From paper to practice.

Guidelines for hand hygiene and infection prevention

Healthcare-associated infections (HAIs) – infections related to a hospital stay – can have a significant impact on healthcare systems, particularly when considering the potential spread of multi-resistant pathogens and their associated treatment complexity.

To minimize infection rates and improve patient safety, healthcare facilities rely on guidelines and recommendations set forth by national and international governments and institutions.

The following section details the most recent iterations of guidelines and recommendations from key national and international organizations.


International guidelines in the medical sector.

The World Health Organization (WHO) is a leading international proponent for patient safety.  In 2009 the WHO released a comprehensive 262 page report, entitled WHO Guideline on Hand Hygiene in Health Care, providing recommendations to support medical facilities in the creation of safe settings for patient treatment.1

These recommendations were further augmented with the release of the Global guidelines on the prevention of surgical site infection in 2016.  This guideline, spanning 184 pages, offers evidence-based measures on how to avoid infections in a variety of situations that may arise before, during and after operations. The preoperative surgical hand preparation is recognized as a particularly critical measure from the WHO.2

National guidelines in the medical sector.


Robert Koch Institute: The Robert Koch Institute (RKI) is Germany’s central scientific institution in the field of biomedicine, and is regarded as one of the most important bodies for safeguarding public health in Germany.  German hospitals and medical facilities follow guidelines on infection prevention and control published by the RKI. In 2016, the RKI released a 30-page updated guideline including the current state of science on this topic, entitled Händehygiene in Einrichtungen des Gesundheitswesens.  Notably, Chapter 7 of the guideline outlines the requirements for dispensing systems of alcohol-based hand rub and soaps in healthcare facilities, and Chapter 8 identifies quality aspects to improve compliance.3 

German Infection Prevention Act (IfSG): forms a basis for complying with the content of this recommendation, the IfSG is essential. Especially paragraph 23 section 3 of IfSG describes the relation between recommendation and law.

German Society for Hospital Hygiene: The German Society for Hospital Hygiene (DGKH) is a specialist society that supports advancements in hospital hygiene in Germany.  Specifically, the DGKH sets forth recommendations on the prevention and control of hospital-related and practice-related diseases, focusing on infection prevention, health promotion, and environmental protection within healthcare settings.  In 2012, the DGKH published a recommendation, entitled Recommendations and requirements for soap and hand rub dispensers in healthcare facilities.  The specific document gives an overview to requirements of soap and alcohol-based hand rub dispensers in context of healthcare facilities.4 For example, a dispenser should allow usage of different types of cartridges made by different manufacturers.

The Association of the Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V., AWMF): The AWMF is a network of more than 175 scientific member societies and three associated societies from all medical specialties.  The aim of the AWMF is to support collaboration among scientific medical societies in innovation and development in the medical sciences and practice.  In 2003 (updated in 2016), the AWMF published a 15 page guideline, entitled “Hand Disinfection and Hand Hygiene” with recommendations for hand hygiene as it relates to medicine, and the general public. The content of the AWMF guideline corresponds with the content of guidelines set forth by the Robert Koch Institute.5  The AWMF represents Germany in the Council for International Organizations of Medical Sciences (CIOMS) at WHO/Geneva.



The Public Health Agency of Canada (PHAC) sets national guidelines for infection prevention and control in Canada.  The PHAC provides evidence-based recommendations to complement provincial and territorial public health efforts in monitoring, preventing, and controlling healthcare-associated infections.6   In 2012, the PHAC published Hand hygiene practices in healthcare settings, a document that provides a framework for developing programs and models to improve hand hygiene in healthcare settings.



The Centers for Disease Control and Prevention (CDC) is the leading public health institution in the United States. The CDC seeks to control and prevent diseases, in addition to other topics of interest. In 2002, the CDC released their Guideline for Hand Hygiene in Health-Care Settings, which includes a comprehensive overview of handwashing and hand disinfection procedures in healthcare settings.7

National guidelines in the non-medical sector.


The Workplace Ordinance (ArbStättV) serves for safety and protection of the health of employees when configuring and operating workplaces. The aim of ArbStättV is to protect and safeguard employees against accidents and diseases in the workplace. Chapter 4 describes the configuration of sanitary rooms with products for hand hygiene including hand drying.

The Ordinance for Food Hygiene (LMHV) is dedicated to companies who manufacture and handle food, defining relevant measures to safeguard consumers from contamination of food and beverages by bacteria or undesirable microorganisms. The second attachment describes that adequate hand hygiene is crucial to secure food hygiene – key measures is a good personnel hygiene including hand hygiene.

1 World Health Organization, WHO guidelines on hand hygiene in health care. 2009. 262.
2 Global Guidelines for the prevention of surgical site infection. World Health Organization, 2016
3 RKI, Händehygiene in Einrichtungen des Gesundheitswesens. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 2016. 59(9): p. 1189-1220.
4 Assadian, O.K., A.; Christiansen, B.; Exner, M.; Martiny, H.; Sorger, A.; Suchomel, M., Recommendations and requirements for soap and hand rub dispensers in healthcare facilities. GMS Hygiene and Infection Control, 2012. 7(1)
5 AWMF Händedesinfektion und Händehygiene. 2016.
6 Public Health Agency of Canada. Hand hygiene practices in healthcare settings. 2012
7 Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR 2002;51