Pan American Health Organization · 2020
Public health guidance on installing handwashing stations and promoting correct handwashing technique to prevent SARS-CoV-2 transmission.
- Issuer
- Pan American Health Organization
- Edition
- 2020
- Audience
- Public health professionals, healthcare facility managers, policymakers
- Evidence
- Expert consensus
- Reviewed
- 19 Oct 2026 · GMJ
What this guideline says
GMJ summary
This Pan American Health Organization guidance addresses the critical role of handwashing in minimising SARS-CoV-2 transmission, given that contaminated hands touching the mouth, nose and eyes represent one of the most common transmission routes. The document recommends free handwashing stations at critical entry points including healthcare facilities, commercial establishments, public transport stations and vulnerable communities with limited water access.
The guidance specifies that handwashing should involve contact with soap for 40–60 seconds and outlines key moments for handwashing: immediately after arriving home or at work, before and after handling money, before and after preparing or eating food, after using the bathroom, and before and after cleaning tasks. Regular soap is effective against SARS-CoV-2; where soap and water are unavailable, 70% alcoholic gel should be applied for 20–30 seconds, whilst sodium hypochlorite solutions at 0.05% concentration are the least recommended option due to risks of allergies, dermatitis, depigmentation and asthma with frequent use.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Handwashing should involve contact with soap for 40–60 seconds to be effective against SARS-CoV-2
- Where soap and water are unavailable, use 70% alcoholic gel applied for 20–30 seconds
- Sodium hypochlorite disinfecting solution at 0.05% concentration can be used when other options are unavailable, but is least recommended due to risks of allergies, dermatitis, depigmentation and asthma with frequent use
- Install free handwashing stations at entrances of healthcare establishments, commercial facilities, public transport stops and public buildings
- In healthcare facilities, place handwashing stations within 5 metres of toilets, at all service points, where PPE is donned and removed, and in all public areas
- Mandatory handwashing before entering critical points such as healthcare facilities and commercial establishments
- Regular soap is effective against SARS-CoV-2; bars of soap cannot transmit the virus
- Key moments for handwashing: immediately after arriving home or work, before and after handling money, before and after food preparation or eating, after using the bathroom, and before and after cleaning tasks
From the guideline
Verbatim
“One of the most commons ways of transmission of SARS-COV-2 is from contaminated hands touching the mouth, nose and eyes.”
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 Georgia continues to strengthen its public health infrastructure, this PAHO guidance offers practical specifications for handwashing programmes that extend beyond COVID-19 to broader infection prevention. The 40–60 second contact time with soap and the 5-metre proximity rule for handwashing stations near toilets in healthcare facilities are concrete benchmarks that Georgian health facilities can audit and implement. However, the recommendation for free handwashing stations at all public transport stops and commercial facilities must be adapted to Georgia's resource context, particularly in rural areas where water infrastructure remains limited. The guidance appropriately cautions against overuse of sodium hypochlorite solutions—a common household product in Georgia—highlighting the dermatological risks that frontline health workers and the public should understand.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 19 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus, this guidance is relevant for public health programmes addressing COVID-19 and other communicable diseases where hand hygiene is critical. National programmes would need to consider water access disparities between urban and rural areas, the feasibility of installing stations in high-traffic public spaces with limited infrastructure, and culturally appropriate messaging campaigns. Healthcare facilities would need to audit handwashing station placement against the 5-metre proximity criterion for toilets and ensure stations are present at all PPE donning/doffing areas as specified.
Questions this guideline answers
Quick answers
How long should handwashing with soap take to be effective against SARS-CoV-2?
Handwashing should involve contact with soap for 40–60 seconds to be effective.
Can SARS-CoV-2 be transmitted through bars of soap?
No, SARS-CoV-2 cannot be transmitted through bars of soap. Regular soap is effective against the virus.
What should be used when soap and water are not available?
When soap and water are unavailable, 70% alcoholic gel should be used, applying it for 20–30 seconds for hand hygiene.
Why is sodium hypochlorite solution not recommended for frequent handwashing?
Sodium hypochlorite solution at 0.05% concentration is the least recommended option because frequent use can lead to allergies, dermatitis, depigmentation and even asthma.
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Quality & accreditation
- ASF Hospital — Standard 18 — Sustainable Care
- ASF PHC — Standard 4 — Acute & Same-Day Care · Primary Health Clinic
- ASF PHC — Standard 7 — Governance & Staffing · Primary Health Clinic
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
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- ASF Laboratory — Standard 7 — Examination: Process & Safety
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- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Status
- Current
- Published
- 2020-01-01
- Scope
- SARS-CoV-2 transmission prevention through handwashing
- Audience
- Public health professionals, healthcare facility managers, policymakers
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus
- Record history
- Created 19 Oct 2026 · updated 19 Oct 2026 · next check Apr 2027
Pan American Health Organization. Recommendations to expand access to hand washing and its proper use. Washington, D.C.: PAHO; 2020. (PAHO/CDE/CE/COVID-19/20-0013). Available from: https://iris.paho.org/handle/10665.2/52064GMJ 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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