Antibacterial and Antimicrobial

I was thinking about the whole concept of antibiotics overuse and how it’s found its way in to the hand washing market because soaps get labeled antibacterial and antimicrobial.  First off, antibiotic and WAY different than antibacterial and antimicrobial but I do recognize why they get lumped in together.  But if you really put your mind to it what becomes clear is that it’s all about an arms race; if we don’t try to kill the bacteria then the bacteria remains easy to kill.  Seems circular on the surface but I think it’s a good way to start thinking about it.

What technology goes in to and makes up antibiotics is way too complex for a blog and I’m willing to bet most of us would have no clue what most of it means anyway; best leave that to the doctors.  But here’s what’s in antibacterial and antimicrobial soaps:  triclosan and/or alcohol or tetrasodium EDTA.  Triclosan and alcohol: these are usually found in most, if not all, liquid type soaps but are contained at preservative levels by soaps labeled as antibacterial/microbial.  As far as I can tell you need to leave these on the hands for 1-2 minutes for the 99.99% effectiveness to kick in.  Tetrasodium EDTA sequesters metals that bacteria need in order to grow.  These metals are also required by other microbes so it also tends to be antimicrobial in nature, so it gets used as a preservative as well.

  1. The SINGLE LARGEST and most effective advancement in public health improvement EVER has been the washing of hands with soap.
  2. Most people do not take 1-2 minutes to wash their hands.  Even the CDC recommends only 40-60 seconds of hand washing (they have good PDF posters).
  3. Current research neither supports nor contradicts the notion that antibacterial/antimicrobial soaps add to bacterial resistance to these substances OR antibiotics.
  4. The vast majority of the benefit you get from washing your hands is from the soap itself and the friction of rubbing your hands together.  Soap “captures” the microbes and allows you to rinse them away, dead or alive.
  5. Surgeons use antimicrobial soaps and washes to “scrub down” before they do surgery and NO ONE complains about that.  It’s also proven to be effective in reducing infections in the patients.

It seems to me that the only thing in this picture that makes antibacterial and antimicrobial soaps a gray area of concern is the lack of scientific data regarding them.  Tons of data shows that alcohol and the other agents we use do in fact kill and  destroy microbes, but nothing suggest that the little buggers are adapting to it like they clearly do with antibiotics.  So what do we do?  Here’s my decision making tree:

  1. Antibacterial/microbial substances help kill the microbes IF you wash for 1-2 minutes with them.
  2. Normal soaps seem to have the majority of the same effect IF you wash for 40-60 seconds with them.
  3. It is unclear if antibacterial/microbial substances add the resistance of the microbes over time.
  4. It’s also unclear as to the percentage of improvement you get by washing properly with antibacterial/microbial soaps.
  • For day-to-day use it seems to me to be more than sufficient to just wash your hands properly with whatever soap you have.  The possible risk of adding to bacterial/viral resistance is likely not worth the incremental benefit you’d get from washing with antibacterial/microbial soaps (even if you DID scrub for 1-2 minutes).
  • Washing with antibacterial/microbial substances IS likely worth it if you work in an environment where you touch people a lot, like health care, daycare, etc., because it prevents the spread of the bacteria and keeps yourself protected (also wearing nitrite gloves helps).
  • Washing with antibacterial/microbial substances IS likely worth it if you are prone to infections or have health concerns or health related procedures in your daily life.

Conclusion:  Only use antibacterial/microbial substances when you need to.  Seems like common sense to me but it’s not that simple when you think about it because what does “need to” mean?  After thinking about it here’s two generalized instances where I would want to use the extra protection of antibacterial/microbial substances:

  1. In any instance where you need to touch or work with an area where skin has been compromised; cuts, scrapes, burns, wounds, etc. either on your own body or on someone else.
  2. In any instance where you’ll be in physical contact with more people than your immediate family; company parties, visiting nursing home, day care settings, public bathrooms, etc.

Keep hand sanitizer in your purse or briefcase, keep hand sanitizer around the house for guests and occasional personal use, and just use regular soap day to day.  Places of work, in my opinion, should have antibacterial/microbial soaps in the bathrooms.

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