More U.S. businesses are helping customers clean up.

No longer the province of hospitals and health clinics, hand sanitizers are being offered at places including health clubs, schools, restaurants and grocery stores, despite evidence that soap-and-water handwashing works best.

"It's being used in every market that we serve," said Joe Drenik, spokesman for Akron, Ohio-based Gojo Industries, which makes Purell hand sanitizer. "This is a way to kill germs on the go — there's an increased awareness of germs, and the implications of germs and getting sick."

Although disease threats such as bird flu or pandemic flu have made headlines in recent years, Drenik said the popularity of hand sanitizers has come mainly from the public's increased awareness of germs and how they are transmitted.

Despite their growing use, hand sanitizers shouldn't be the prime arsenal for germ control, according to the U.S. Food and Drug Administration.

The FDA recommends soap and water for proper handwashing, and that hand sanitizers serve as an adjunct to control the spread of bacteria.

Barbara Almanza, an associate professor at Purdue University in Indiana, studied the use of hand sanitizers and found that they may in fact increase the quantity of bacteria on the hands.

"In terms of the regulations regarding food services, the Food and Drug Administration says hand sanitizers may be used as a supplement, but not as a substitute for handwashing," Almanza said in a release. "By the same token, people should not use hand sanitizers in place of a good lathering with soap and water if it's available."

Sanitizer use grows

Still, hand sanitizer sales in the United States have enjoyed double-digit growth since 2003, according to marketing information company ACNielsen, although Drenik declined to release Purell's sales figures,

This year through December, more than $70 million US in all brands of hand sanitizers (Purell is the market leader, enjoying more than $36.6 million US of the sales) have been sold in U.S. supermarkets and drugstores, up 14.4 per cent from the year before.

The largest sales growth in recent years came in 2005, when more than $67.3 million US in sanitizers were sold, a whopping 53.5 per cent increase from 2004, according to ACNielsen figures.

Drenik said the increasing availability of hand sanitizers at businesses shows how public perception has changed about germs in the last few decades. Yet most restaurants still are slow to offer hand sanitizers to customers, although some chains are considering it, Drenik said.

"When Purell came out in the 1980s, it was used behind the scenes. If a business then provided hand sanitizer, it would raise questions about cleanliness," he said. "Today it's just the opposite — the perception is the facility pays attention to the details."

Perception of cleanliness also is a big factor in bringing customers to health clubs, said Skip Lennon, owner of 13 Gold's Gym franchises in North Carolina and South Carolina where wipes are offered to members to clean off equipment.

"Everybody's germophobic. There are people out there sweating" as they work out, said Lennon, who is based in Wilmington, N.C. "After they grab the cardio equipment and free weights, they can wash their hands as well."

Hand wipes offered at drive-thrus

Atlanta-based Chick-fil-A started offering hand sanitizer packets this past fall at playgrounds at its restaurants and also at some drive-thru windows.

"We provide the playground area for kids to come and play, and we do sanitize those surfaces. But because of the traffic, kids can come in … and as soon as they come in, it's dirty again," said Hal King, food safety manager for Chick-fil-A. "When you come up to the drive-thru window, you can't wash your hands before you eat."

Contact with other people and environmental surfaces — such as a table, door or playground slide — plays a role in whether people become infected with a cold or the flu, said Dr. Edward Chapnick, director of infectious disease at Maimonides Medical Center in New York.

Just trying to treat those surfaces "is clearly not the way to go — cleaning has limited effectiveness because if you clean it, the next time someone touches it who has a cold, the germs are there again," Chapnick said. "Much more effective than treating surfaces is frequent use of hand disinfectant, especially in areas in which there are a lot of people and areas where people eat."