How can global guidelines support sustainable hygiene systems?

According to consulted future guideline end-users, sustainable implementation of such recommendations to improve hand hygiene requires government-led system-strengthening approaches that build sustainable and resilient national systems. Background Hand hygiene is a cost-effective preventive measure to reduce transmission of infectious diseases.1 Alongside water and sanitation, hand hygiene protects community health and contributes to resilient health systems.1 However, a quarter of the global population lack access to even a basic handwashing facility2 and sustained hand hygiene practice everywhere is low.3 Following the COVID-19 pandemic, and in response to government demand, WHO and UNICEF are now developing guidelines on hand hygiene in community settings.4 These guidelines will provide evidence-based recommendations to governments on actions to improve coverage and practice of hand hygiene in non-healthcare settings that include households, public spaces and institutional settings. Alignment of hand hygiene indicators of interest with existing monitoring frameworks (eg, for school settings, the WHO and UNICEF Joint Monitoring Programme has developed a simple school-level self-assessment form for integration into national education management information systems). Contributors The commentary reports back on a meeting attended by all co-authors and is a summary of discussion and consensus points. [...]all co-authors have contributed to the content of the commentary.