General public Alcohol-based<unk> s may not be effective if the hands are greasy or visibly soiled. In hospitals, the hands of healthcare workers are often contaminated with pathogens, but rarely soiled or greasy. In community settings, on the other hand, grease and soiling is common from activities such as handling food, playing sports, gardening, and being active outdoors. Similarly, contaminants like heavy metals and pesticides (generally found outdoors) cannot be removed by<unk> s.<unk> s might also be swallowed by children, especially if brightly colored. Some commercially available<unk> s (and online recipes for homemade rubs) have alcohol concentrations that are too low. This makes them less effective at killing germs. Poorer people in developed countries and people in developing countries may find it harder to get a<unk>  with an effective alcohol concentration. Fraudulent labelling of alcohol concentrations has been a problem in Guyana. Schools The current evidence for the effectiveness of school hand hygiene interventions is of poor quality. In a 2020 Cochrane review comparing rinse-free hand washing to conventional soap and water techniques and the subsequent impact on school absenteeism found a small but beneficial effect on rinse-free hand washing on illness related absenteeism. Health care Hand alcohol in a hospital A pump with hand alcohol in a square in Ystad, Sweden, on 28 November 2020. An automated<unk>  dispenser<unk> s were first introduced in 1966 in medical settings such as hospitals and healthcare facilities. The product was popularized in the early 1990s. Alcohol-based<unk>  is more convenient compared to hand washing with soap and water in most situations in the healthcare setting. Among healthcare workers, it is generally more effective for hand antisepsis, and better tolerated than soap and water. Hand washing should still be carried out if contamination can be seen or following the use of the toilet.<unk>  that contains at least 60% alcohol or contains a "persistent antiseptic" should be used. Alcohol rubs kill many different kinds of bacteria, including antibiotic resistant bacteria and TB bacteria. They also kill many kinds of viruses, including the flu virus, the common cold virus, coronaviruses, and HIV. 90% alcohol rubs are more effective against viruses than most other forms of hand washing. Isopropyl alcohol will kill 99.99% or more of all non-spore forming bacteria in less than 30 seconds, both in the laboratory and on human skin. In too low quantities (0.3 ml) or concentrations (below 60%), the alcohol in<unk> s may not have the 10–15 seconds exposure time required to denature proteins and lyse cells. In environments with high lipids or protein waste (such as food processing), the use of alcohol hand rubs alone may not be sufficient to ensure proper hand hygiene. For health care settings, like hospitals and clinics, optimum alcohol concentration to kill bacteria is 70% to 95%. Products with alcohol concentrations as low as 40% are available in American stores, according to researchers at East Tennessee State University. Alcohol rub<unk> s kill most bacteria, and fungi, and stop some viruses. Alcohol rub<unk> s containing at least 70% alcohol (mainly ethyl alcohol) kill 99.9% of the bacteria on hands 30 seconds after application and 99.99% to 99.999% in one minute. For health care, optimal disinfection requires attention to all exposed surfaces such as around the fingernails, between the fingers, on the back of the thumb, and around the wrist. Hand alcohol should be thoroughly rubbed into the hands and on the lower forearm for a duration of at least 30 seconds and then allowed to air dry. Use of alcohol-based hand gels dries skin less, leaving more moisture in the epidermis, than hand washing with antiseptic/antimicrobial soap and water.<unk> s containing a minimum of 60 to 95% alcohol are efficient germ killers. Alcohol rub<unk> s kill bacteria, multi-drug resistant bacteria (MRSA and VRE), tuberculosis, and some viruses (including HIV, herpes, RSV, rhinovirus, vaccinia, influenza, and hepatitis) and fungi. Alcohol rub<unk> s containing 70% alcohol kill 99.97% (3.5 log reduction, similar to 35 decibel reduction) of the bacteria on hands 30 seconds after application and 99.99% to 99.999% (4 to 5 log reduction) of the bacteria on hands 1 minute after application. Drawbacks There are certain situations during which hand washing with soap and water are preferred over<unk> , these include: eliminating bacterial spores of Clostridioides difficile, parasites such as Cryptosporidium, and certain viruses like norovirus depending on the concentration of alcohol in the<unk>  (95% alcohol was seen to be most effective in eliminating most viruses). In addition, if hands are contaminated with fluids or other visible contaminates, hand washing is preferred as well as after using the toilet and if discomfort develops from the residue of alcohol<unk>  use. Furthermore, CDC states<unk> s are not effective in removing chemicals such as pesticides.
Hand sanitizer
Disinfectant
Insect repellent
Automatic soap dispenser
Tooth polishing
Topical medication
Mouthwash
Hand washing