Alcohol gel is the clinical default, but in alcohol-restricted environments the regulator has flagged it as a danger, and everywhere it leaves the pathogens that close wards, homes and classrooms untouched.
Alcohol-based hand gel is a documented poisoning and ingestion hazard. UK enquiries to the National Poisons Information Service about hand sanitiser rose sharply over a single year, and coroners' reports record deaths from ingestion in confused and detained people. NHS England now requires alcohol gel to be stored securely on mental-health wards as a direct result.
It is also a highly flammable liquid that carries fire, self-harm and contraband risk into secure and supervised settings. That is why UKHSA restricts wall-mounted alcohol rub in prisons, and why estates teams must risk-assess it under COSHH and DSEAR before it goes on a wall.
And it leaves a gap. Alcohol gel does not kill norovirus, the pathogen that most often closes wards, homes and classrooms, and it has no activity against C. difficile spores. The official advice when these are circulating is to fall back to soap and water. The everyday tool is not covering the everyday threat.