A non-aerosol, foaming high alcohol content hand sanitizer is provided which has excellent antimicrobial activity and tolerance for organic load and excellent residual activity, as well as enhanced moisturization and skin-feel properties over currently marketed alcohol-based sanitizers. The inventive composition achieves an unexpectedly large amount of quality, stable foam even in the presence of significant quantities of skin conditioning agents through the use of novel silicone surfactants and achieves enhanced and prolonged antimicrobial efficacy through the combination of high alcohol content and activity enhancing components.