By: Rosemary Stephen.
Not too long ago, public bathrooms were equipped with liquid soap that smelled like bubble gum; boy, I really loved that scent! Hand washing, however, has evolved a great deal since my rookie days as an inspector. In the past, most food facilities used soap bars. Bars were never really clean so they were replaced by liquid soap. These soaps either had an ‘industrial’ scent or no scent at all. Recently, liquid soap was replaced by foamy soap. This soap lathers really well, but alas … no bubble gum scent….
When I go to the grocery store, I am amazed at the number of soaps available. There are numerous brands of bar soap, each type available with or without fragrances. There are ‘hundreds’ of bottles of brightly coloured liquid soap, also available in scented or unscented varieties. Most of the liquid soaps, however, are also antibacterial. As I stand there in the aisle, I always ask myself which soap is better: regular or antibacterial? In some applications, such as care facilities and food service establishments, I am a proponent of antibacterial soaps, but for the general public I am not really sure. There are negative rumors about the effect of antibacterial soap on the natural flora of the skin which in turn raises some serious questions:
- should antibacterial soap be recommended for the general population?
- should we be worried about antibacterial soap resistance at home?
- should we be worried about antibacterial soap resistance in hospitals and in the food industry?
- have there been sufficient studies to guide us in our recommendations?
Let’s start from the beginning — what are antibacterial soaps anyway? Antibacterial soaps are divided into two groups: non-residue-producing and residue-producing. Non-residue producing kill bacteria and evaporate, quickly. They leave no active residue and include ingredients such as alcohols, chlorine, peroxides, and aldehyde. Residue-producing soaps kill bacteria at a slower rate and leave a long acting residue. The active ingredients are: triclosan, triclocarban, and benzalkonium chloride .
From the dozen antibacterial products available in the mid 1990s there are more than 700 in the market today. Stuart Levy, from the Center for Adaptation Genetics and Drug Resistance, Tufts University School of Medicine in Boston writes in Antibacterial Household Products : Cause for Concern, that such a proliferation of antibacterial soaps are a worry. He says that “the public is being bombarded with ads for cleansers, soaps, toothbrushes, dish washing detergents, and hand lotions, all containing antibacterial agents” and that “antibacterial substances added to diverse household cleaning products are similar to antibiotics in many ways” . Antibacterial products have extended to window cleaners, chopsticks and plastic food storage containers in England. In Italy, they are in public laundries, while in the US, in Boston, Stuart Levy notes that “you can purchase a mattress completely impregnated with an antibacterial agent. Whole bathrooms and bedrooms can be outfitted with products containing triclosan (a common antibacterial agent), including pillows, sheets, towels, and slippers” .
The results of the increased use of these antibacterial agents ? Mr. Levy mentions that “in a recent study, 7% of Listeria monocytogenes strains isolated from the environment and from food products showed resistance to quaternary ammonium compounds” while lab tests on residue-producing antibacterial soaps show resistance to Triclosan (according to Mr. Levy, non-residue-antibacterial soaps that contains alcohols, bleaches, and peroxides are not a concern) .
A shorter patient stay in hospitals means that medical care is continued at home. If the home is “too clean”, we may end up with hospital-like bacteria in a home environment. “Excessive hygiene, therefore, may interfere with the normal maturation of the immune system by eliminating the stimulation by commensal microflora” . Another worrisome possible side effect is the increase of allergies in children. At the moment this is still an hypothesis, but one thing is sure — “in one rural community, children who grew up on farms had fewer allergies than did their counterparts who did not live on farms”. According to Levy, “the immune system must be stimulated to achieve the right balance between the T-helper 1 (TH-1) cells providing cellular immunity and the TH-2 cells promoting antibody production” .
I agree with Mr. Levy. “We are not at war with the microbial world”  because we know that it is a losing battle. Should we then recommend the use of regular liquid soap or non-residue antibacterial soap to the general public instead of residue-producing antibacterial soap ?
I think we should.
 Anti bacterial agents (2008) APUA, Alliance for the prudent use of Antibiotics. (On-line). Available: http://www.tufts.edu/med/apua/Q&A/Q&A_antibacterials.html. Cited Nov 17.
 Levy, S.B. Antibacterial Household Products: Cause for Concern (2001). Emerging Infectious Diseases, CDC. (On-line). Available: http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm. Cited 2008 Nov 18.