The weekly dose: are antimicrobial hand washes beneficial?

{Once a week we will examine the evidence pertaining to a health-related matter-- usually something that would be of interest to families with young children.  You should expect a thought out and concise summary of the issue along with several solid references-- there may or may not be a true conclusion.  Sometimes, “more research is needed”  really is the best answer that can be given.  Please leave me a comment if you have thoughts, questions, or another topic idea that you’d like addressed.}

It seems lately everyone has been ill with something or other, and as you know, I was no exception.  The common (and simple!) anecdote to not spreading illness, that we have all been taught since we were small, of washing our hands, is still one of the best ways to avoid spreading illness.  With flu season in full swing, it seems appropriate to examine what we wash our hands with.  Hopefully I’m not beating a dead horse here, but here’s the promised discussion about triclosan and hand soap.

The question I would like to answer is: in the home (or another community, non-healthcare setting) is it beneficial to use an antibacterial soap containing triclosan?

It is estimated that in America, about half of the commercially available hand soaps contain an antibacterial additive(1).  Most of the time this additive is Triclosan.  According to Wikipedia, Triclosan has been used since the early 1970’s, and is a chemically synthesized antimicrobial.  The FDA states that Triclosan is not known to be hazardous to humans, however there are some new studies that raise potential concerns so the FDA is now reevaluating the use of Triclosan in consumer products (2). 

Triclosan is often used in healthcare facilities, and because of this, many studies look at this application.  I would like to point out though, that the needs of a household are much different than the needs of a healthcare facility, and therefor the decision on whether to use antimicrobial soap in one setting will not necessarily transfer to another setting.  According to one study(3), the primary purpose of handwashing in the community, or home, is to prevent or reduce the acquisition of “transient organisms” which have a potential to cause disease. This can be contrasted to a healthcare setting where handwashing is designed to minimize the organisms naturally found on a provider’s hands, as well as to prevent cross contamination during patient care.  It is also important to note that the products available to the consumer contain a much lower concentration of antimicrobial than products that are available in a health care setting, and so the efficacy of the soaps will differ. 

After looking at some miscellaneous articles about Triclosan on the web, I went to PubMed (http://www.ncbi.nlm.nih.gov/pubmed) and searched “triclosan hand soap” which resulted in 58 hits with publication dates from August 1975 through May 2012.  At least 18 of these hits were highly relevant, based on the title alone.

Historically, there hasn’t been much research concerning the effects antimicrobial soap in a community setting (3).  One double blind study in 2003 compared the use of triclosan (0.2%) handwash soap to plain handwash soap in 238 inner city households.   The effects of handwashing after a year were significant, regardless of whether plain soap or antimicrobial soap was used, however there was not a significant difference between the two types of soap.  Because there was no definitive evidence in favor of triclosan soap, the authors suggest against using antibicorbial soap as general household soap.

One meta-analysis (a review-type article where they synthesis results from many published studies) did find that antimicrobial soap produced statistically significant reductions when compared with plain soap (4).  However, I only have access to this abstract, and so don’t know whether they looked at hospitals or communities, and what concentrations of antimicrobials they considered.  Since the abstract says they also considered chlorhexidine gluconate, iodophor, and povidone I’m guessing that they were not specifically considering household, or community use.

In 2007 a systematic review was published which examined the efficacy of products containing triclosan in a community setting (5).  The authors concluded that soaps containing triclosan at concentrations commonly used (0.1%-0.45% wt/vol) were no more effective than plain soap at preventing infectious illness symptoms and reducing bacterial levels on the hands.  The authors also noted that it is possible that triclosan contributes to the development of antibiotic-resistant bacteria. 

There are other studies suggesting that there are several harmful risks associated with triclosan, even at the low levels found in consumer products.  These risks range from being harmful to the environment and aquatic organisms (6), to weakening muscles (8), to developing antibiotic resistant bacteria. However, I haven’t taken the time to fully examine these, or other potential risks.

So, in the home is it beneficial to use an antibacterial soap containing triclosan? No, I believe the research shows there are no benefits to be gained by using a triclosan antibacterial soap in the home, and therefore, my family will continue to avoid buying these products.

(1)The Handiwork of Good Health. Harvard Health Letter. 2007 Jan;32(3):1-3.  http://www.ncbi.nlm.nih.gov/pubmed/17323497.  Accessed 1/28/2013.
(2) FDA: For Consumers. Triclosan: What Consumers Should Know. Aug. 29, 2012.  http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm.  Accessed 1/29/2013.
(3) Larson E, Aiello A, Lee LV, Della-Latta P, Gomez-Duarte C, Lin S. Short- and long-term effects of handwashing with antimicrobial or plain soap in the community.  J Community Health. 2003 Apr;28(2):139-50. http://www.ncbi.nlm.nih.gov/pubmed/12705315. Accessed 1/30/13.
(4) Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot. 2011 Nov;74(11):1875-82. doi: 10.4315/0362-028X.JFP-11-122. http://www.ncbi.nlm.nih.gov/pubmed/22054188.  Accessed 1/30/13.
(5) Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps: effective or just risky? Clin Infect Dis. 2007 Sep 1;45 Suppl 2:S137-47. http://www.ncbi.nlm.nih.gov/pubmed/17683018.  Accessed 1/30/13. 
(6) Bedoux G, Roig B, Thomas O, Dupont V, Le Bot B. Occurrence and toxicity of antimicrobial triclosan and by-products in the environment. Environ Sci Pollut Res Int. 2012 May;19(4):1044-65. doi: 10.1007/s11356-011-0632-z. Epub 2011 Nov 5. http://www.ncbi.nlm.nih.gov/pubmed/17683018. Accessed 1/30/2013. 
(7) Fritsch EB, Connon RE, Werner I, Davies RE, Beggel S, Feng W, Pessah IN. Triclosan Impairs Swimming Behavior and Alters Expression of Excitation-Contraction Coupling Proteins in Fathead Minnow (Pimephales promelas). Environ Sci Technol. 2013 Jan 28. [Epub ahead of print].  http://www.ncbi.nlm.nih.gov/pubmed/23305567.  Accessed 1/30/2013.