Participants consisted of 655 individuals (318 males, 335 females, 2 other) from the 10 provinces of Canada. No survey responses were received from the 3 territories. The age of respondents ranged from 19–85 years, with an arithmetic mean of 44.3 years. Most respondents were from Ontario (n = 311); followed by Alberta (n = 82), Quebec (n = 70), and British Columbia (n = 63).

Most adults (n = 468, 71%) reported more frequent use of hand sanitizer during the pandemic than before it. Some reported the same frequency of use (n = 162, 25%) and very few adults reported a decrease in use (n = 25, 3.8%). Nearly half of the adults (47%) responded that they did not use hand sanitizer (0 times/day) before the pandemic (Fig. 1). Further, more than half of adults (55%) indicated their use of hand sanitizers would remain the same once the pandemic was over while 31% would use it less. Overall, 65% of adults reported using hand sanitizer in a non-work setting up to 4 times/day while 35% of respondents reported use of 5 or more applications per day (Table 1), with 16% of respondents reporting use of 7 or more applications per day. In contrast, prior to the pandemic, 41% used it up to 4 times/day while ~13% used it 5 or more times/day (Fig. 1). No significant differences were seen between males and females.

The frequency of use as self-reported by adult respondents (%) before the pandemic presented in the dark bar; during the pandemic shown in the light bar, with 95% confidence interval range shown as a line.

The pump form of hand sanitizer (gel, liquid, or foam) appears to be most often used (n = 578, 88% of all responses), and gel pump (n = 437, 41%) more often than liquid pump (n = 382, 36%) or foam pump (n = 254, 24%). Respondents reported using squeeze forms less often than pump (squeeze gel, n = 287; squeeze liquid, n = 213) and spray form the least often (n = 214). Adults most frequently reported using hand sanitizer during a pandemic in public buildings (n = 573) followed by the car (n = 441), bathroom (n = 262), and kitchen (n = 210). Use in other places in the home (n = 160) and outside (n = 105) were also reported. These categorical responses were not exclusive; respondents could select all that applied.

The amount of hand sanitizer used during the pandemic was most often reported as 1 pump, squeeze, or spray (Table 2). Two or more pumps, squeezes or sprays were reported by 22%, 25% and 47% of adults, respectively. Three or more pumps or squeezes was reported by <5% of adults, and 15% of adults for sprays.

Of the respondents from the general population survey, 231 of the 655 individuals (35%) reported having children in the home and completed the survey regarding use of hand sanitizer by those children. All age groups (<2–17 years old) had at least one response, for a total of 310 children in the different age groups. Responses were secured from 9 of the 10 provinces; no responses for children were received from Prince Edward Island. More than one form of dispenser could be selected, but “pump” (n = 259, 84%) was chosen most often and “spray” (n = 34, 11%) was least often selected. Gel (n = 205, 66 %) was the most frequently selected form of hand sanitizer overall for all age groups.

Adults reported that children in the home used hand sanitizer more during the pandemic than prior and most respondents stated that use of hand sanitizer by children will remain the same or increase after the pandemic. Adults reported more frequently assisting children aged ≤7 years with application of hand sanitizer, with 77% of those providing assistance reporting helping this age range in some way.

It was reported that 0 or 1–3 applications of hand sanitizer per day was most frequent among children aged <2 years in a home setting during the pandemic, while the majority of 2-year-olds were reported to use hand sanitizer 4–6 times/day (Fig. 2, Supplementary Table 1). There were no reports of 15–25 uses of hand sanitizer per day in the ≤3-year-old group. In children aged 4–17 years, 35% were reported to use hand sanitizer 1–3 times/day and 58% were reported to use 4 or more times/day (Table 3). Application of hand sanitizer 15–25 times per day when at home was reported in 3.2% of respondents overall (Table 3) and was not reported in age groups 4–5 or 8–9 years.

Frequency of hand sanitizer use in children ≤ 3 years of age as reported by adult caretakers at home (left) or at school (right), with 95% confidence interval range shown as a line.

Amounts of hand sanitizer per use among children ≤3 years old at home was most often reported as 1 pump or 0.5 squeezes (Fig. 3, Supplementary Table 2). Spray hand sanitizer was the least often selected option for type of hand sanitizer in the home, with only 6 reports of children aged ≤3 years using this form (Supplementary Table 2). In children aged 4–17 years, use of a pump form of hand sanitizer was most often reported (Fig. 3), followed by the squeeze form with only 28 reports of use of spray (Supplementary Table 3).

Amount of pump form of hand sanitizer used per application by children (as reported by adult caretakers), by increasing age group from left to right, with 95% confidence interval range shown as line.

Three hundred twenty-six responses were collected from the independent teacher/childcare-oriented survey. Responses were collected from all 10 provinces, with the most responses from Ontario (n = 157), Alberta (n = 41), and British Columbia (n = 36). No responses were received from the 3 territories. Approximately 95% of respondents reported teaching or supervising children aged <18 years, while the rest taught adults or in a setting unrelated to children. Only responses from teachers/childcare providers whose students were <18 years were included in the analysis (n = 298 teachers, representing 7 age grouped responses for children). Respondents could provide answers for up to two different age groups, if they supervised more than one age group. In these responses, a “day” reflects a school day.

The respondent could select all answers that applied for type of hand sanitizer and location of use, while frequency and amount per use selections were exclusive categories. Pump form of dispenser (n = 375, 76.1%) was most often reported as being used in school/childcare settings by children aged 4–17 years, with gel pump (n = 235) being the most frequently reported. Spray (n = 66, 13.4%) was the second most common form of dispensing reported and squeeze forms were least frequently used (n = 52, 10.5%). Location of use in schools/childcare facilities was most often the classroom/playroom for all age groups (n = 385), followed by the hallway (n = 215). Bathroom (n = 190) and lunchroom (n = 201) were less frequent locations of use, and outside was least frequent (n = 114).

Teachers and childcare providers were asked how often hand sanitizer is used by or applied to the children that they supervise. This response for frequency of use at school may not capture the full extent of use in a given day by a child (e.g., application at home before or after school). It was most frequently reported (45%) that hand sanitizers were used 4–6 times/day across all age groups (4–17 years old) in school/childcare settings with about 34% reporting a use of between 7–25 times/day and 21% reporting 1–3 times/day (Table 3). Approximately 17% of 4–17 year olds in the school/childcare survey reported a frequency of use ranging from 10–25 times/day. In the youngest age group (≤3 years old), 91% used hand sanitizer up to 6 times per day and <5% reported use of 7–9 or 10–14 times/day (Fig. 2). There were no reports of use >14 times per day in the ≤3 years age group.

The amount of hand sanitizer used per application was most frequently answered as one pump, squeeze, or spray (Supplementary Table 3). When a pump dispenser was reported, 85% reported that one or half a pump was dispensed per application in children aged 4–17 years in a school setting; only 1% reported using ≥3 pumps per application. One squeeze (60%) and one spray (67%) were also the most frequently reported in this group followed by 2 squeezes (27%) or 2 sprays (20%). Few reported ≥3 squeezes (4%) or sprays (7%). There were no reports of ≥3 pumps, squeezes or sprays in the ≤3-year-old age group in school/childcare settings (Supplementary Table 2). Overall, there were more reports of use of spray in a school setting (n = 67) than a home setting (n = 34). Therefore, it seems that while spray is least often used, the number of sprays per application tends to be higher than pump or squeeze forms (Supplementary Table 3).

Frequency and amount used reported by adults for children at home and school/daycare were compared for 4–17-year-olds. There was a statistically significant difference in the frequency of use between home and school (p < 0.0001), in particular children between 4–17 years old were more likely to use hand sanitizer 4–6 times/day while at school, whereas most of the children at home reported using hand sanitizer 1–3 times/day (Table 3). There was no statistically significant difference in the amount of pump or squeeze product used (p > 0.05 in both cases) in schools and homes. Regarding the amount of spray product used, there was a marginal statistically significant difference between the amount of product used at home compared to at school, after adjusting for age (p = 0.04); home children were more likely to use >2 sprays while school children were more likely to use 1 spray.