Evidence-based recommendations for homes, schools and public spaces to improve public health and reduce preventable illnesses
On Global Handwashing Day, WHO and UNICEF have released the first-ever global Guidelines on Hand Hygiene in Community Settings to support governments and practitioners in promoting effective hand hygiene outside health care – across households, public spaces and institutions. Framing hand hygiene as a public good and a government responsibility, the Guidelines translate evidence into ready-to-adopt actions that enable sustainable access to effective hygiene services. This will reduce diarrhoeal disease, acute respiratory infections and other preventable illnesses, strengthening routine public health where people live, work, visit and study, and emergency preparedness, including outbreaks like cholera.
Despite clear benefits, 1.7 billion people still lacked basic hand hygiene services at home in 2024, including 611 million with no facility at all. Meeting the 2030 target will require accelerated progress – about a doubling in the global rate, and much faster in specific settings (up to 11-fold in least-developed countries and 8-fold in fragile contexts). Hand hygiene remains one of the most cost-effective health investments, reducing diarrhoea by 30% and acute respiratory infections by 17%, with large, measurable gains for population health.
"Clean hands save lives, but results at scale require policy, financing and accountability," said Dr Ruediger Krech, Director a.i, Department of Environment, Climate Change, One Health & Migration at the World Health Organization. "These Guidelines help countries move beyond fragmented projects to government-led systems that make soap, water, and conditions conducive to everyday hand hygiene the norm."
"Children and young people pay the highest price when basic hygiene is out of reach," said Cecilia Scharp, Director, Water Sanitation and Hygiene (WASH) Team, Programme Group, UNICEF. "These Guidelines provide practical steps to ensure facilities are accessible when they need to be – in homes, schools, markets, and transport hubs – so every child can learn, play and thrive with dignity."
The guideline recommendations are:
- hand hygiene in community settings is an important public health measure; governments should promote it by removing barriers and enabling sustained behaviour change. This includes clear roles, financing and monitoring at national and local levels, consistent with international health obligations;
- hand hygiene should be practiced using plain soap and water long enough to fully cover and rub both hands; when hands are not visibly dirty, alcohol-based hand rub (≥60% alcohol) is an effective alternative. Five key times are emphasized: before preparing food; before eating or feeding/breastfeeding others; after using the toilet or handling faeces; after coughing/sneezing/nose-blowing; and when hands are visibly dirty; and,
- core requirements include: (a) Minimum materials on premises – reliable water plus soap or alcohol-based hand rub (ABHR) – with safe grey water disposal; (b) clear information on why, when, how and where to clean hands; and (c) a conducive physical and social environment so facilities are convenient, accessible and easy to use, and norms support regular practice.
The Guidelines also set out seven cross-cutting principles for implementation: prioritize meeting minimum material needs; understand drivers/barriers to behaviour; engage communities; ensure gender responsiveness; commit to progressive improvement; strengthen systems; and monitor, evaluate and improve.
Efforts to improve hand hygiene must move beyond project-based approaches and short-term service delivery, towards government-led strengthening of national and local systems for hand hygiene. Governments and international institutions often mobilize rapidly during disease outbreaks, deploying resources, strengthening health systems and raising public awareness. However, once an emergency is contained, momentum is often lost, budgets are cut, preparedness plans go dormant and political attention shifts elsewhere. This reactive approach undermines long-term resilience, leaving systems vulnerable when the next crisis arises. To break this cycle of panic and neglect, governments should strengthen systems that can deliver hand hygiene services as part of broader health systems.
Effective government measures to strengthen systems include providing policy and legal frameworks, regulation and monitoring that support planning and actions and coordinating these processes through national institutions with a clear delineation of mandates and sufficient human and financial resources. These measures should enable effective, equitable and sustainable delivery of the preconditions and an enabling environment needed for the sustained provision of hand hygiene services. These services, in turn, provide reliable, accessible and affordable hand hygiene facilities for all, along with their operation and maintenance and ongoing behaviour change strategies for sustained practice.
