Antibacterial products
What’s the myth?
It has been suggested that use of antimicrobial cleaning and hygiene products, including antimicrobial hand hygiene products, contributes to development of antimicrobial resistance (AMR).
AMR is a major global public health concern. It occurs when microorganisms—bacteria, viruses, fungi and parasites—change over time and no longer respond to antimicrobial products such as antibiotics. This makes infections hard or impossible to treat.
The major cause of AMR is widely acknowledged to be the overuse and misapplication of antibiotics, both in human and animal treatment. However, the use of household antibacterial cleaning and hygiene products, particularly hand hygiene products, has also been implicated by some.
FACT: Studies have not concluded that antimicrobial product use causes AMR
Antibacterial hygiene products have been in use for over 50 years.
During this time, studies have investigated whether there is a link between the use of antibacterial products—in both households and clinical settings—and AMR. Several reviews of the accumulated evidence have not found a definitive link between the use of antibacterial products and AMR.
The International Scientific Forum on Home Hygiene (IFH) published an information paper titled ‘Use of Disinfectants and Antibacterials in the Home: Concerns About Antibiotic Resistance’ in 2015.[1] This paper concludes that ‘although some laboratory studies have demonstrated links between microbiocide and antibiotic resistance there is no equivocal evidence that microbiocide usage contributes to the development of antibiotic resistance either in clinical practice or in the general environment’, and that this is despite ‘decades of continuous use of microbiocides in clinical and other situations’. The IFH notes that other reviews [2][3][4] have reached the same conclusion but also highlights the importance of continuing to research and monitor the situation.
FACT: Global health authorities are not focusing on antimicrobial cleaning and hygiene products in the fight against AMR
The World Health Organization (WHO) has declared AMR to be one of the top 10 global public health threats facing humanity. Many countries and cross-jurisdictional organisations have or are developing strategies to combat AMR.
Antimicrobial household or hand hygiene products are not the focus of these strategies. In fact, hygiene is commonly mentioned in the context of its importance in preventing the spread of infection. For example, as part of Australia’s response to the threat of AMR the Australian Government has provided guidance for the public that emphasises good hygiene and the appropriate use of antibiotic medicines. Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond, launched in March 2021, makes no explicit mention of concerns regarding antimicrobial household or hand hygiene products.
Additionally, the seeming lack of recent publications or new studies exploring antimicrobial cleaning and hygiene products and AMR suggests that this is not a priority area of focus.
FACT: The USA FDA’s ban on certain antibacterial ingredients in antibacterial hand wash products was based on lack of information, not on new evidence of bacterial resistance
In the USA, the use of some antibacterial ingredients, including triclosan, has been banned in consumer antibacterial hand wash products since late 2017. The ingredients are still permitted in products used in clinical settings and in consumer hand wipes.
This ban was based on a lack of information rather than any new evidence of safety concerns. The US Food & Drug Administration (FDA) stated that ‘manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections’.[5]
The Australian chemical ingredient regulator, AICIS (formerly NICNAS), reviews the safety of chemical ingredients used in many household and personal care products on an as-needed basis. For example, in 2009 NICNAS reviewed triclosan and concluded ‘that there is no evidence that the use of triclosan is leading to an increase in triclosan-resistant bacterial populations or that there is any increased risk to humans regarding antibiotic resistance.’[6]
In another example, a 2011 study showed ‘no increased antibiotic resistance in participant groups regularly using wash products containing triclocarban or triclosan…This adds to and confirms previous yet limited community data showing lack of evidence that the use of antibacterial wash products facilitates antibiotic resistance and antibiotic/antibacterial cross-resistance.’[7]
Australian regulators continue to review emerging evidence and decisions made by overseas regulators, including the FDA. At present there is no ban on these ingredients in Australia.
FACT: Good hygiene is essential in the fight against antimicrobial resistance.
Good hygiene is essential in the fight against AMR. This includes appropriate hand washing and surface cleaning/disinfecting in your home. Good hygiene helps prevent infection, which means less need for antibiotic prescribing. And good hygiene also helps stop the spread of infections that are caused by antibiotic-resistant bacteria.
‘Targeted hygiene’ is a relatively new term that emphasises the use of appropriate hygiene at key moments when harmful microbes are most likely to pose an exposure/infection risk. These key moments include when handling/eating food and after coughing or sneezing, using the toilet/bathroom, handling dirty clothing, caring for infected family members and touching surfaces that are frequently touched by others. Antimicrobial products may be called for in some of these situations, whereas physical removal with soap and water may be sufficient for others.
The bottom line? You can continue to use antibacterial products with confidence—there is no new evidence to show that using these products in the home contributes to AMR. Target use of these products to situations where there is greatest risk of transmission of pathogenic microorganisms.
Sources
[1] International Scientific Forum on Home Hygiene. (2015). ‘Use of Disinfectants and Antibacterials in the Home: Concerns About Antibiotic Resistance’. Accessible from https://www.ifh-homehygiene.org/factsheet/use-disinfectants-and-antibacterials-home-concerns-about-antibiotic-resistance
[2] Gilbert, P. and McBain, A. (2003) ‘Potential impact of increased use of biocides in consumer products on prevalence of antibiotic resistance’. Clinical Microbiological Reviews. 16, 189-208.
[3] Aiello, A.E. and Larson, E. (2003) ‘Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community’. The Lancet infectious diseases, 3. 501-506.
[4] Russell, A.D. and Maillard, J-Y. (2000) Response. American Journal of Infection Control 28, 204-206.
[5] FDA News Release, 2 September 2016, "FDA issues final rule on safety and effectiveness of antibacterial soaps". www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm
[6] National Industrial Chemicals Notification and Assessment Scheme 2009, PEC Assessment Report 30, Triclosan
[7] Cole E. C., Addison R. M., Dulaney P. D., Leese K. E., Madanat H. M. and Guffey A. M. 2011, Investigation of antibiotic and antibacterial susceptibility and resistance in Staphylococcus from the skin of users and non-users of antibacterial wash products in home environments, International Journal of Microbiology Research, Vol. 3(2), pages 90-96
It has been suggested that use of antimicrobial cleaning and hygiene products, including antimicrobial hand hygiene products, contributes to development of antimicrobial resistance (AMR).
AMR is a major global public health concern. It occurs when microorganisms—bacteria, viruses, fungi and parasites—change over time and no longer respond to antimicrobial products such as antibiotics. This makes infections hard or impossible to treat.
The major cause of AMR is widely acknowledged to be the overuse and misapplication of antibiotics, both in human and animal treatment. However, the use of household antibacterial cleaning and hygiene products, particularly hand hygiene products, has also been implicated by some.
FACT: Studies have not concluded that antimicrobial product use causes AMR
Antibacterial hygiene products have been in use for over 50 years.
During this time, studies have investigated whether there is a link between the use of antibacterial products—in both households and clinical settings—and AMR. Several reviews of the accumulated evidence have not found a definitive link between the use of antibacterial products and AMR.
The International Scientific Forum on Home Hygiene (IFH) published an information paper titled ‘Use of Disinfectants and Antibacterials in the Home: Concerns About Antibiotic Resistance’ in 2015.[1] This paper concludes that ‘although some laboratory studies have demonstrated links between microbiocide and antibiotic resistance there is no equivocal evidence that microbiocide usage contributes to the development of antibiotic resistance either in clinical practice or in the general environment’, and that this is despite ‘decades of continuous use of microbiocides in clinical and other situations’. The IFH notes that other reviews [2][3][4] have reached the same conclusion but also highlights the importance of continuing to research and monitor the situation.
FACT: Global health authorities are not focusing on antimicrobial cleaning and hygiene products in the fight against AMR
The World Health Organization (WHO) has declared AMR to be one of the top 10 global public health threats facing humanity. Many countries and cross-jurisdictional organisations have or are developing strategies to combat AMR.
Antimicrobial household or hand hygiene products are not the focus of these strategies. In fact, hygiene is commonly mentioned in the context of its importance in preventing the spread of infection. For example, as part of Australia’s response to the threat of AMR the Australian Government has provided guidance for the public that emphasises good hygiene and the appropriate use of antibiotic medicines. Australia’s National Antimicrobial Resistance Strategy – 2020 and Beyond, launched in March 2021, makes no explicit mention of concerns regarding antimicrobial household or hand hygiene products.
Additionally, the seeming lack of recent publications or new studies exploring antimicrobial cleaning and hygiene products and AMR suggests that this is not a priority area of focus.
FACT: The USA FDA’s ban on certain antibacterial ingredients in antibacterial hand wash products was based on lack of information, not on new evidence of bacterial resistance
In the USA, the use of some antibacterial ingredients, including triclosan, has been banned in consumer antibacterial hand wash products since late 2017. The ingredients are still permitted in products used in clinical settings and in consumer hand wipes.
This ban was based on a lack of information rather than any new evidence of safety concerns. The US Food & Drug Administration (FDA) stated that ‘manufacturers did not demonstrate that the ingredients are both safe for long-term daily use and more effective than plain soap and water in preventing illness and the spread of certain infections’.[5]
The Australian chemical ingredient regulator, AICIS (formerly NICNAS), reviews the safety of chemical ingredients used in many household and personal care products on an as-needed basis. For example, in 2009 NICNAS reviewed triclosan and concluded ‘that there is no evidence that the use of triclosan is leading to an increase in triclosan-resistant bacterial populations or that there is any increased risk to humans regarding antibiotic resistance.’[6]
In another example, a 2011 study showed ‘no increased antibiotic resistance in participant groups regularly using wash products containing triclocarban or triclosan…This adds to and confirms previous yet limited community data showing lack of evidence that the use of antibacterial wash products facilitates antibiotic resistance and antibiotic/antibacterial cross-resistance.’[7]
Australian regulators continue to review emerging evidence and decisions made by overseas regulators, including the FDA. At present there is no ban on these ingredients in Australia.
FACT: Good hygiene is essential in the fight against antimicrobial resistance.
Good hygiene is essential in the fight against AMR. This includes appropriate hand washing and surface cleaning/disinfecting in your home. Good hygiene helps prevent infection, which means less need for antibiotic prescribing. And good hygiene also helps stop the spread of infections that are caused by antibiotic-resistant bacteria.
‘Targeted hygiene’ is a relatively new term that emphasises the use of appropriate hygiene at key moments when harmful microbes are most likely to pose an exposure/infection risk. These key moments include when handling/eating food and after coughing or sneezing, using the toilet/bathroom, handling dirty clothing, caring for infected family members and touching surfaces that are frequently touched by others. Antimicrobial products may be called for in some of these situations, whereas physical removal with soap and water may be sufficient for others.
The bottom line? You can continue to use antibacterial products with confidence—there is no new evidence to show that using these products in the home contributes to AMR. Target use of these products to situations where there is greatest risk of transmission of pathogenic microorganisms.
Sources
[1] International Scientific Forum on Home Hygiene. (2015). ‘Use of Disinfectants and Antibacterials in the Home: Concerns About Antibiotic Resistance’. Accessible from https://www.ifh-homehygiene.org/factsheet/use-disinfectants-and-antibacterials-home-concerns-about-antibiotic-resistance
[2] Gilbert, P. and McBain, A. (2003) ‘Potential impact of increased use of biocides in consumer products on prevalence of antibiotic resistance’. Clinical Microbiological Reviews. 16, 189-208.
[3] Aiello, A.E. and Larson, E. (2003) ‘Antibacterial cleaning and hygiene products as an emerging risk factor for antibiotic resistance in the community’. The Lancet infectious diseases, 3. 501-506.
[4] Russell, A.D. and Maillard, J-Y. (2000) Response. American Journal of Infection Control 28, 204-206.
[5] FDA News Release, 2 September 2016, "FDA issues final rule on safety and effectiveness of antibacterial soaps". www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm517478.htm
[6] National Industrial Chemicals Notification and Assessment Scheme 2009, PEC Assessment Report 30, Triclosan
[7] Cole E. C., Addison R. M., Dulaney P. D., Leese K. E., Madanat H. M. and Guffey A. M. 2011, Investigation of antibiotic and antibacterial susceptibility and resistance in Staphylococcus from the skin of users and non-users of antibacterial wash products in home environments, International Journal of Microbiology Research, Vol. 3(2), pages 90-96