Updated

Whenever Joan Aycock brings her children to a fast-food restaurant, she lets them spend time in the play area. And when they come out, so does the hand sanitizer.

"We have skin issues, things we are sensitive to — dirt and germs. We want to get them off as soon as possible," the Fayetteville mother said while helping her sons Wesley, 7, and Andrew, 9, with hand sanitizer packets offered at a Chick-fil-A restaurant.

More U.S. businesses are helping customers clean up. No longer the province of hospitals and health clinics, hand sanitizers are being offered from health clubs and schools to restaurants and groceries.

"It's being used in every market that we serve," said Joe Drenik, spokesman for Akron, Ohio-based GOJO Industries, Inc., 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 better awareness of germs and how they are transmitted.

"All of these things kind of work together to create this snowball effect with potential pandemics being one of many factors," he said. "People are more apt to take steps to protect themselves."

Although Drenik declined to release Purell's sales figures, hand sanitizer sales in the United States have enjoyed double-digit growth since 2003, according to marketing information company ACNielsen. This year through December, more than $70 million in all brands of hand sanitizers (Purell is the market leader, enjoying more than $36.6 million of the sales) have been sold in U.S. supermarkets and drugstores, up 14.4 percent from the year before.

The largest sales growth in recent years came in 2005, when more than $67.3 million in sanitizers were sold, a whopping 53.5 percent 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."

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, a door or a 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."

The Cincinnati-based supermarket chain Kroger Co. has been offering hand-sanitizing wipes near its shopping carts.

"It's very popular with many customers," said spokeswoman Meghan Glynn. "You grab it, you wipe down the cart and you dispose of it. Customers tell us they appreciate it's there. It doesn't require a lot of effort."

The hand wipes also are popular at smaller stores — New York grocery store Really Cool Foods has incurred the extra cost of offering them, about $75 for a case of 4,000 wipes, since May.

"We're not really concerned. If our customers feel they need them, then we're OK with it," said spokesman Hans Dempsey. "It's a small price to pay for saving the world from the flu."