When asked about the difference between soaps and sanitizers, one manufacturer commented that soap is designed to successfully remove dirt and soil from hands. When used properly, it will also remove germs. (This is further explained in the article, Soap vs. Sanitizer: What's The Difference?) Sanitizers, on the other hand, will not remove dirt.

This manufacturer said, "If soap is not available and someone who has visible dirt on their hands uses only sanitizer, the product will do a great job at killing bacteria and disinfecting the dirt. But, that clean dirt will still remain on their hands."

The main difference between soap and hand sanitizer is that soap removes soil from a persons hands. Sanitizers kill bacteria and remove germs, but will not remove dirt. For this reason, both manufacturers and distributors recommend facilities offer hand sanitizers as an extra precautionary measure in restrooms or in the absence of water.

"Alcohol rub sanitizers kill most bacteria, fungi and some viruses," says Ronnie Kent, president of Associated Paper in Conyers, Ga. "Sanitizers containing at least 70 percent alcohol kill 99.9 percent of bacteria on hands 30 seconds after application and 99.99 to 99.9999 percent of bacteria in one minute."

According to the Centers for Disease Control and Prevention (CDC), hand sanitizers should contain an alcohol content of at least 60 percent, and in healthcare settings, the U.S. Food and Drug Administration recommends alcohol-based sanitizers with a concentration of 60 to 95 percent ethanol or isopropanol, the concentration range of greatest germicidal efficacy.

Yet, despite hand sanitizer's effectiveness at killing germs, users should be cautious of becoming complacent. Jack Van Reeth, director of environmental services at Geisinger Medical Center in Danville, Pa., says the hospital has found alcohol sanitizer ineffective against the spore form of clostridium difficile (C.diff), a bacteria found in the intestines.

"Whenever we have a patient with C.diff, we put up a green sign that says ‘Please wash your hands with soap and water,' and we put a bag over the alcohol sanitizer to discourage people from using it," he says.

In most situations, however, custodial executives need to place hand sanitizers in areas that encourage their use, such as lobbies, food service areas and waiting rooms.

"I think it's good to have hand sanitizer in places where you come into contact with people and you don't want to go to the restroom," says Kent. "We place it by the front door where people come in and shake hands. You don't want to run to the restroom, but it's always good to use hand sanitizer to keep the germs from spreading."

Gary McCain, sales manager for Five Star Janitorial Supply in Leesville, La., suggests placing hand sanitizer dispensers near cash registers.

"That's usually your last point of contact with the customer before they leave," he says. "If it's at a register, it's also considered a compulsive buying tool because an individual will see it, try it, and if they like it, they'll buy it. So it may also increase sales."

In school settings, Kent recommends placing hand sanitizers at the doors — particularly in computer labs — and having the students use them before entering the room.

"The keyboard is one of the biggest places you have germs," he says. "We've had schools that have told us that just from [placing hand sanitizer at the doors] students' visits to the nurse are less frequent and attendance has increased. It makes such a huge difference."

Likewise, at Geisinger Medical Center, hand sanitizer is placed outside every patient room, exam room and treatment room, as well as any other room that involves patient activity. That way hospital staff has the opportunity to sanitize their hands immediately prior to patient contact.

As with soaps, touchfree dispensers and foam sanitizers are increasing in popularity. According to VanReeth, Geisinger Medical Center is in the process of switching from a liquid to a foam hand sanitizer. Ease of use, convenience and cost per use are often drivers for the switch to foam, but for VanReeth the reason for the change is likely to take custodial managers by surprise.

"Our previous hand sanitizer had a high alcohol content," says VanReeth, "and as people began to rub their hands together they would walk away from the dispenser, and sanitizer would drip onto the floors, damaging the VCT and carpet. It increased the necessity for scrubbing, recoating and aggressive floor care because the drip marks on the floor created marks."

He continues, "We're currently transitioning to a foam hand sanitizer that also has a drip catch pan under each dispenser. We found this completely eliminates damaging drips of alcohol falling onto the floor and has improved the appearance of the floor."

What type of hand sanitizer or soap to purchase depends on the needs and preferences of the facility. While distributors agree that regular hand soap is suitable for most facilities, some industries, such as healthcare, may require the use of antimicrobial soaps. Similarly, some facilities may dictate the percentage of alcohol required in a hand sanitizer, while other facilities, such as schools or prisons, may require the use of non-alcohol sanitizers.

More important than the type of soap or sanitizer a facility offers is how the product is used and the frequency with which it's used — these are among the main concerns when devising a good hand hygiene program.

"People are seeing the value of soaps and hand sanitizers in reducing illnesses because there's been so much coverage in the news and from the CDC," says Kent. "For the last three or four years, with the outbreaks of different flus, Mercer and H1N1, they've been pounding it in that you've got to wash your hands and use sanitizer. People are beginning to understand that they need to do this."  

Kassandra Kania is a freelance writer based in Charlotte, N.C.

Click here to read about the benefits of both soaps and sanitizers.