Hand Hygiene Facilities, Behaviors and Promotion

Photo by Steve Sara / MCSP

Appropriate Resources:

In their 2017 progress update report, the Joint Monitoring Programme released the first international standard monitoring service ladders for WASH services in HCFs. Hand Hygiene service levels are defined as:

  • Basic: Hand hygiene materials, either a basin with water and soap or alcohol hand rub, are available at points of care and toilets.
  • Limited: Hand hygiene station at either points of care or toilets, but not both.
  • No service: Hand hygiene stations are absent, or present but with no soap or water.

Handwashing facilities should be located near all toilet facilities, in waiting rooms, near food preparation areas, and in convenient locations for healthcare providers, especially accessible to surgery and maternity (labor and delivery) wards.

Note: National policies and standards should also be consulted when designing, monitoring or evaluating hand hygiene standards.

Appropriate Staff, Process and Management Considerations:

Maintaining functioning and conveniently placed handwashing stations facilities is an essential part of HCF infection prevention and control. Good hygiene facilities and practices serve to protect HCF staff, patients and visitors. Management and assurance of a continuous stock of soap and hand drying supplies at a HCF requires a designated staff person. HCF management should establish routine and frequent (multiple times/day) water and soap re-stocking schedules for all handwashing stations within the facility. Patients and visitors should be instructed to comply with HCF handwashing protocol at critical times (after toilet use, before visiting patient, etc), and these rules should be enforced by HCF staff.

MCSP Rapid Assessment Questions:

To improve hand hygiene among staff, patients and visitors, each HCF can consider the following questions from MCSP’s HCF rapid assessment tool. The tool was adapted from WHO’s Essential Environmental Standards in Health Care.

Hand Hygiene: Correct use of environmental HCF by management of staff, patients and caregivers is encouraged through hygiene promotion.

Design and construction Operation and maintenance
  • Are conveniently placed handwashing stations available for patients and visitors?
  • Is there always soap or a suitable alternative at handwashing points?
  • Are conveniently placed handwashing stations accessible to each labor and delivery ward?
  • Is there always soap or a suitable alternative at handwashing points?
  • Is there a plan for hygiene promotion and staff management?
  • Are staff aware of this plan?
  • Is there a dedicated staff person responsible for hand hygiene locations?
  • Is there a staff person with hand hygiene management in their job description?
  • Is there sufficient communication support available for hygiene information?
  • Do staff provide appropriate hygiene information to caregivers and patients?
  • Are IEC materials/reminders available (e.g., visible on walls in appropriate places) for patients, staff, and caregivers?
  • Is there an Information, Education and Communication (IEC) plan for display in the Health Facility?

Additional Tools and Resources for Hand Hygiene Facilities, Behaviors and Promotion in health care settings:

  • In 2017, WHO & UNICEF published the WASHFit Tool, which includes essential indicator and advanced indicator assessment tools for hygiene (Tool 2), risk assessment templates (Tool 3), and improvement plan templates (Tool 4).
  • Soap Box Collaborative’s WASH and Clean toolkit, which includes various WASH HCF assessment tools. Tool 1: Facility needs assessment Tool, and Tool 3: Walkthrough Checklist have hand hygiene questions.