Ummm, hand sanitizer can replace soap and water washing if your hands are not soiled with organic matter. So if I changed a nappy I would wash my hands, if I remade a bed gave a drug etc, then I use hand sanitizer. Maybe the phrase primary method was the wrong choice of words, but it is very very commonly used, much more then you probably think. The use of it was also brought in to reduce the amount of dermatitis that health workers develop on their hands from the very strong disinfectants in the soaps.

This site http://www.rch.org.au/washup/for_hea...ts_Techniques/ details when alcohol gel can be used instead of hand washing in a hospital setting.