Coming Clean: Why you Don’t Need Antibacterial Soap

Cindy Russell, M.D., Chair Environmental Health Committee SCCMA

Many of us are reasonably worried about spreading germs, from Staphylococcus skin infections to Avian Flu viruses to Salmonella on food. There has understandably been an increased anxiety about infectious disease lately. It is important to wash your hands but if you think using antibacterial soaps or products will be safer and more effective, think again.

Adverse Effects of Triclosan
Triclosan, a common “antibacterial” ingredient has many adverse effects.
* It is toxic to fish and frogs and an environmental endocrine disruptor found to affect thyroid hormone gene expression. Note the packaging on some of these soaps that have lovely pictures of happy fish.
* It bioaccumulates in the tissues of fish and humans and is found in the breast milk of mothers who use it .
* It forms chloroform and other toxic byproducts when mixed with chloramine or chlorine treated tap water.
* It photodegrades into a carcinogen –dioxin- when exposed to UV light.
* Dermatologist caution that it causes dermatitis.
* The use of Triclosan has been shown to promote bacterial resistance in pathogenic bacteria such as methicillin resistant staphylococcus.

Triclosan is an “antibacterial” found in many common household products
Triclosan is frequently added to hand soaps, laundry detergents, cosmetics, toothpaste, lotions and now to household fabrics, cutting boards and plastics such as combs (as Microban). It is found in many products labeled “antibacterial”. It’s use is escalating. Labels may or may not identify this antimicrobial on the product.

AMA and US Food and Drug Panel : No added Benefit
The U.S. Food and Drug Panel and the American Medical Association have advised physicians to inform their patients that soaps and lotions that include antibacterial agents have “no added benefit” over ordinary soap and water. In addition, studies have shown that using antimicrobial chemicals such as triclosan that are commonly added to numerous consumer products may cause skin irritation and dermatitis of the hands as well as other health effects.

Promotion of Bacterial Resistance
Another major concern for public health officials and physicians is how antimicrobial products can promote resistance in pathogenic bacteria. The World Health Organization has an international campaign to combat antimicrobial resistance. This relates to the widespread use of both antibiotics by physicians and in our food production. There is evidence that using antimicrobial soaps may also be a factor. Because triclosan interferes with specific bacterial enzymes bacterial resistance can develop. This is unlike non specific antiseptics such as alcohol or peroxide that break down the cell wall thus have an immediate effect on the bacteria. The American Medical Association’s Council on Scientific Affairs published a report in the August 2002 Archives of Dermatology which stated it was prudent for people to avoid antimicrobial products due to the concern over antibiotic resistance and a lack of efficacy.

Toxicity to Humans and the Environment: From the sewer to your farm
There is also toxicity to humans and the environment to consider when choosing soaps or other antimicrobial products. Several studies show that triclosan photodegrades into potent carcinogens called dioxins. It also biodegrades into methyl triclosan which is lipophilic and bioaccumulates in our fatty tissue. Another breakdown product is 2, 4, dichlorophenol, a U.S. EPA priority pollutant.
One of the most popular antimicrobials triclocarban (TCC) defies water treatment methods. It is a known carcinogen and once we flush it down the toilet about 75% of TCC doesn’t break down. Once these compounds go down the drain they are either reused in “recycled water” or they become more toxic additives to sewage sludge which is then legally put on our crops as an agricultural amendment. A significant percentage of sewage sludge in California gets put on farmland. Many chemicals and pharmaceuticals we discard in addition to their metabolites we excrete are present in this mix.

Contamination of Streams

A recent study by Rolf Haden in the Department of Environmental Health Sciences at John Hopkins University found that TCC contaminated 60% of U.S. streams. That is in addition to a host of other contaminants such as manufacturing waste, pesticides, dioxins from paper manufacturing, and heavy metals. A 2000 study by USGS found Triclosan in 57% of 139 U,S. waterways used for urban or agricultural use.

Local Cities are Eliminating Tricosan from Purchasing Agreements
The City of Palo Alto recently enacted a green purchasing policy to eliminate Triclosan from all city run offices, janitorial services and bathrooms. They are just starting their educational campaign. As the City of Palo Alto gears up it is looking at greening the city in many ways by looking at the entire life cycle of all products used.
The Santa Clara Basin Watershed Management Initiative is a group of city agencies examining the broad field of what are known as emerging contaminants such as Triclosan. More recommendations will follow from this research.

CDC’s Advice for Physicians: Just wash your hands
It’s been said that the hospital is a good place to get an infection. Statistics show that this is true. Each year about 2 million patients in America develop infections while in the hospital. Infections are also spread in long-term care facilities and off site clinics. A key factor in reducing infections is for all health care personnel to wash their hands.

For physicians on the go the CDC recommends the use of alcohol based hand rubs. Many antimicrobial hand washing products used in health care settings have chemicals which may cause dermatitis, respiratory problems or long term chemical sensitivity in susceptible healthcare workers. While using stronger antimicrobials is often necessary it is also recommended to use the least toxic products as these chemicals go back to the sewage treatment plant and into our Bay or farmland affecting other species as well.

“Clean hands are the single most important factor in preventing the spread of dangerous germs and antibiotic resistance in health care settings, “ CDC director Julie Gerdberding,MD,MPH.

Advice for Patients: Just Wash Your Hands
Local infectious disease physicians such as Dr. Daniel Shin advises patients that regular hand washing for 20 seconds is “just as effective as using antimicrobial soaps”. Just washing your hands with traditional plain soap and water for 10-30 seconds works well.

Knowing that many products we use are both harmful to us and the environment it is important for physicians to advise patients to use safer alternatives in the home. These small acts may have much broader implications for both personal and global health. Future articles will discuss other household products.

Websites:
www.ama-assn.org/
www.tufts.edu/med/apua/
www.beyondpesticides.org/
www.ewg.org/

References
1) Triclosan in Plasma and milk from Swedish nursing mothers and their exposure via personal care products. Sci Total Environ. 2006 Sep 25. Allmyr M.
2) Effects of three organic wastewater contaminants on American toad, Bufo americanus, tadpoles. Ecotoxicology, 2005 May;14(4): 477-82. Smith GR.
3) Confirmation of the formation of dichlorodibenzo-p-dioxin in the photodegradation of triclosan by photo-SPME. Anal Bioanal Chem. 2005 Mar; 381(6);1294-8. Lores M.
4) Pharmaceuticals and personal care products (PPCP’s)and endocrine disrupting chemicals (EDC’s) in stormwater canals and Bayou St John in New Orleans, Louisiana, USA. SCi Total Environ. 2004 Oct15;333
(1-3);137-48. Boyd GR.
5) Formation of chloroform and chlorinated organics by free-chlorine
mediated oxidation of triclosan. Environ Sci Technol. 2005
May 1;39(9):3176-85. Rule KL.
6)Reduced triclosan susceptibility in methicillin resistant Staphylococcus epidermidis. Antimicrobial Agents Chemother. 2004 Apr; 48(4);1397-9. Schmid MB.