IPC link person with dedicated time in each facility; IPC-trained officer at district level for supervision
- Secondary care: one full-time trained IPC officer per 250 beds (e.g., 50% FTE for 120-bed facility) with dedicated budget
- Tertiary care: at least one full-time trained IPC focal point per 250 beds, multidisciplinary committee, access to microbiology laboratory, and dedicated budget
- All facilities: evidence-based SOPs for hand hygiene, decontamination of medical devices, environmental cleaning, waste management, injection safety, HCW protection, aseptic techniques, and triage
- Water: improved source on premises for all IPC measures (primary); piped water inside facility 24 hours to high-risk wards minimum (secondary/tertiary)
- Sanitation: minimum two functional improved toilets (one for patients, one for staff) with menstrual hygiene facilities (primary); two for outpatient, one per 20 beds inpatient (secondary/tertiary)
- Hand hygiene: functional stations with ABHR or soap, water, and single-use towels at all points of care; hand hygiene compliance monitoring essential in secondary/tertiary care
Minimum requirements for IPC programmes across facility levels (Core Component 1)
Table extracted from the guideline
| Level | IPC staffing | Programme structure | Additional requirements |
|---|---|---|---|
| Primary care | Trained IPC link person with dedicated (part-) time in each facility; One IPC-trained health care officer at district level | — | District officer supervises IPC link professionals |
| Secondary care | One full-time trained IPC officer per 250 beds with dedicated time (e.g., 50% FTE for 120 beds) | Dedicated budget for IPC implementation | — |
| Tertiary care | At least one full-time trained IPC focal point per 250 beds | Dedicated budget; Programme aligned with national programme | Multidisciplinary committee/team; Access to microbiology laboratory |
Source: World Health Organization, Minimum requirements for infection prevention and control programmes. Reproduced in summary form.
From the guideline
Verbatim
“IPC standards that should be in place at both national and health facility level to provide minimum protection and safety to patients, health care workers and visitors, based on the WHO core components for IPC programmes.”
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 someone who has worked with WHO on health systems strengthening in the region, I recognize this document addresses a critical gap: many facilities in Georgia and neighbouring countries attempt IPC activities without the foundational structures in place. The minimum requirement I would stress to Georgian colleagues is the 1:250 IPC officer ratio for secondary and tertiary hospitals with dedicated time—too often we see IPC assigned as an additional duty to already overburdened infection disease physicians. The practical challenge for implementation will be at primary care level: training and supporting district-level IPC officers to supervise link persons in dozens of rural ambulatories, many with fewer than 10 staff, requires a coordinated national training programme and sustainable financing that Georgia's decentralized PHC financing model must accommodate. The document's integration with WASH requirements is particularly important given that the 2018 WHO/UNICEF baseline report found only 55% of health facilities in the European Region had basic water services.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 23 Oct 2026
Applicability
Georgia and the South Caucasus
This document is highly relevant for Georgia and the South Caucasus as countries strengthen health systems toward universal health coverage and prepare for EU accreditation pathways. Georgia’s National Action Plan on Antimicrobial Resistance (adopted 2019) requires functional IPC programmes at all levels, yet resource constraints mean most facilities must begin with minimum requirements before achieving full implementation. The document’s tiered approach—differentiating primary, secondary, and tertiary care—aligns well with Georgia’s health system structure and the regional reality of limited IPC-trained personnel. National programmes should prioritize: establishing at least one full-time national IPC focal point (currently absent in some South Caucasus countries), ensuring water availability on premises in all primary care facilities (a gap in rural Armenia and Azerbaijan), implementing hand hygiene monitoring with feedback in all secondary and tertiary hospitals, and training district-level IPC officers to supervise primary care link persons. The emphasis on starting with minimum standards while planning stepwise progress toward full core component implementation provides a realistic roadmap for resource-limited settings in the region.
Questions this guideline answers
Quick answers
What is the difference between minimum requirements and full core component requirements?
Minimum requirements are the essential starting point that MUST be in place immediately to provide basic protection to patients and healthcare workers. Full requirements represent the gold standard—complete implementation of all WHO core components. Countries and facilities should assess current status, implement minimum requirements first, then progressively build toward full implementation through a stepwise, prioritized action plan.
How many IPC staff are needed in a 200-bed district hospital?
At minimum: one full-time trained IPC officer (nurse or doctor) at 80% FTE (200 beds ÷ 250 = 0.8), with dedicated time to carry out IPC activities and a dedicated budget. The full requirement is the same ratio (1:250 beds), though facilities with higher patient acuity may need a higher ratio of 1:100 beds due to complexity of care and multiple IPC responsibilities.
What hand hygiene facilities are required at primary care level?
Functional hand hygiene facilities must always be available at points of care and toilets. This means: ABHR at points of care OR soap, water, and single-use towels (or clean reusable towels if single-use unavailable); AND soap, water, and single-use towels within 5 metres of toilets. Secondary and tertiary care require ABHR at points of care (soap and water is not sufficient at this level).
Is HAI surveillance required in primary and secondary care facilities?
No, HAI surveillance is not a minimum requirement for primary care, though facilities should follow national plans if available (e.g., outbreak detection and reporting). Secondary care should follow national or sub-national plans. Active HAI surveillance with timely feedback is a minimum requirement only for tertiary care facilities, where it should include AMR data and be directed by facility and country priorities.
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- Issuer
- World Health Organization
- Type
- Technical document
- Edition
- 1st edition, 2019 (published 2020)
- Status
- Current
- Published
- 2020-05-05
- Languages
- English (original); translations not specified in document
- Scope
- National and health facility levels (primary, secondary, tertiary care); all eight WHO IPC core components
- Audience
- IPC and AMR focal points, policy-makers, senior managers, facility directors, IPC teams and committees, quality and patient safety leads
- Pages
- 55
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 9789241516945
- Evidence
- Expert consensus (>70% agreement threshold) based on systematic review of IPC minimum standards literature and global inventory of IPC guidance
- Next review
- Not specified (guideline development date: 2019; published 2020)
- Record history
- Created 23 Oct 2026 · updated 23 Oct 2026 · next check Apr 2027
World Health Organization. Minimum requirements for infection prevention and control programmes. Geneva: WHO; 2019. 55 p. ISBN 978-92-4-151694-5.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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