Hand sanitizer in cold and flu season: at least 60% alcohol, rubbed in until dry, and soap first when you can

Soap first

CDC’s view is simple: soap and water remove all types of germs from hands, while sanitizer kills certain germs on the skin. That’s why it calls handwashing the best way to get rid of germs in most situations, and sanitizer the backup when there’s no sink. [S1] [S3]

• Wet. Clean, running water, warm or cold. Turn off the tap and apply soap. [S2]
• Lather. Rub your hands together, including the backs, between your fingers and under your nails. [S2]
• Scrub for at least 20 seconds. Humming “Happy Birthday” from beginning to end twice is CDC’s timer. CDC says studies show 20 seconds is what it takes to remove harmful germs and chemicals. [S2] [S3]
• Rinse and dry. Rinse well under clean, running water, then dry with a clean towel or an air dryer. [S2]

CDC’s key times to wash include before, during and after preparing food, before eating, after using the toilet or changing a diaper, after blowing your nose, coughing or sneezing, after caring for someone sick with vomiting or diarrhea, and after touching an animal or garbage. Plain soap is fine: CDC says studies haven’t found an added health benefit from antibacterial soap outside health care settings. [S2] [S3]

Read the label

Hand sanitizers are regulated by FDA as over-the-counter drugs, so the bottle has a Drug Facts label. FDA says to read and follow it, especially the warnings section. [S4]

• At least 60% alcohol. CDC says you can tell whether a sanitizer has at least 60% alcohol by checking the label. [S1] [S2]
• Which alcohol. FDA names ethyl alcohol (ethanol) and isopropyl alcohol as the active ingredients these products should contain enough of. [S4]
• Alcohol-free bottles. CDC says sanitizers with at least 60% alcohol work against a wider range of germs than sanitizers without alcohol, including those that use benzalkonium chloride. CDC recommends the alcohol-based kind. [S3]
• Food look-alikes. FDA warns about sanitizers packaged to look like food or drinks, and found some with food flavors or fragrances, such as chocolate or raspberry. Swallowing them can cause serious injury or death. [S4]
• Homemade. CDC doesn’t recommend making your own. It notes reports of skin burns from homemade sanitizers, and says not to rely on recipes based only on essential oils. [S3]

How to use it

• Enough to cover. Put the product on the palm of one hand. Read the label for the right amount, and use enough to cover all surfaces of both hands. [S1]
• Every surface. Rub it all over, between your fingers and on the backs of your hands. [S4]
• Rub until dry. Keep rubbing your hands and fingers together until they’re dry. CDC says that should take around 20 seconds. [S1]
• Don’t wipe it off. CDC and FDA both say not to rinse or wipe sanitizer off before it’s dry, or it may not work as well against germs. [S1] [S4]
• Keep it out of your eyes. FDA says it can cause burning and damage. If it gets in, rinse thoroughly with water. [S4] [S5]

When it falls short

CDC lists the limits plainly. Sanitizer is quick, but it doesn’t do everything soap does. [S1] [S3]

• Visibly dirty or greasy hands. CDC says don’t use sanitizer then, for example after gardening, playing outdoors, fishing or camping. Wash with soap and water instead. [S1]
• Some germs. Sanitizers don’t get rid of all types of germs. CDC says soap and water work better against norovirus, Cryptosporidium and C. difficile. [S1]
• Chemicals. Sanitizer might not remove harmful chemicals such as pesticides, or heavy metals like lead. [S1]
• Wipes. CDC says hand sanitizing wipes with at least 60% alcohol kill germs on hands. Baby wipes don’t reliably remove germs, and disinfecting wipes are for surfaces, not skin. [S3]
• Water but no soap. CDC says to use a sanitizer with at least 60% alcohol. With no sanitizer either, rub your hands together under the water and dry them with a clean towel or let them air dry. That rinses off some germs, though it’s not as good as soap. [S3]

FDA’s do-not-use list

FDA says testing turned up some hand sanitizers that are contaminated with potentially toxic types of alcohol, don’t contain enough active ingredient, or carry false or unproven claims. It asks you to check its list before you buy a sanitizer or use one you already have. [S4]

The contaminants FDA has found include methanol (wood alcohol) and 1-propanol. In most cases, methanol doesn’t appear on the product label, which is why the label alone can’t clear a bottle. FDA lists methanol’s effects as including nausea, vomiting, headache, blurred vision, permanent blindness, seizures, coma, permanent nerve damage or death, and says young children who swallow these products are among those most at risk. [S7]

• Search with the label. FDA’s table can be searched by product or brand name, manufacturer, distributor or NDC (National Drug Code) number. [S6]
• Manufacturer missing. If the label doesn’t name the manufacturer, FDA says to contact the distributor to find out. If the distributor won’t say, FDA recommends you don’t use the product. [S6]
• Same brand, different maker. FDA notes that one brand name can be made by more than one manufacturer, so a warning about one maker doesn’t automatically cover everything under that brand. [S6]
• Problems. FDA asks people to report side effects from hand sanitizer to its MedWatch program. [S4]

Kids and pets

• Up and away. FDA says to store hand sanitizer out of children’s reach and sight, and out of reach of pets. Toddlers may be drawn to the pleasant smell or brightly colored bottles. [S4] [S5]
• Supervise. CDC and FDA both say adults should supervise young children using hand sanitizer, so they don’t swallow it. [S1] [S4]
• Small amounts matter. FDA says drinking even a small amount of hand sanitizer can cause alcohol poisoning in children. It also says there’s no need for concern if children eat with or lick their hands after using it. [S4]
• Dispensers. Wall dispensers are often at a small child’s eye level and can splash, so FDA says to watch young children around them. [S5]
• Pets. Don’t use hand sanitizer on pets or let them swallow it. If you think your pet ate something dangerous, FDA says to call your veterinarian or a pet poison control center right away. [S4]

Flames and vapors

• It’s flammable. FDA says to keep hand sanitizer away from heat and flames, and to rub your hands until they feel completely dry, with the vapors cleared, before anything involving heat, sparks, static electricity or open flames. That includes lighting a candle or the stove. [S4] [S5]
• Fresh air. FDA has warned that headache, nausea and dizziness can follow using alcohol-based sanitizer, likely from breathing the vapors in enclosed spaces. Use it where air moves. [S5]
• In the car. FDA says to open a window until the sanitizer is dry and the vapors have cleared. [S5]

Check a bottle

Pick what the label says. The check puts the CDC and FDA points from this page in one place. It can’t test what’s in the bottle, so FDA’s list is still the last step. [S1] [S3] [S4] [S6]

If the check says the bottle looks fine, search FDA’s list with the product name, manufacturer, distributor or NDC number before you rely on it. Methanol usually isn’t on the label. [S6] [S7]

Before the next cold

If someone at home is already sick, our guide to taking a child’s temperature covers thermometers by age and when to call the pediatrician.

Quick answers