The dirt on antibacterials

CHOICE goes beyond the health hype of cleaners and sanitisers.
 
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01 .Advertising blitz

antibacterials_NOV11_WEB_LEAD

When it comes to the hype around beating bugs and germs, CHOICE discovers that antibacterial products don't hold up to much scrutiny.

If you believe the advertising, every home should be bristling with an arsenal of antibacterial sprays, gels, wipes and washes. Consumers are being told they need to eliminate germs from their homes to protect themselves and their families from sickness. Antibacterial products, we’re told, are the answer.

In this article we take a look at:

  • The battle of the bugs How these products kill both bad and good bacteria.
  • Vive la resistance How the overuse of antibacterial products could lead to antibiotic-resistant bacteria.
  • Hand sanitisers How these commonly used quick-cleaners don't protect you from everything.
  • The soap story How do antibacterials stack up against soap and water, and what sorts of ingredients are they made with?

A survey in the US found 75% of all liquid hand soaps and almost 30% of all bar soaps contained antibacterial agents – and our survey of Australian supermarkets confirmed they are still prevalent in handwashing products. 

Antibacterials such as triclosan are now being added to pillows, mattresses, food storage containers and household fittings.

For more information on Children's health, see Health, and for more information on Cleaning, see Household.

Battle of the bugs

Some bacteria keep us healthy by keeping harmful bacteria in check. When we bombard them indiscriminately with antibacterials, we disrupt the balance between good and bad. Worse, we may end up giving the bad bugs the upper hand.

Antibacterial agents don’t care which bacteria they kill, and that can have serious consequences. “The mechanism for disturbing good versus bad bacteria has to do with selection,” says Dr Stuart Levy, Director of the Center for Adaptation Genetics and Drug Resistance at Tufts University School of Medicine in the US. “The [antibacterial] products inhibit growth of susceptible and harmless strains of bacteria while not affecting resistant strains that may be infectious.”

Vive la resistance

It’s this selective process that has scientists worried, since studies under laboratory conditions have demonstrated that it’s possible to use antibacterials to create antibiotic-resistant bacteria. Along with the overuse of antibiotics, the extensive use of handwashing products and cleaners containing biocides could contribute to the emergence of antibiotic-resistant strains and ultimately reduce the efficacy of prescription antibiotics.

If antibacterials are included in consumer products at sub-lethal concentrations, for instance, they create the perfect environment for the evolution of resistant strains. While evidence that using antibacterials causes antibiotic resistance has only been borne out in the lab, some scientists such as Levy believe it’s fair to assume that the antibacterial cleaners we use at home are a significant contributor to the development of superbugs - antibiotic-resistance bacteria.

“Antibacterials should be limited to use in healthcare settings, where they are used under optimal conditions to protect against infection,” he says, adding that antibacterial use in the home may make them less effective in healthcare environments, where they are needed most.

Hand sanitisers under the pump

antibacterials_NOV11_WEB5Alcohol hand sanitisers are a popular way of cleaning while out and about, but if used incorrectly, they may be giving you a false sense of cleanliness.

Hand Hygiene Australia supports the use of alcohol-based hand rubs as an effective alternative to soap and water for healthcare settings where preventing the spread of infection is critical. But the type and level of dirt that an individual comes into contact with is different to what a healthcare professional encounters, and this can have an impact on how effective hand sanitisers are.

  • They won’t be appropriate if your hands are visibly soiled, and water will reduce the effectiveness of a hand rub, so they may not be the best choice if you are handling food or if your hands are wet.
  • Many consumer hand sanitisers contain either ethanol or isopropyl alcohol.
  • Some products do not state the alcohol content, which must be between 60% and 80% to be effective.
  • Most of these products claim to kill 99.9% of germs, but the accuracy of this claim is highly dependent on the ingredients and how the product is used.

“People should read product information carefully – the devil is always in the detail,” says Brett Mitchell from Infection Control Australia, adding that “contact time is important”.

Alcohol sanitisers do not protect you from everything. Clostridium difficile, for example, is responsible for many instances of diarrhoea and its spores are not affected by alcohol-based rubs, so prevention requires soap, water and scrubbing.

Hand sanitisers should only be used as an optional followup to hand washing. But they’re better than nothing if you don’t have access to soap and water.

 
 

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antibacterials_NOV11_WEB6Another good reason to limit antibacterials to healthcare is that many of the products we find in the supermarket are no more effective than soap and water.

antibacterials_NOV11_WEB4Suds stack up

Regardless of whether antibacterial products contributing are to antibiotic resistance, there’s a strong case to be made that they’re targeting a need that’s already met.

Although soap doesn’t actually kill all bacteria, what it does do quite effectively is lift dirt off the skin and other surfaces, so dirt and bacteria can be easily rinsed away. Washing with soap and water will reduce the amount of bacteria to safe levels without the use of an antibacterial agent.

In fact, scientists have demonstrated that washing hands with plain old soap is just as effective at reducing bacterial load as washing with antibacterial soap. And, this time-honoured approach has the added bonus of not disturbing the balance of good and bad bacteria.

What’s more, many studies have shown that the use of antibacterials does not reduce infection rates in healthy households. One well established fact that product makers don’t mention in their marketing is that many of the common illnesses you need to worry about are caused by viruses, not bacteria.

Keeping these facts in mind, it’s fair to say that antibacterials do little beyond what soap and water can do.

The allergy link

Dirt may not be such a bad thing after all. Health scientists have suggested that our war on bacteria may be partially responsible for the increase in rhinitis and allergic asthma in children.

Based on studies showing a lower incidence of allergic disease in children who grow up in large families, attend childcare or have pets, the current consensus is that exposure to microbes as a child plays an important role in regulating the immune system. In other words it may reduce the body’s tendency to develop allergic reactions to common allergens.

The overuse of antibacterials in your home could mean that your child is more likely to develop allergies.

Triclosan – the household pesticide

One of the most common antibacterials to be added to household products is triclosan (or triclocarbon) . You may find it if you look at the ingredients list on your liquid or bar soaps or toothpaste.

Triclosan is a highly effective agent against harmful organisms, but there is concern that it could also pose a risk to our health and the environment.

  • Animal studies have indicated that it may be an endocrine disruptor as it interferes with both thyroid and sex hormones.
  • Since humans have similar hormone systems to other animals, these chemicals may also be affecting us in similar ways.
  • About three-quarters of Americans have triclosan in their urine.
  • It has also been detected in human blood and breast milk, and blood levels spike after using antibacterial soaps and toothpaste containing the chemical.
  • After you use soap and toothpaste, most of the product goes down the sink where it enters the environment and waterways.

The US Food and Drug Administration (FDA) has proposed a rule that requires manufacturers of antibacterial soaps to prove their products are more effective than soap and water and safe for long-term use.  

According to the FDA, there’s currently no evidence that antibacterial soaps are more effective at preventing illness and may in fact be harmful. Research suggests that long-term exposure to active ingredients such as triclosan, found in liquid soaps, and triclocarban, found in bar soaps, is causing bacterial resistance. 

Under the new rule, manufacturers in the US would either have to provide evidence for the antibacterial claim or either remove the antibacterial ingredients from the product or the claim from the label. In Australia, such rules do not exist. but the  Therapeutic Goods Administration has said it is aware of the FDA’s review and will monitor developments.


In the meantime, if you’re concerned about triclosan, check the ingredients list of your soaps and toothpaste before buying.

Safe sanitising

  • Choose a sanitiser with 60%-80% alcohol. Use soap and water first if your hands are visibly soiled.
  • Apply the amount recommended by the manufacturer and rub hands together, coating all surfaces.
  • Continue rubbing until the hands are dry. If it takes less than 15 seconds to dry, then you haven’t applied enough.

CHOICE verdict

While antibacterial soaps and cleaners are needed in a healthcare setting, they provide little benefit in our homes. Next time you’re in the cleaning products aisle and looking for a germ eradicator, take a moment to consider the ingredients of what you buy.

Antibacterials have their place in certain circumstances, but as they’re no better than soap and water, why take the chance that using them might be contributing to antibiotic resistance or reducing their effectiveness in hospitals? Not buying them can save you a few dollars too.

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