What are antibacterial soaps and cleaning products?

Some manufacturers add antimicrobial ingredients to cleaning products and soaps, often branding them as ‘antiseptic’ or ‘antibacterial’. The logic is that consumers prefer to use a product that will eliminate bacteria and microorganisms, reducing the risk of infection, especially in bathrooms and kitchens. Commonly added antibacterials include:

• Triclosan and triclocarban
• Phenol
• Fluorosalan
• Benzalkonium chloride
• Chloroxylenol

There are many common antimicrobials, and they can be difficult to identify on ingredient labels. If a product contains an antimicrobial it will normally be branded as ‘antiseptic’, ‘disinfectant’ or ‘antimicrobial’.

[Note: Doctors prescribe antimicrobial washing products for a range of conditions (e.g. eczema). These are regulated, evidence-based products, and not discussed in this article.]

How effective are these products?

The question essentially revolves around whether adding an antimicrobial to products would have any impact on reducing the number and severity of infections. Influential research has suggested that there is no significant difference between antimicrobial and plain soaps:

‘Consumer antibacterial soaps: effective or just risky?’ (2007) [1]

• This literature review identified 27 studies published between 1980 – 2006. It found that combined, the studies showed there was no evidence that antimicrobial soaps reduced infections or bacteria levels on hands, compared to plain soap.

Hand Hygiene with Soap and Water Is Superior to Alcohol Rub and Antiseptic Wipes for Removal of Clostridium difficile’ (2009) [2]

• • A crossover study of 10 volunteers found that using plain soap and water was more effective at removing Clostridium difficile on the skin than antimicrobial soaps, alcohol rubs, or antiseptic wipes.

With a growing body of evidence, in 2013 the FDA required manufacturers to submit safety data for the use of antimicrobial soaps [3]. In 2016, after a review period, the FDA concluded that there was insufficient evidence for the safety in daily use or effectiveness of 19 commonly added microbials, effectively banning their use [4].

What are the risks in using antibacterial soaps and cleaning products?

The FDA ruling in 2016 highlighted that there was insufficient evidence that antimicrobial soaps were any more effective than plain soaps, but also that there was a lack of safety data. Antimicrobial soaps have been linked with increased bacterial resistance, hormonal effects (endocrine disruption), and allergic diseases.

1. Bacterial Resistance

Resistance can occur when bacteria adapt to an antimicrobial agent. The theory is that by widely using antimicrobials in soaps, bacteria will adapt, rendering the ingredient useless. This removes one of the methods we have for eliminating bacteria, crucial given the emergence of multi-drug resistant organisms (e.g. tuberculosis).

Several studies have noted that the use of antimicrobial soaps increases the concentration of antibiotics required to overcome a bacterial population [5]. The relevance for these findings among the general population is unclear, and studies in the community have not always come to the same conclusions.

2. Hormonal Effects

Antimicrobials are widely added to both soaps, and less obvious products to prevent bacterial growth, including: toothpastes, clothing, toys, plastics, and paints [6]. The prevalence of these ingredients in daily life means that they can be detected at low levels in blood and urine samples, in both children and adults, as well as aquatic life [7].

Both triclosan and triclocarban have been shown to imitate reproductive and thyroid hormones – with implications for infant development [8]. A statement signed by over 200 researchers and medical professionals urged regulatory agencies to prevent the widespread use of triclosan and triclocarban in household products [6]. Both the FDA and European Union (EU) now restrict the use of these ingredients.

3. Allergic Diseases

The underlying cause of allergic diseases like asthma, eczema, and hay fever are not yet fully understood. A 2014 study questioned 35,000 Korean children and found that those exposed to the highest concentrations of household antimicrobials were significantly more likely to suffer from allergic diseases [9]. The correlation highlights the need for more robust studies into the risks of widespread antimicrobial use.

In Summary

Antimicrobial soaps have been shown to be no more effective at reducing bacteria on the skin or the risk of infection than plain soaps. They are associated with potentially harmful bacterial resistance, and are present in urine and blood samples, with links to hormonal disruption and allergic diseases.

So should you use them?  In our opinion – no! Aside from not being very effective, there’s health and environmental risks with using them.

References

[1] Aiello, A. E., Larson, E. L., & Levy, S. B. (2007). Consumer antibacterial soaps: effective or just risky? Clinical Infectious Diseases, 45, S137-S147.

[2] Oughton, M. T., Loo, V. G., Dendukuri, N., Fenn, S., & Libman, M. D. (2009). Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infection Control & Hospital Epidemiology, 30(10), 939-944.

[3] FDA. (2013). Safety and Effectiveness of Consumer Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use. www.fda.gov

[4] FDA. (2016). FDA issues final rule on safety and effectiveness of antibacterial soaps. www.fda.gov

[5] Sheldon Jr, A. T. (2005). Antiseptic “resistance”: real or perceived threat? Clinical Infectious Diseases, 40(11), 1650-1656.

[6] Halden, R. U., Lindeman, A. E., Aiello, A. E., Andrews, D., Arnold, W. A., Fair, P., & McNeill, K. (2017). The Florence statement on triclosan and triclocarban. Environmental Health Perspectives, 125(6).

[7] Kookana, R. S., Ying, G. G., & Waller, N. J. (2011). Triclosan: its occurrence, fate and effects in the Australian environment. Water Science and Technology, 63(4), 598-604.

[8] Rodricks, J. V., Swenberg, J. A., Borzelleca, J. F., Maronpot, R. R., & Shipp, A. M. (2010). Triclosan: a critical review of the experimental data and development of margins of safety for consumer products. Critical Reviews in Toxicology, 40(5), 422-484.

[9] Hong, S., Kwon, H. J., Choi, W. J., Lim, W. R., Kim, J., & Kim, K. (2014). Association between exposure to antimicrobial household products and allergic symptoms. Environmental health and toxicology, 29.

[10] CDC. (2017). Handwashing: Clean Hands Save Lives. www.cdc.gov