When Sandy Summers picks up her children - ages 6 and 10 - at elementary school, they're greeted with squirts of hand sanitizer.
"When they get in the car, I put a glob on their hands," said the nurse, who lives in Homeland. "If they're going to eat a snack in the car, I make them use some. ... If I go to the grocery store, when I get in the car, the first thing I do is use the sanitizer. If I forget to use it before I touch the steering wheel, I put a whole bunch on my hands and just wipe it all over the steering wheel.
"With the flu season approaching, I find that we're using it more."
The germ-killing gel, foam and spray is suddenly everywhere, with dispensers bolted to walls in supermarkets, hospitals and kindergarten classrooms, with giant bottles standing guard at church services, with tiny ones stowed in purses, briefcases and backpacks. Fears of H1N1 flu have led the state to install dispensers in the public areas of all 56 of its office buildings.
Hand sanitizer has grown into a more than $112 million-a-year industry in the United States, and sales have been rising, much of it due to the swine flu pandemic. With the mantra "wash your hands" being practically shouted from the rooftops - President Barack Obama has encouraged it, while Sesame Street's Elmo is sharing the message in public service announcements - many people are using alcohol-based sanitizer as a quick and convenient alternative to good old soap and water.
And while some efforts are being made to more frequently disinfect surfaces where the swine flu virus may live - subway cars and buses in Washington are undergoing weekly cleansings - governments and businesses are putting out sanitizer in hopes that people will protect themselves and others around them by actually using the stuff. Liberally.
"Everyone has a role to play in stopping the spread of flu," said David Paulson, spokesman for the state's Department of Health and Mental Hygiene. "Everyone has to take personal responsibility. That means keeping clean, covering your cough, getting the vaccine."
The conventional wisdom among public health officials is that hand sanitizer works well, but soaping up at the sink is best because it is the only way to wash off dirt. But others say hand sanitizer may actually be better, especially since so few people wash their hands properly and because the gels are always at the ready when you have sneezed or pushed an elevator button or turned a doorknob.
"It's actually better than soap," said Dr. Philip M. Tierno Jr., director of clinical microbiology and immunology at New York University Langone Medical Center. "Soap and water does not kill germs. Soap and water washes them off your skin. ...
"The best thing you can do for yourself is wash appropriately with soap and water, 15 to 20 seconds," he said. "[But] most people don't wash appropriately because they don't do it long enough, suds up appropriately, don't get in between the digits."
Studies have shown for years that people don't wash their hands as often or as well as they should.
Alcohol-based hand sanitizers only work if their alcohol concentration is greater than 60 percent (some products have 40 percent), experts say. Less is known about those marketed as alcohol-free.
In some places, schools have banned the use of alcohol-based sanitizers because of their alcohol content and concerns about accidental or even intentional ingestion.
Still, few see much downside to the ubiquity of sanitizers.
"The hand sanitizer tends to be more convenient. It tends to be less of an issue of drying [out] your hands," said Dr. Richard Boehler, chief medical officer at St. Joseph Medical Center in Towson. "If you're washing your hands 20 to 30 times a day ... hand sanitizers seem to do a better job of keeping the skin intact."
Boehler said the recent swine flu outbreak has not changed St. Joseph's emphasis on hand sanitizer. The hospital became vigilant about its use several years ago after cases of hospital-acquired MRSA infections (methicillin-resistant Staphylococcus aureus) were becoming a problem. Boehler said the religious use of hand sanitizer among staff cut MRSA infections by 50 percent.
"Our staff use it before they enter a patient's room and after as they are leaving," he said. "You'll find it all over. You'll see signs encouraging it. I wouldn't say we're fanatical, but we're really vigilant about it and vigilance is what you need."
Sales of hand sanitizer have been rising along with fears of the swine flu.
For the 12 weeks ending Aug. 9, sales in the category were up 19 percent from a year earlier, according to Information Resources Inc., a Chicago-based market research firm. The data include supermarkets, drugstores and mass-market retailers, excluding Walmart.