By Jules Storr
Origins of Clean Care is Safer Care
In 2005, I was part of the original team that launched the first Global Patient Safety Challenge: Clean Care is Safer Care. Led by the World Health Organization (WHO), it was an ambitious and, at the time, unprecedented initiative in the field of patient safety and infection prevention and control (IPC). Its premise was simple but profound: healthcare-associated infection (HCAI) harms people everywhere, across every health system, and preventing it is fundamental to safe, quality care.
The Challenge was largely funded by the UK and brought together global experts across disciplines, united by a shared determination to tackle one of healthcare’s most persistent and devastating sources of harm. Borrowing the modus operandi of the WHO Framework Convention on Tobacco Control, the aim was to galvanise political will. Ministries of Health across the world were asked to make a formal pledge – at policy level – to address the root causes of healthcare-associated infection.
Clean care as a system-wide responsibility
The concept of clean care became an umbrella for action across a number of essential domains including
- Clean hands – focusing on hand hygiene in healthcare
- Clean water – closely aligned with the WASH agenda
- Clean surgery – preventing avoidable harm in operative care
- Clean equipment – effective cleaning and decontamination
- Clean practices – safe practice including injections
- Clean blood – safe blood
This framing mattered. It deliberately positioned infection prevention not as a narrow technical specialty, but as a cross-cutting, system-wide responsibility. It created a powerful coalition that cut across professions, sectors, and geographies. And remarkably, every country in the world eventually made the pledge to act.
Hand hygiene as a logical entry point
Hand hygiene was chosen as the initial focus or entry point, mainly because it was tangible, evidence-based, universally relevant, and achievable. It opened the door to broader conversations about safety, quality improvement, and systems thinking. I vividly remember the then CEO of the International Council of Nurses (ICN) telling me that ICN was 100% committed to supporting the Challenge because hand hygiene was relevant to every nurse, everywhere, regardless of setting or resources.
From guidelines to global momentum
That same year, 2005, also saw the release of the draft WHO Guidelines on Hand Hygiene in Health Care. I had the privilege of being part of their development, under the technical leadership of Benedetta Allegranzi and the external leadership of Professor Didier Pittet. As the first Global Patient Safety Challenge unfolded over two years, a small team from WHO Geneva, alongside Sir Liam Donaldson – who championed this approach relentlessly – travelled the world advocating for action on HCAI (this preceded the technology that is available today – no smart phones for one thing!). Spread and buy-in does not happen by osmosis. I’ve learned over the years the art, the craft and the power of advocacy. We also led pilot testing and evaluation of the draft guidelines and implementation tools across two WHO regions.
It was, to coin a phrase I borrowed from a colleague recently, a hearts-and-minds endeavour. The evaluation was later published, the guidelines were finalised and formally launched in 2009, and a comprehensive suite of implementation tools followed. The momentum from this first Challenge directly led to the second Global Patient Safety Challenge on safe surgery led by Atul Gawande, which I was again fortunate to play a small role in – and the development of the WHO Surgical Safety Checklist. The rest, as they say, is history.
From those beginnings, WHO’s patient safety programme grew and evolved – first into service delivery and safety, then integrated health services, and today into the Department of Performance, Financing and Delivery. That early World Alliance for Patient Safety was the foundation. The original generation. The OG.
But that was twenty years ago.
A changed world, a diminished focus
A generation has passed. In that time, we’ve lived through a global financial crash and a once-in-a-century pandemic. The world looks very different. WHO looks very different. And patient safety, as a visible, resourced priority, has undeniably shrunk internationally and in my home country. Infection prevention and control (IPC) at WHO is now almost non-existent compared to its former scale and influence.
Perhaps most concerning of all, we now have a generation of healthcare workers whose understanding of IPC has been shaped primarily by COVID-19 – by a crisis, emergency measures, shortages, and fear – rather than through a quality, safety, and systems lens. Anecdotally I am hearing from too many colleagues that IPC risks being remembered as something exceptional and burdensome, rather than fundamental, enabling, and person-centred.
Why this still matters
This matters. Because the microbes have not gone anywhere.
This year we marked 20 years since Clean Care is Safer Care and I firmly believe that this is not a moment to move on – it is a moment to reconnect and to re-commit. To remember what IPC was always meant to be about – protecting people from avoidable harm, enabling safe, reliable care and embedding dignity, trust, and quality into every interaction within health systems.
Reframing IPC for the future – from silos to coherence
We cannot let IPC become a relic of the past or something only relevant in a pandemic. It is a cornerstone of safe, high-quality, person-centred care in 2025 and beyond. And hand hygiene, far from being a narrow technical task, remains a powerful entry point – because it teaches us something much bigger than behaviour change alone. It helps us understand how systems work (or fail), how culture is shaped, how leadership is expressed, and how environments can be designed so that doing the right thing at the right time becomes the easy, expected, and reliable choice (human factors and all that).
What we need now is not competition between agendas – between IPC, patient safety, quality improvement, or health system performance – but coherence. These are not rival priorities – they are interdependent parts of the same whole. IPC strengthens patient safety. Patient safety reinforces quality. Quality underpins trust, outcomes, and sustainability. When we work together, rather than in silos, the impact on people’s lives is far greater than any single programme can achieve alone.
Looking ahead
There is still a critical need for a strong, visible global voice for IPC – one that speaks not only to outbreaks and emergencies, but to everyday care, to values, systems, and people rather than rules and compliance. A credible voice (a leader or leaders) that remind us that clean care is safer care isn’t just an on-trend soundbite, but an evidence based mantra that saves lives.
The challenge in 2026 and beyond is daunting but it is also an opportunity to re-frame IPC as enabling rather than burdensome, a foundational piece of the health care jigsaw and central to shaping health systems that are safe, humane, and trustworthy.
As we look forward to an uncertain future I will continue to work together with my colleagues in IPC, patient safety, quality and health systems – learning, collaborating and taking action on this important issue.
Image credit: Alones Creative