World Health Organization · 2025 · 38 pages
Strategic framework and key IPC/WASH actions for national and subnational health authorities managing active mpox outbreaks
- Issuer
- World Health Organization
- Edition
- 2025
- Audience
- Mpox response IPC/WASH pillar leads, implementing partners, donors, national/subnational health authorities, academic partners
- Evidence
- Derived from WHO mpox SPRP, Clinical management and IPC guideline, and Framework for IPC in outbreak response; expert contributor review
- Reviewed
- 14 Oct 2026 · GMJ
What this guideline says
GMJ summary
This WHO guideline presents a three-pronged strategic framework for infection prevention and control (IPC) and water, sanitation and hygiene (WASH) during mpox outbreak response. It is designed to complement the global mpox Strategic Preparedness and Response Plan (SPRP) and provides actionable guidance for national and subnational health authorities responding to active mpox transmission.
The strategy focuses on: (1) safe and scalable care within health-care facilities and mpox treatment centres, protecting patients and health workers; (2) enhanced community protection during home care and in high-risk congregate settings such as IDP camps, prisons, sex-on-premises venues and schools; and (3) cross-pillar technical support for vaccination activities, points of entry, and safe burials. The document emphasises coordination mechanisms, rapid capacity-building, assessment-driven improvement plans, and supply chain management.
Implementation is guided by context-specific prioritisation based on transmission dynamics, evidence-based interventions, and sustainable infrastructure investments. The framework includes monitoring indicators, tools (mpox rapid assessment tool for health facilities, screening forms, training modules), and operational guidance for isolation, referral pathways, and WASH services in resource-limited settings.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Establish screening, identification, isolation and referral pathways for suspected/confirmed mpox cases at health-care facility entrances using national screening tools and case definitions
- Implement mpox IPC-WASH Rapid Assessment Tool (RAT) in priority health facilities quarterly to develop improvement plans and monitor progress by at least one level improvement
- Target zero mpox infections among health and care workers through proper PPE use, exposure risk assessment, hand hygiene stations at all facility entrances, and infection investigation protocols
- Provide complete hygiene kits to households with mpox home-based care (UNICEF kit list) where facility isolation capacity is limited
- Ensure hand hygiene stations (soap and water or alcohol-based hand rub) at entrances of all public buildings including schools, health facilities, markets, IDP camps, and congregate settings
- Cascade training-of-trainer materials to health and care workers, community health workers and WASH practitioners using pre- and post-test assessment methods
- Coordinate IPC/WASH supply forecasting using the Essential Items Estimator Tool based on RAT results and ensure regular availability to mpox treatment centres and referral facilities
- Establish or strengthen national and subnational IPC and WASH coordination taskforce with clear terms of reference, partner mapping (4 W's: who, what, when, where), and integration with health/WASH clusters in humanitarian contexts
Key actions for safe and scalable care in health-care settings
Table extracted from the guideline
| Element | National-level key actions | Subnational/facility implementation | Available tools |
|---|---|---|---|
| Screening, isolation & referral | Establish strategy for screening, identification, isolation/referral and notification aligned with national pathways | Develop/adapt clinical care and referral pathway guidance; disseminate screening plans at facility entrances; assess isolation facilities for IPC requirements | Mpox RAT for health facilities; Screening form; Case definition; Isolation blueprints; Training modules |
| IPC/WASH assessments | Support identification, planning, implementation and monitoring of assessments in priority facilities with improvement plans | Disseminate WHO IPC-WASH RAT; define criteria for priority facilities; compile results; provide supportive supervision and mentorship | WHO mpox RAT for health facilities; Training modules |
| Health worker protection | Ensure implementation and monitoring of measures to protect health/care workers and patients | Develop/adapt guidelines for case management and exposure prevention; establish exposure identification and infection investigation; implement hand hygiene improvement strategies | Clinical management/IPC guidance; Health worker exposure risk assessment tool; Mpox RAT |
| Training | Leverage, develop/adapt and disseminate health and care worker training | Adapt/develop training materials including training-of-trainers; cascade trainings with pre/post-test assessment; update based on epidemiology; establish ongoing mentorship | Mpox HCW training modules; Mpox RAT |
| Essential supplies | Ensure availability of supplies, infrastructure, equipment and IEC materials | Use forecasting tools and RAT results to forecast needs; identify and allocate resources subnationally; ensure regular WASH/IPC supply availability; develop training on proper use | Essential Items Estimator Tool; IPC-WASH RAT |
| Surge capacity | Plan for surge capacity to manage increased cases and maintain IPC/WASH | Assess IPC/WASH focal point capacity; include programmatic and emergency teams; plan additional facilities with resources; re-evaluate based on epidemiology | Workload Indicators of Staffing Need User Manual; Guidelines on core components of IPC programmes |
Source: World Health Organization, Strategic actions for infection prevention and control and water, sanitation and hygiene during mpox outbreak response. Reproduced in summary form.
From the guideline
Verbatim
“The target is zero mpox infections among health and care workers in all affected Member States.”
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 on outbreak response capacity in Georgia and the region for many years, I find this framework particularly valuable because it moves beyond generic IPC principles to provide concrete, mpox-specific assessment and monitoring tools. For Georgian clinicians and public health professionals, I would stress the quarterly facility assessment cycle using the RAT tool—this structured approach to identifying and closing IPC gaps has proven effective in our tuberculosis and hepatitis C programmes, and the same discipline will serve mpox preparedness well. The framework's emphasis on home-based care with proper support is realistic for our context, where rural facility capacity is limited but community health worker networks are relatively strong. One important implementation caveat: the document assumes functional coordination between health and WASH sectors, but in Georgia as in many countries, these often operate in separate administrative silos. Establishing the recommended IPC-WASH taskforce with clear terms of reference and regular meetings will require deliberate effort and high-level ministerial support, not just technical goodwill. The investment is worthwhile—the coordination gaps we saw during COVID-19 in some congregate settings must not be repeated.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 14 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this framework is directly applicable given the potential for mpox importation through cross-border movement and the need for preparedness in settings with limited IPC/WASH infrastructure in some congregate environments. Georgia’s national IPC programme would need to adapt the rapid assessment tool to Georgian health facilities, integrate mpox screening into existing syndromic surveillance at points of entry (land borders with Turkey, Armenia, Azerbaijan), and ensure hygiene kit specifications align with locally available supplies. The emphasis on coordination between health and WASH sectors is particularly relevant for IDP settlements in Georgia and conflict-affected areas across the region. National programmes should consider baseline WASH infrastructure gaps in rural health facilities and schools when prioritising improvement plans, and leverage existing training platforms (e.g. the National Center for Disease Control and Public Health’s outbreak response training) for cascaded capacity-building.
Questions this guideline answers
Quick answers
When should mpox cases be isolated at home versus in health facilities?
Each country must review its epidemiologic situation and health system capacity to determine the strategy. Where isolation capacity is limited, uncomplicated mpox cases may be managed at home with appropriate IPC/WASH support, complete hygiene kits, community health worker supervision, and education materials for the person with mpox and household caregivers. Facility isolation should be prioritised for severe cases, vulnerable populations, and where home conditions cannot support safe isolation.
What are the essential components of a hygiene kit for mpox home-based care?
According to the document, complete hygiene kits should be distributed to households where persons with mpox are cared for, following the UNICEF/WHO essential supplies list. The basic kit can be adapted based on identified needs at the subnational level. It should include supplies for hand hygiene (soap and/or alcohol-based hand rub), safe water access, sanitation, safe waste disposal, and personal protective equipment for caregivers.
How often should health facilities be assessed using the mpox IPC-WASH RAT?
The document specifies quarterly measurement frequency. The target is for 100% of priority health-care facilities in targeted areas to achieve at least one level of improvement on the IPC-WASH RAT for mpox from baseline, measured quarterly. Results should be compiled from subnational levels to inform resource allocation and identify needs for additional support.
What IPC measures are needed during mpox vaccination activities?
The document references specific operational guidance on IPC and WASH during mpox vaccination activities (WHO 2025). This includes standard IPC precautions, hand hygiene before and after each vaccination, safe waste disposal of used materials, and appropriate WASH infrastructure at vaccination sites. Cross-pillar coordination between IPC/WASH and vaccination teams is emphasised to ensure proper implementation.
Related on GMJ
Interconnected resources
Dictionary of Public Health
GMJ News coverage
Quality & accreditation
- ASF Hospital — Standard 5 — Safety & Emergency Preparedness
- ASF Medical Transport — Standard 5 — Infection Prevention & Control
- ASF Laboratory — Standard 7 — Examination: Process & Safety
- ASF Hospital — Standard 11 — Critical Care
- ASF Medical Transport — Standard 6 — Emergency Response During Transport
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- Issuer
- World Health Organization
- Type
- Guideline
- Edition
- 2025
- Status
- Current
- Published
- 2025-06-19
- Languages
- English
- Scope
- National and subnational IPC/WASH strategic planning and operational implementation during mpox outbreak response
- Audience
- Mpox response IPC/WASH pillar leads, implementing partners, donors, national/subnational health authorities, academic partners
- Pages
- 38
- Licence
- CC BY-NC-SA 3.0 IGO
- ISBN
- 978-92-4-010776-2
- Evidence
- Derived from WHO mpox SPRP, Clinical management and IPC guideline, and Framework for IPC in outbreak response; expert contributor review
- Record history
- Created 14 Oct 2026 · updated 14 Oct 2026 · next check Apr 2027
World Health Organization. Strategic actions for infection prevention and control and water, sanitation and hygiene during mpox outbreak response. Geneva: World Health Organization; 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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