| | Handwashing — health professionals do it hundreds of times a week. Antibacterial soaps for handwashing are nothing new in clinical settings, but now that antibacterials have found their way into the consumer market, some researchers and health workers are concerned that too much germ-fighting power could be hazardous to our health.Triclosan—an antibacterial agent found in products as diverse as dish soap, shampoo, toothpaste, and body washes—has permeated the retail market since being introduced into consumer products in 1995. Today it’s hard to find a hand soap in your grocery store aisle not containing triclosan or some other antimicrobial germ fighter.Widespread useTriclosan’s pervasiveness prompted geneticists at Tufts University School of Medicine in Boston to investigate whether its widespread use could generate a strain of resistant bacteria, causing it to lose its effectiveness.”The potential is there for a problem because of the dramatic increase in its use,” said Stuart Levy, MD, director of the Center for Adaptation Genetics and Drug Resistance at Tufts, where the study on triclosan was conducted. “[Nurses] need to realize there’s another force out there going on in our homes that could compromise what’s going on in hospitals.”The study, published in the Aug. 6 edition of the scientific journal Nature, found—in tests on E. coli bacterium—that triclosan targets a specific bacterial gene. Although researchers have not yet found resistant bacteria that are the product of triclosan exposure, the discovery that the compound targets a specific genetic site means the potential for developing a resistant bacterial strain is much higher, the study’s authors conclude.Levy said triclosan and other antimicrobials have valid uses in clinical areas, but cautioned against their indiscriminate use. Antimicrobials guard against many forms of infection, including bacterial infections. Antibacterials guard against only bacterial infections.Use of antimicrobials needs to be monitored, said Linda Doyle, RN, an infection control consultant in Oxnard. “I do have some concerns that the more we use it, it could cause some problems along the way,” she said. “Infection control people have to be alert and look for changes in organisms in their own facilities.” Doyle recommended nurses be vigilant about following handwashing guidelines with regular soap and have access to antimicrobials when needed. “We have to be prudent in our use,” she said.The national Centers for Disease Control and Prevention (CDC) in Atlanta says vigorous handwashing in warm water with plain soap for at least 10 seconds is sufficient in most cases, even for healthcare workers. CDC guidelines recommend using antimicrobial soaps when caring for newborns, patients in high-risk units, and severely immunocompromised patients.Marketing ploy?Fran Slater, MBA, RN, manager of the infection control department at The Methodist Hospital in Houston and president of the Association for Professionals in Infection Control and Epidemiology (APIC) in Washington, agreed there is reason to worry about the widespread use of antimicrobials. “It’s a concern to us from the standpoint that the [soap] industry uses the characteristics of these products as a marketing ploy,’’ Slater said.A statement from APIC says, “These products are marketed to the consumer with the implication that their use will lower the risk of infection. We are concerned that the public may develop a false sense of security and may not be aware of the continued need for valid hygienic practices (such as frequent handwashing).”APIC asked 11 companies that market products containing antimicrobials for information on the efficacy of such products for consumers, but received no industry response. “There is no proven infection-prevention benefit in the use of these products,” APIC states. “APIC does not advocate the use of antimicrobial household products which are marketed with the implication of preventing infections.”At The Methodist Hospital, clinicians use antimicrobial soaps in critical care and surgical units, but not on regular nursing floors, Slater said. “We don’t want to overload the environment with antimicrobial agents—it’s a matter of being prudent,” she said.She recommends that nurses not use antimicrobials routinely— “only when you absolutely have to,” she said.Industry standpointThe Tufts study drew criticism from the soap industry as lacking “real world” value.”These were laboratory-engineered bacteria,” said Elizabeth Moore, spokesperson for Procter & Gamble Co., which uses triclosan in Dawn and Joy dish-washing soaps. “These were not real world conditions. In the real world [germs] have to compete with a host of other organisms. We’re really not worried about [triclosan use] leading to superbugs or resistant germs.”A spokesperson for the New York-based Soap and Detergent Association (SDA), which represents 140 North American manufacturers of cleaning products, said those containing triclosan have been used for more than 30 years and have never been shown to promote antibiotic resistance.Contrasting studiesTwo recent studies by hospital infection control researchers showed triclosan-based wash products controlled and reversed outbreaks of resistant bacteria infections in hospitals. One showed the use of Bacti-Stat—containing 0.3 percent triclosan—eradicated an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal nursery. An Australian study showed that triclosan body washes were effective in reducing the impact of MRSA in acute care facilities.”Hospitals are areas where antibiotic resistance is closely monitored,” said Janet Donohue, SDA spokesperson. “Triclosan has been used in hospitals for years with no evidence that antibiotic resistance is an issue.”The Food and Drug Administration said research is continuing into triclosan’s use. “The jury’s still out,” said FDA spokesperson Stephanie Bernier. “It is an issue that we are looking into, but we don’t see it as a major health problem.” |
