In the midst of the 2009 H1N1 outbreak, officials from the CDC stated official hand hygiene guidelines had not been updated since first being published in 1996. These same officials cautioned against the use of alcohol based hand sanitizers in a variety of settings. Federal agencies such as the U.S. Military and Homeland Defense are using and testing non-alcohol based products similar to Prefense. The CDC went on to say the guidelines were intended exclusively for institutional healthcare settings.