Here's How to Use Hand Sanitizer Properly

Americans have made it a habit to stock up on hand sanitizer during cold, flu, and Covid-19 season. And with good reason: The Centers for Disease Control and Prevention (CDC) says hand sanitizer with at least 60% alcohol is an effective alternative to hand washing when hand washing isn't an option, like at the grocery store or after pumping gas, for example.

Here's the best method for using hand sanitizer—and whether it's safe for young children and pregnant women.

Does Hand Sanitizer Actually Work?

When it comes to banishing germs, nothing beats washing your hands with soap and water for at least 20 seconds, says Christine Schindler, CEO and founder of PathSpot, a hand hygiene system that protects against food-borne illness. Soap loosens dirt and bacteria off the skin and helps wash it down the drain.

But in a pinch, the CDC says you can use an alcohol-based hand sanitizer—as long as it has at least 60% alcohol. They note that alcohol-based hand sanitizer, while convenient to carry with you, is not a simple replacement for hand washing because while it can quickly reduce the number of microbes on your skin, it can't eliminate all germs. So, when you use hand sanitizer, you're still leaving some germs behind on your skin, which can still make you sick.

Additionally, the CDC says that choosing a hand sanitizer that has less than the recommended 60% alcohol base may actually encourage bacterial growth.

How to Use Hand Sanitizer

It's not enough to briefly rub sanitizer on your palms and call it a day. To use hand sanitizer effectively, follow these steps:

1. Use a nickel to quarter-size dollop.
2. Rub the sanitizer all over your hands, including between your fingers, the fronts and backs of your whole hand, around your wrists, and under your nails by scraping them against your palms.

You should keep rubbing until the sanitizer is completely dry, says Schindler. Don't let kids wipe any off on their pants; that reduces effectiveness.

Also, keep in mind that hand sanitizer isn't effective immediately. Research published in mSpherefound ethanol-bred disinfectants doesn't swiftly destroy the influenza A virus. The study found it takes at least four minutes to kill it, and that's due to the "stronger than expected" mucus surrounding the virus. Only once the mucus is completely dry will the virus die.

Hand washing without soap was found to be more effective—it killed the virus within 30 seconds. However, as novel as that finding may be, the CDC strongly recommends using soap when washing hands. While the action of flowing water can remove dirt and some germs, it is ineffective at killing germs or protecting you against viruses such as flu or COVID-19. The best practice is to use warm water and soap and wash for at least 20 seconds.

Is Hand Sanitizer Safe for Pregnant People?

Pregnant people may be especially reliant on hand sanitizer to banish germs. But as it turns out, some ingredients may be unsafe while expecting—although this hasn't been proven definitively.

Hand sanitizers often contain triclosan, a chemical used for antibacterial purposes that are also found in antibacterial soaps, fluoride toothpaste, and some cosmetic products. According to a study published in the journal Environmental Research, "Triclosan may reduce the levels of thyroid hormones that are important for fetal growth and development." In particular, it's associated with lower birth weight and reduced gestational age.

Research from the University of Florida also found that triclosan interferes with estrogen metabolism. According to the study, a disruption could affect how estrogen is moved through the placenta—and it may also impact brain development, gene regulation, and fetal oxygen levels.

The Food and Drug Administration (FDA) previously noted that triclosan was found in the urine of 75% of Americans, so exposure is very common. But if pregnant people want to avoid it, they can choose a hand sanitizer made without it. Triclosan should be listed on the ingredient label of any product containing it.

How About Young Children?

Babies have thin and delicate skin, so the chance of absorption is high. "Parents need to keep in mind that hand sanitizer contains alcohol," says Debra M. Langlois, M.D., an assistant professor of pediatrics at the University of Michigan. Also, she notes that young children might accidentally ingest the hand sanitizer or put their hands in their mouths before the product is fully rubbed in.

"Ingestion of hand sanitizer could lead to alcohol poisoning, which is an emergency that requires immediate medical attention. Symptoms include confusion, vomiting, slowed breathing, seizures, and coma," she says.

The good news is that there are rarely major effects from exposure in kids under 6, according to Poison Control. In two cited cases, one when a child covered a large part of their body in hand sanitizer and another when a child ingested some, both turned out OK after following Poison Control's instructions.

To be safe, Dr. Langlois says parents should store hand sanitizer out of children's reach and always monitor usage.

The Bottom Line

Using a hand sanitizer with at least 60% alcohol can be a safe and effective way to keep germs away especially for pregnant people and kids. That said, washing hands with warm water and soap for at least 20 seconds is considered the gold standard for safely and effective killing and removing germs that cause viruses such as COVID-19 and flu.