The Antimicrobial Controversy
Anti-bacterial soap overuse may help spread disease!
By Ed Susman
SPECIAL TO MSNBC

ANAHEIM, Calif., Aug. 1 — Scrubbing your hands is the first line of defense against bacteria and other germs that can cause colds, the flu, skin problems and even deadly communicable illnesses. And many people believe that antibacterial potions work even better at stopping disease. But now researchers say that too much of a good thing can have the opposite effect — spreading disease instead of preventing it.

THE QUESTION of whether overuse of antibacterial soaps is contributing to the emergence of drug-resistant superbugs is still a matter of debate. But some experts say there is no doubt that too much hand-washing can create an environment that allows bacteria to flourish and spread.

When overused, the relatively harsh detergent action of antibacterial soaps leaves you vulnerable to open sores that can attract bacteria, resulting in skin problems such as eczema, doctors said here at the summer scientific meeting of the American Academy of Dermatology.

This begins a vicious cycle, whereby a person who develops hand eczema or another form of dermatitis touches a surface, leaving microscopic germs behind. Another person comes along, touches that surface and he too can be infected with the bacteria, said Dr. Marianne O’Donoghue, associate professor of dermatology at Rush-Presbyterian St. Luke’s Medical Center in Chicago.

Similarly, bacteria can directly jump from a person with dermatitis to an uninfected person when they shake hands, she said.

“There is nothing quite as good to spread bacteria as hand eczema,” O’Donoghue said.
Dr. William Baugh, chief of dermatology at the Beaufort Naval Hospital in Beaufort, S.C., agreed. “I’ve seen patients who have developed hand eczema from these [antibacterial] products,” he said. “It certainly can occur [and spread].”

Ironically, the very people who believe that frequent hand-washing with antibacterials will ward off disease are most likely to get caught up in the vicious cycle, the experts said.
“When I ask patients [with eczema] how often they wash their hands, they say 20 to 25 times a day,” Baugh said. “They think they are being good citizens by washing frequently. But you can over do a good thing.” Plus, the ease of pump dispensers is leading people to wash more frequently, O’Donoghue said. There’s no doubt the products are widespread: A recent survey found that nearly half of 1,100 liquid and solid soaps contain antibacterial agents.

From a dermatologist’s point of view, antibacterials are among the most worrisome products contributing to skin problems, O’Donoghue said. That’s because the same detergent chemicals that kill bacteria wreak havoc with the skin on the hands, Baugh explained. Advertisement

“They literally strip away fatty acids, moisture and amino acid from the skin,” O’Donoghue said. “They increase dryness, increase roughness and disturb the healthy growth process.”
Overuse of antibacterials is worse than frequent use of other soaps as chemicals in the detergents strip away the naturally protective fats and oils on the skin, Baugh said.
“The fist thing to correct the condition is to remove the offending product,” Baugh said. Yet patients are often disappointed when told to use non-detergent products that don’t eliminate the fat layers, he said. Eczema can be treated with standard emollients that replace oils in the hands, he added.

THE SUPERBUG DEBATE
Dr. Eli Perencevich, a research fellow in infectious diseases at Beth Israel Deaconess Medical Center in Boston, said he wishes people would skip the antibacterial products altogether, pointing to lab studies that link them to the emergence of superbugs.
“No one has ever been able to prove that using antibacterial soaps meant that anyone was better off than those using standard soap,” said Perencevich, who performed the recent soap survey.

“However, there are [lab] studies that suggest use of such products kill off the sensitive bacteria, leaving [behind] hardier bacteria such as E. Coli and staphylococcus aureus, which could be detrimental to health,” said Perencevich.
“The fear is that this process will result in bacteria that live longer,” he said.
That fear may be misplaced, said industry representatives.
“The rising incidence of antibiotic-resistant bacteria is a serious worldwide concern,” said Dr. Jerry McEwen, vice president for science at the Cosmetic, Toiletry and Fragrance Association.

“There is no real-life evidence that antibacterial products — as they are normally used in hospitals, in food preparation and in people’s homes — contribute to bacterial resistance.
“While some studies have shown that antibacterial ingredients may promote resistant bacteria, these studies have been done under controlled laboratory conditions that do not reflect what happens to bacteria that consumers encounter in the real world.”
While the debate over antibacterials and superbugs continues, what is certain in the real world, O’Donoghue said, is that people who use the products can end up with serious skin diseases that need an expert’s help to correct.



For Immediate Release: October 24, 2002
ANTIBACTERIAL SOAP NO BETTER THAN REGULAR SOAP, NIH-FUNDED STUDY SHOWS

CHICAGO - Despite medical experts' doubts that antibacterial soap is a better germ-killer than regular soap, half to two-thirds of hand cleansers on store shelves are labeled as antibacterial. Now a National Institutes of Health (NIH)-funded study confirms what medical experts have suspected. Results are being presented here at the 40th Annual Meeting of the Infectious Diseases Society of America (IDSA).
" It makes you wonder why they call it antibacterial, because according to our research, it isn't any more so than plain soaps," said Elaine Larson, Ph.D., R.N., associate dean for research at the Columbia University School of Nursing, New York, principal investigator of the study. "We found antimicrobial or antibacterial soaps provide no added value over plain soap."
Further, some health care professionals are concerned that the ubiquitous use of triclosan, the antibacterial agent most commonly found in such soaps, could add to the growing problem of antibiotic resistance.

" There is no proof that antibacterial soaps can lead to resistance, but if there's even a theoretical risk of that, why use it?" said Dr. Larson, who searches out soaps that are not marketed as antibacterial for use in her own home.

The study was the first double-blinded, randomized controlled clinical trial - the protocol considered most scientifically sound - to compare antimicrobial soap to regular soap. The study involved primary caretakers in 222 New York City households: half were randomly assigned to use antimicrobial soap for daily hand washing and half were given non-antimicrobial hand soap. Microbe cultures were taken after a single hand washing and following a year of washing with the assigned soap. Neither the caretakers using the soap nor the investigators who analyzed the cultures were aware who had been assigned regular vs. antibacterial soap.

The two groups were assessed after one wash with the particular soap and after one year of regular use of the assigned soap. Cultures showed that after a year, there were fewer microbes on the caretakers' hands in each group, but there was no difference between the groups.

Although the soaps are typically labeled antibacterial, they are actually antimicrobial, meaning they affect viruses as well as bacteria, just as regular soaps do.
The study was funded by the National Institute of Nursing Research, a division of the NIH.
Research suggests that the waterless alcohol-based antiseptics used by health care workers in hospitals are the more effective germ killers.

The waterless antiseptics are not cleaning agents, however, as they don't remove surface dirt, which is why hand-washing with regular soap is still the best approach for regular daily hygiene.

" If you've got a newborn or a preschooler with a cold, you might consider using an alcohol-based waterless product for a little extra protection against germs," said Dr. Larson. "But for daily hygiene, hand-washing with regular soap is fine. Just be sure to wash all of the surfaces on your hands, the backs, between the fingers, etc. It's not the amount of time that's important, but covering all the surfaces, as well as applying friction."
The American Medical Association (AMA) recently noted that there was no evidence that antibacterial products - including soaps, lotions and other household products - work, whereas this study substantiates that they don't, said Dr. Larson.
Co-authors of a paper on the topic being presented at IDSA by Dr. Larson are Allison Aiello, Susan Lin, Lillian V. Lee, D. James Kain and Phyllis Della-Latta.
IDSA is an organization of physicians, scientists and other health care professionals dedicated to promoting human health through excellence in infectious diseases research, education, prevention and patient care. Major programs of IDSA include publication of two journals, The Journal of Infectious Diseases and Clinical Infectious Diseases, an Annual Meeting, awards and fellowships, public policy and advocacy, clinical affairs and other membership services. The Society, which has nearly 7,000 members, was founded in 1963 and is headquartered in Alexandria, Va.