Bureau of Epidemiology
Bureau of Epidemiology        August 2000 Utah Department of Health
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Consumer Use of Products Containing Antimicrobial Agents

The result of effective public health education programs has made the public more aware of infectious diseases. Diseases such as E. coli, Mycobacterium tuberculosis, Salmonella, Cryptosporidium, hantavirus, HIV, hepatitis C, and Ebola have become common words used in daily conversations. The public has become concerned about infectious diseases and transmission of diseases in homes, day-care centers, restaurants, and other public places. By marketing good public health information, the general public became conscious of preventing infectious diseases. It’s hard to imagine the days in the not-so-distant past where a sink with running water and soap wasn’t always available in a public setting.

Industry has also responded to the public’s interest in diseases by marketing products to consumers with the implication that the risk of infection will be reduced. In the clinical setting, the use of antibacterial soaps for handwashing is nothing new. Now that the consumer market has been flooded with antibacterials, some researchers and health care providers are concerned that too many antibacterial agents could be hazardous to our health. A statement from the Association for Professionals in Infection Control and Epidemiology (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).” The Centers for Disease Control and Prevention (CDC) recommends handwashing in warm water with plain soap for at least 10 seconds. This should be sufficient in most cases, even for health care workers. Antimicrobial soaps should be used when caring for newborns, patients in high-risk units, and severely immunocompromised patients.

Hundreds of products are being sold to combat germs touting messages such as, “Contains antibacterial agents” or “Prevents the transmission of germs”. Some even state the specific germs, i.e.: “Kills hepatitis virus, Salmonella, E. coli O157, and Giardia.” The products are mostly directed to home use and include: toys, toilet seats, cutting boards, telephones, toothbrush handles, sponges, laundry soaps, dishwashing soaps, handwashing soaps, shampoo, lotions, mouthwash, underwear, and air fresheners to name just a few. Do we really need a shampoo that can add volume and shine to your hair and also kill the diarrhea causing germs there too?

Antimicrobial agents that have been added to plastics and other solid materials should not be expected to kill surface microorganisms. Water must be present to transport the antimicrobial chemical agents across the cell wall of the microorganisms. As a result, an object such as a plastic toy with an incorporated antimicrobial agent is not self-sanitizing. Any microbial contamination of the toy will require soap and water to wash it off or will be killed by adding a liquid germicide.

In the past, antimicrobial agents were used as a preservative in plastics and other materials. One of the best antimicrobial agents is triclosan that prevents mildew growth. This is often used in shower curtains and leather products. During the Korean War, US Army troops were going through shoes every few weeks because of rotting in the water-rich environment. When triclosan was incorporated into the shoe material, they lasted until they were worn out. Now triclosan has permeated the retail market since being introduced into consumer products. Marketed under Microban Plastic Additive “B”, the presence of triclosan in products may be perceived as providing protection from harmful microorganisms and provide a health benefit. If there is the belief that toys and other objects containing Microban are sanitary or self-sanitizing, standard hygiene practices, such as washing with soap and water, may not be performed.

Certain models of cutting boards have been removed from the market as a result of making unsubstantiated claims that they prevented the growth of common food-poisoning organisms, including Salmonella and E. coli, and reduced the danger of bacterial contamination. The cutting boards are treated with an antimicrobial agent that protects products from odor-causing bacteria but has not been shown to be effective against organisms that can cause disease in humans. The concerns are similar as with toys and triclosan, if it’s assumed that the product is self-sanitizing then consumers may skip ordinary hygiene practices like washing with soap and water. Sponges have also made claims to killing germs while in the sponge. What the germicide-impregnated sponges can do is inhibit odor-causing germs in the sponge but does not disinfect or kill germs on surfaces. Again, consumers should use, let’s say it together, “soap and water” to prevent transmission of pathogenic microorganisms.

Now the question of, “What soap should be used?” is often raised. Dr. Eli N. Perencevich, of Beth Israel Deaconess Medical Center in Boston and other researchers found antibacterial agents such as triclosan present in about 75% of liquid soaps and 30% of bar soaps. Researchers are now looking into whether antibacterial products lead to resistance. The American Medical Association (AMA) states that antibacterial soaps may be no more effective against germs than common soap, and could contribute to the threat posed by drug-resistant bacterial strains. “There’s no evidence that they do any good and there’s reason to suspect that they could contribute to a problem” by helping to create antibiotic-resistant bacteria, said Myron Genel, chairman of the AMA’s Council on Scientific Affairs. He also said use of the products may contribute to the well-recognized problem created by excessive use of antibiotics that has led to mutated bacterial strains that are resistant to drugs. “Washing with plain soap might be just as affective in battling illness”.

A trade group, the Cosmetic, Toiletry and Fragrance Association, had lobbied the AMA against having any position on antibacterial products. They state that the public should not be deterred from using antibacterial products, which can “kill or inhibit the growth of bacteria that cause skin infections, intestinal illnesses or other commonly transmitted diseases. They claimed the AMA’s action was based on “untested scientific theory”. The group instead blamed antibiotic resistance on what it said were “50 million unnecessary prescriptions for antibiotics that doctors write each year”. Touché!

It’s true, excessive use of antibiotics has led to resistance and Dr. Stuart Levy, director of the Center for Adaptation Genetics and Drug Resistance at Tufts University in Boston, said antibacterial soaps and sprays may actually encourage the growth of ever-hardier, drug-resistant germs. Rather than killing all bacteria, the products destroy only the weakest, leaving stronger ones to survive and multiply. Researchers at Tufts University working with E. coli recently found that triclosan acts on a single gene and that if that one E. coli gene mutated, triclosan was rendered ineffective against that bacteria. Because bacteria are capable of exchanging genetic material, resistance developed by one type or strain of bacteria can be transferred to another.

The bottom line here is that consumers should check the ingredients when buying soap. Antimicrobial agents in consumer products are beneficial for purposes of preservation and preventing microbial degradation of materials. Their inclusion in toys, cutting boards, soaps, and other products intended for home use does not prevent transmission of infectious diseases and has little, if any, public health benefit. There is a place for antibacterials in the home, for example when caring for a vulnerable sick person following hospitalization. The Department of Family and Consumer Sciences at the University of Wyoming encourages people to “keep it simple” and to use plain soap and water and to wash their hands frequently and thoroughly. Reasons include the following:

  • Plain soap and water are effective when people follow the proper technique.

  • Antibacterial soaps and hand sanitizers may contribute to a false sense of security. More specifically, people may mistakenly think they don’t need to wash their hands as often if they use “special” products like antibacterial soaps or hand sanitizers.

  • Some special hand-washing products are not approved for use with food, necessitating that they be rinsed off prior to handling food.

  • Some special products are much more expensive than plain soap.

  • Use of antibacterial soaps may be contributing to antibiotic resistance, which has serious implications for public health in general.

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Update: Influenza Vaccine Supply

Public health officials recently announced that influenza vaccine supplies should be approximately equal to what was distributed last year; however, they also noted a substantial amount of vaccine will reach providers later than usual. In June, influenza vaccine manufacturers told federal public health officials to expect delays in influenza vaccine shipments this season and possible shortages.

Influenza vaccine is the best tool to prevent severe illness and death related to influenza among the elderly and chronically ill in the United States. The UDOH Immunization Program has outlined the following guidelines based on priorities recommended by the Centers for Disease Control and Prevention (CDC).

First priority to receive available influenza vaccine are those individuals at highest risk of complications and death from influenza as follows:

  • Residents of long term care facilities, nursing homes, and other residential health care settings.

  • Individuals with chronic disease or immunosuppression ages 6 months to 65 years and older.

  • General population age 65 and older.

Second priority to receive available influenza vaccine in the following order:

  • Health care workers with direct patient contact.

  • Household contacts of chronically ill or immunosuppressed patients.

  • Maternity patients in second or third trimester.

Third priority to receive available influenza vaccine in the following order:

  • Critical community workers (police, fire, public works, teachers).

  • Population 50 and older

  • Foreign travelers

  • General work force

  • General population (stay at home)

During the fall, vaccination of persons in the first priority group should proceed routinely during regular health care visits as vaccine becomes available. Health care providers, health organizations, commercial companies, and other organizations planning organized influenza vaccination campaigns for the general population should delay these campaigns until late November. Community level discussions are encouraged to develop vaccine contingency plans based on these priority recommendations and available vaccine supplies.

The degree of delay for individual providers will vary, depending on the vaccine manufacturer, distributor, and when vaccine was ordered. Officials urge high risk persons to remain patient but persistent as they work with their health care provider to obtain their annual influenza vaccination.

Although the vaccine supply this year should be sufficient to meet the usual demand, some questions about supply and demand will remain unanswered until much later into the influenza season. All influenza vaccine for use in the United States is produced in the private sector and virtually all influenza vaccine is distributed in the United States through private-sector distributors for use by health care providers. For more information about influenza disease, contact the Bureau of Epidemiology (801)538-6191. For more information about influenza vaccine, contact the Immunization Program (801)538-9450.

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Utah Department of Health, Bureau of Epidemiology
Monthly Morbidity Summary
August 2000 - Provisional Data

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The Epidemiology Newsletter is published monthly by the Utah Department of Health, Division of Epidemiology and Laboratory Services, Bureau of Epidemiology, to disseminate epidemiologic information to the health care professional and the general public.

Send comments to:  The Bureau of Epidemiology, Box 142104, Salt Lake City, UT 84114-2104, or call (801) 538-6191

Approval 8000008:  Appropriation 3705

Rod Betit, Executive Director, Utah Department of Health
Charles Brokopp, Dr.P.H., Division of Epidemiology and Laboratory Services
Craig R Nichols, MPA, Editor, State Epidemiologist, Director Bureau of Epidemiology
Gerrie Dowdle, MSPH, Managing Editor
Connie Dean,Production Assistant

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