Could the use of antibacterial products in the home contribute to development of antibiotic resistance? – a survey of UK and US media coverage 1997 to 2017

Sally F Bloomfield, February 2018International Scientific Forum on Home Hygiene

Summary

This review covers 3 decades of media coverage about the possible relationship between exposure to microbiocides used for domestic hygiene and development of antibiotic resistance. In all, 23 media articles published between 1997 and 2017 were analyzed together with consumer feedback. The review illustrates the considerable amount of inaccurate or misleading reporting of this issue and suggests it is a cause of public misunderstanding and mistrust about hygiene. It also shows how inconsistent understanding of the term “antibacterial” has contributed to the confusion. In the UK it is estimated that 84% of the adult population read a newspaper (either print or online).

Many of the early articles were prompted by the “explosion” in marketing of antibacterial products during the 1990s, including soaps, cleaners, dishwash liquids, and products impregnated with antibacterial agents such as chopping boards, cloths, etc. This coincided with publication of studies showing that exposing bacterial populations to residue-forming phenolic disinfectant or triclosan could produce an increase in resistance to antibiotics. In 14/23 of the articles, journalists were careful to use conditional terms such as “helps, may contribute, could lead to antibiotic resistance, but 4 articles implied that the link was proven. Concern that “overuse of consumer antibacterial products is fuelling the rise of antibiotic resistance” is widely publicised in the media. Quotes, reviewed in this report reflect the extent to which the experts and the public oppose use of these products because of these concerns about resistance – despite new data which has since been published which shows the link is not proven.

Opposition to microbiocidal products reflects lack of understanding of what is meant by resistance – namely that antibiotic resistance demonstrated in the lab studies is “reduced susceptibility” not “resistance”. Although links have been widely demonstrated by lab studies, after nearly 20 years of investigation, there is still no valid evidence that home use is contributes to emergence and spread of antibiotic resistant strains.

Another source of confusion is the assumption that all types of microbiocidal agents have the same potential to induce reduced susceptibility to antibiotics. There is lack of appreciation that antibacterial agents such as alcohol and oxidizing biocides are inherently less likely to cause development of resistance, partly because of their rapid killing effect, and partly because they quickly evaporate i.e. they are non-residue forming. Only 3/23 articles (2,13,14) made reference to this. This is exacerbated by the headlines to 8/23 articles which

make generalized statements such as “Antibiotic resistance linked to common household disinfectant triclosan”, “Antibacterial cleaners are creating new super bugs” which suggests that the issue applies to all types of microbiocides. Confusion is also due to lack of clarity about use of the term antibacterial. Some experts, when expressing concern about “links between antibacterial use and antibiotic resistance” are are talking only about residue-forming microbiocides such as triclosan, whilst others assume that the term to apply to any disinfectant. Since, in 15/23 articles, were based on research related to triclosan, this further tends to imply that the link applies to all types household disinfectants.

In developing hygiene procedures, sustainability issues must be carefully weighed. Procedures must be effective in reducing contamination to safe levels, whilst at the same time avoiding overuse of resources (water, detergents, soaps, heat, mechanical action, and microbiocides) and managing possible risks (environmental, toxicity, resistance etc).

A particular concern is widespread marketing of consumer antibacterial soaps and washes for routine hand cleansing, particularly those containing triclosan. Although hand soaps containing triclosan produce some increase in reduction of bacteria on hands, compared with plain soap, there is no convincing evidence of reduced infection rates. Alongside this there are concerns about environmental impact, toxicity and resistance issues. After weighing the evidence, the US FDA and European Commission remain unconvinced that benefits of antibacterial soaps outweigh risks, and have issued rulings on marketing of these products. In the absence of data suggesting that routine use of antibacterial surface cleaners is associated with reduced exposure to harmful microbes or reduced infection rates, marketing of these products is also opposed by experts.

This however creates problems, because opposition to “antibacterials” is preventing objective assessment of evidence showing that, in risk situations, wiping or detergent-based cleaning is not enough, and that a disinfectant or hand santizer is required to break the chain of infection. For alcohol handrubs, data confirms that they are as effective as handwashing with soap. Since alcohol and oxidizing biocides, used in many surface disinfectants have a non-specific microbiocidal action and leave no active residue, it is unlikely to encourage resistance development. Thus, there is little to suggest that risks outweigh health benefits – when used as part of targeted hygiene.

Opposition to microbiocides reflects a lack of understanding of how they work. Antibiotics must be administered at low concentrations to avoid side effects, but declining drug levels between doses creates conditions favourable for emergence of resistant strains. By contrast disinfectants can be safely used at much higher concentrations, which rapidly kill microbes before they can enter the body and obviating the need for antibiotic prescribing. It is rarely considered that disinfectants or hand sanitizers, used as part of a targeted hygiene approach (right place, right time, right product) could combat antibiotic resistance by reducing the need for antibiotic prescribing.

A number of reports have been commissioned on this issue in the last 10 years. These expert bodies agree that laboratory evidence does indicate that use of certain types of biocidal products could contribute to reduced susceptibility to antibiotics, but the correlation cannot be extended toward clinically relevant antibiotic resistance at present. These bodies stress the hygiene importance of microbiocides, but also the need to use them prudently,

only in situations where there is identifiable risk of spread of harmful microbes. This view was also supported by experts in 9 of the 23 of the media articles

Taken together, these examples demonstrate the need to evaluate hygiene practices involving disinfectants/antibacterials on a case by case basis according to the type of microbiocidal agent involved and where it is to be used.

Conclusions - Across the world, health agencies recognise the need for greater emphasis on hygiene as a central pillar in fighting infection, including hygiene in home and everyday life. A current driver is the fundamental part which hygiene now plays in global strategy to tackle antibiotic resistance. This report illustrates the common misconceptions about hygiene and the use of microbiocides, which threaten to undermine efforts to promote higher standards of public hygiene.

Although responses from consumers do not necessarily represent a true cross section of opinion, it highlights the need to do further studies to elucidate what consumers understand about how infections are spread and the role of hygiene. Also to find out where consumers get their knowledge, and to what extent media reporting contributes. There is need to develop consistent and more accurate public messaging to ensure that people better understand issues related to antimicrobial resistance.

Methodology

The media coverage covers the years 1997 to 2017, For each media article, relevant points were extracted and analyzed and are summarized in Appendix 1. In some cases, examples of consumer opinion feedback have also been extracted. The articles were analyzed and results tabulated in Table 1. Table 2 summarize of some of the consumer responses to the articles set out in Appendix 1.

Results

Section 1 Media coverage

Extracts of 23 media articles evaluating the possibility that use of microbicidal products in the home could be linked to the development of resistance to antibiotics are set out in Appendix 1. In all 23 articles were extracted (see Appendix 1) and analyzed. The key findings are set out in Table 1:

Table 1 Evaluation of the possibility that use of microbicidal products in the home could be linked to the development of resistance to antibiotics Of the 23 articles, the first 14 articles covered the period 1998 to 2007. After this there

was little further coverage until 2016. Since then, a further 8 articles were identified, some specifically related to the FDA ruling in 2016 – others featuring new research findings

In 14/23 articles, journalists were careful to use conditional terms to qualify the risk by using the terms: helps or may help (1,9,11,18), may be (6) contributes, may/can/could contribute (2,13), could lead to (16) could be creating (6), fosters development of (14 ), can cause (8) Could breed (3), can develop, will select (12), are turning (5), threat is

compounded by ((18), will select (12), could be making bacteria more resistant (16), can encourage the growth of antibiotic resistant bacteria (17).

However 4 articles (4,7,19, 21) talked about the issue in a way that implied that the link was proven: A study has shown how a common antibacterial agent used in homes for more than

30 years can spread resistance to antibiotics (8) Antibiotic use on people or pets, and use of biocidal cleaning products such as

bleach, are associated with multidrug resistance in MRSA in the home. (19) Researchers made the unexpected finding that bacteria that mutated to become

resistant to quinolone antibiotics also became more resistant to triclosan.(21) Antibacterial cleaners are creating new super bugs (8)

In some articles the expert pointed out that some antibacterial e.g non residue-forming agents such as alcohol and oxidising biocides were less likely to cause resistance than those such as triclosan which are residue-forming (2,13,14)

Of the 23 articles 15 (1,2,3,5,7,8,9,14,16,17,18,21,22, 23) were centred around or made specific reference to triclosan

Most (1,2,3,7,8,9) of these early articles (1998 to 2003) reported on the studies carried out in Stuart Levy’s lab which demonstrate that exposure of bacteria to phenolic disinfectant or triclosan could produce increase in resistance of the bacteria to antibiotics

Of 9 articles which referred to lab experiments demonstrating a link between exposure to microbiocide and a increased resistance to antibiotics – most (1,3,4,7, 13,14) pointed out that did not mean resistance in clinical practice (i.e. failure of antibiotic treatment. They pointed out that, there was, as yet, no evidence of a link in practical use. Only 3 articles (6,14,23) failed to make reference to this issue – thereby implying the possibility of resistance to antibiotic treatment in clinical practice

Many of the early articles (3,4,5,7,8,9,18) made reference to the main concern as overuse of microbiocidal products by proliferation of products including antibacterial soaps and dishwash liquids, and products impregnated with antibacterial agents

Four articles (2,5,10,18) referred to concerns that widespread use of microbiocidal products in the home would wipe out good bacteria allowing bad bacteria to become dominant thereby increasing risk of infection

In 9 articles, experts said that disinfectants/ antibacterials are of benefit in domestic situations, but qualified this by stressing the need for correct use (6,10), use only in risk situations (e.g cleaning up poop (2), when someone is sick (15), where needed (16)). Others said disinfectants should only be used in hospitals (12,14)

Some articles showed the opposing views between scientists (4), and between health agencies and manufacturers ((6,7,11) about these issues.

In most of the articles, the term antibacterial was used, but in 13 articles the term disinfectant was used (1,3,6,8,9,10,13,14,15,16,18,21,22). In 3 articles ( ) the term antibacterial and disinfectants were used interchangeably.

In some articles however (13,14,16) the experts appeared to regard the word antibacterial to mean those agents such as triclosan which leave an active residue on the surface – but the non residue forming agency such as alcohol, peroxide and bleach were not antibacterials

8 article headlines imply that any antibacterial/disinfectant may cause antibiotic resistance

Section 2 Public responses to media articles

Table 2 summarizes comments posted by the public in response to media articles summarized in Apendix 1. These 8 comments illustrate the belief that use of antibacterials causes bacteria to become resistant to them, and is also a cause of resistance to antibiotics:

Table 2. Public responses to media articles which discuss whether exposure to antibacterials/disinfectants may encourage development of antibiotic resistance Antibacterials are way overused, and probably causing us harm, whether it's making

allergies more common or leading to antibiotic-resistant bacteria. Those wipes and so-called anti-bacterial soaps are just marketing.   They push the

population of bacteria toward more resistance to antibiotics. That's the problem with them. They make the 'enemy' stronger and the 'local population' less friendly.

The article doesn't mention the fact that easily-killed bacterial strains out-breed the superbug variety in a normal dirty environment, leaving the superbugs as an infinitesimally small group, thus unable to infect people. But when we fanatically clean with bleach and so on, only the superbugs remain (they can't metabolise or drink properly, so avoid the toxins we use), so they eventually breed up and become the dominant group.

The overuse of these wipes is serious, but for different reasons. Many of them rely on antibiotics. This leads to germ developing resistance to antibiotics. 

Isn't this painfully obvious? You start fighting against nature and she will fight back: hospital superbugs and the gradual erosion of the effectiveness of antibiotics. Dirty kids are healthy kids. Clean kids are weak and neurotic - like their mothers.

When I was a child it was a bar of Lifebuoy soap and a galvanised bath in the kitchen for my weekly bath. I seem to have survived to my eighties and seem to still be going strong!

I wonder how my children managed to get to adulthood without all these antibacterial things, only need soap and hot water.

I don't use them but I rarely get ill and haven't had a flu or cold for over 15-20 years so I'm probably not the person to ask... then again....

Discussion and conclusions

This review covers 3 decades of media coverage about concerns that overuse of microbiocidal products is a causative factor in development of antibiotic resistance. In all, 23 media articles (1997 to 2017) were analyzed. Analysis shows the considerable amount of inaccuracy in reporting, which failed to reflect advances in scientific understanding and opinion over this period. It also shows how inconsistent use of the term “antibacterials” contributes to the confusion. Public misunderstanding and scepticism about use of antibacterials is illustrated by consumer’s feedback

Many of the early articles were prompted by the “explosion” in marketing of antibacterial products during the 1990s, including antibacterial soaps, antibacterial cleaners, dishwash liquids, and products impregnated with antibacterial agents such as chopping boards, cloths, etc.1 This coincided with publication of studies carried out in Stuart Levy’s lab (Professor at Tufts University, Boston USA and founder of APUA, Association for Prudent Use of Antibiotics) which demonstrated that exposing bacteria to residue-forming phenolic disinfectant or triclosan could produce an increase in resistance to antibiotics.2,3 This review shows that their concern about possible links between overuse of microbiocidal agents in the domestic situation and antibiotic resistance was widely publicised in the media. The review

also shows the extent to which marketing of antibacterial products (disinfectants) has been – and still is - opposed by experts and the public – despite new data which has since been published which questions this.

In 14/23 of the articles, journalists were careful to use conditional terms to qualify the risk: helps or may contributes, could lead to, fosters development of, can cause, could breed, can develop, will select, could be making bacteria more resistant, can encourage the growth of antibiotic resistant bacteria. However 4 articles (4, 7, 19, 21) talked about the issue in a way that implied that the link was proven e.g a study has shown how a common antibacterial agent used in homes for more than 30 years can spread resistance to antibiotics.

Opposition to use of microbiocidal products in the home reflects lack of understanding of how they work. Health professionals and journalists sometimes fail to understand that so-called resistance demonstrated in the lab studies is “reduced susceptibility” not “resistance”, and that reduced susceptibility to antimicrobial agents is common (Note 1) and may be only temporary (Note 2). Although a link has been widely demonstrated by lab studies, after nearly 20 years of investigation, there is still no valid evidence that domestic use of microbiocidal products is contributing to emergence and spread of antibiotic resistant strains in clinical practice.4,5 Of 9 media articles which referred to lab experiments demonstrating a link, most (1,3,4,7,13,14) journalists did stress that, there was, as yet, no evidence of a link in practical use. Only 3 articles (6,14,23) failed to make reference to this, thereby implying the possibility of failure in antibiotic treatment in clinical practice.

Another source of confusion is the assumption that all types of microbiocidal agents have the same potential to induce reduced susceptibility to antibiotics. There is lack of appreciation that microbiocides such as alcohol and oxidizing biocides are inherently less likely to cause development of resistance, partly because of their rapid killing effect, and partly because they quickly evaporate i.e. they are non-residue forming.6 Only 3/23 articles (2,13,14) made reference to this distinction. This confusion was exacerbated by the headlines to 8/23 articles which made general statements such as “Antibiotic resistance linked to common household disinfectant triclosan”, “Antibacterial cleaners are creating new super bugs”, “Rise in Antibiotic Resistance Caused by Triclosan in Household and Cosmetic Products”.

Confusion is also caused by the term antibacterial. Whereas the scientifically accepted meaning of the term disinfectant is any product containing a microbiocides which kills/inactivates microbes, the term antibacterial, has no defined meaning and was introduced in the 1990s as a more consumer friendly term for disinfectants. In most articles, the term antibacterial was used, but in 13 articles the term disinfectant was used. In 3 articles the terms were used interchangeably. Confusion arises because some experts when expressing concern about link between use of antibacterial and antibiotic resistance believe that the term antibacterial applies only to residue-forming microbiocides such as triclosan. Since in 15/23 articles, concerns about possible risks associated microbiocide use were drawn from articles related to triclosan, this further tends to imply that the risks are widespread amongst all types biocides used in household disinfectants than is the case.

Achieving hygiene in home and everyday life i.e. breaking chain of infection transmission, requires using combinations of various agents including water, detergents, soaps, heat, mechanical action, and sometimes also microbiocides. In developing hygiene procedures,

sustainability issues must be carefully weighed. Procedures must be effective in reducing contamination to safe levels, whilst at the same time avoiding overuse of resources (heat, water, microbiocides etc) and managing possible risks (environmental, toxicity, resistance etc).

Of particular concern are consumer antibacterial soaps and washes for routine hand cleansing, particularly those containing triclosan and other chlorinated hydrocarbons. Although tests show antibacterial hand soaps produce some increase in reduction of bacteria on hands, compared with plain soap, there is no convincing evidence of a reduction in infection rates.7, 8 Alongside this there are concerns about environmental, toxicity and resistance issues.9 After weighing the evidence, the US FDA (Note 3) and EC (Note 4) remain unconvinced that benefits outweigh risks, and have issued rulings on marketing of these products. In the absence of data suggesting that routine use of antibacterial cleaning products and impregnated materials e.g chopping boards).1 for routine cleaning is associated with reduced exposure to harmful microbes or reduced infection rates (Note 5), this media survey shows that marketing of these products is also opposed by experts10

This however has created problems, because the opposition to antibacterial soaps. cleaners and impregnated products is preventing objective assessment of evidence that, in specific risk situations, cloth wiping or detergent-based cleaning is not enough, and that targeted use of a disinfectant product or hand santizer is required to break the chain of infection. Failure to use a disinfectant in these situations can increase transmission and exposure to infectious microbes (Note 6). For alcohol handrubs, data confirms that they are as effective as handwashing with soap.11 (Note 7). Importantly, since alcohol, and the oxidizing biocides used in many surface disinfectants have a non-specific microbiocidal action and leave no active residue, they are unlikely to encourage resistance. Thus, there is little to suggest that risks of these microbiocides outweigh health benefits, when used as part of targeted hygiene.

Unqualified opposition from some health professionals to use of microbiocides in the home, reflects lack of understanding of how they differ from antibiotics.75 Antibiotics must be administered at relatively low concentrations to avoid side effects, but declining drug levels between doses creates conditions favourable for emergence of resistant strains. By contrast disinfectants can be safely used at relatively higher concentrations, which rapidly kill microbes before they can enter the body, obviating a need for antibiotic prescribing. Whereas concerns about antibiotic resistance are frequently raised, it is never considered that disinfectants, used as part of a targeted hygiene approach (right place, right time, right product), could work to combat antibiotic resistance by reducing the need for antibiotic prescribing and preventing spread of resistant strains. Unfortunately, lack of an authoritative voice advocating for hygiene means that risk issues have been allowed to take precedence.12

A number of reports have been commissioned on this issue in the last 20 years. In 2009 an EU report4 concluded “evidence does indicate that use of certain types of biocidal products in various settings may contribute to increased occurrence of antibiotic resistance”, but it also stated “there is no evidence that microbiocide use has contributed to antibiotic resistance in clinical practice”. Unfortunately the former statement is often quoted without reference to the latter, leading to the conclusion that the problem has been identified under real life conditions. The conclusions of the EU report are also supported by APUA5 and by an

2012 expert workshop13 These expert bodies agree about the hygiene importance of microbiocides, but also the need to use them prudently in situations where there is identifiable risk of spread of harmful microbes. They generally agree that correlation between microbiocide use and reduced antibiotic susceptibility cannot be extended toward clinically relevant antibiotic resistance at present. This view was also supported in 9 of the 23 articles, where experts said that disinfectants/antibacterials are of benefit in domestic situations, but qualified this by stressing the need for correct use (6,10), and use only in risk situations (e.g cleaning up poop (2), when someone is sick (15), where needed (16)). However, others said disinfectants should only be used in hospitals (12,14). Some articles illustrated the opposing views between scientists (4), and between health agencies and manufacturers (6,7,11) about these issues.

Taken together, these examples demonstrate the need to evaluate hygiene practices involving disinfectants/antibacterials on a case by case basis according to the type of microbiocidal agent involved and where it is to be used.

Conclusions biocides and resistance

Overall this review illustrates the considerable amount of inaccurate reporting of this issue and suggests that this is a significant cause of misunderstanding and mistrust amongst consumers about hygiene and the use of antimicrobial products.

Although the consumer responses recorded here, do not represent a true cross section of consumer opinion, it highlights the need to do further studies to elucidate what consumers understand about how infections are spread and the role of hygiene products in infection prevention. Also to find out where consumers obtain their knowledge, and to what extent media reporting contributes.

Across the world, government and non-government agencies recognise the profound impact of infectious disease on global health and prosperity, and the need for greater emphasis on infection prevention as a central pillar in fighting infection. A current driver for promoting hygiene, is the fundamental part it now plays in the strategy to tackle antibiotic resistance - but it also reflects factors such as the growing number of people at greater risk of infection being cared for, or caring for themselves in the community.

This report illustrates the common misconceptions about the use of products containing microbiocidal agents which threaten to undermine efforts to promote higher standards of public hygiene. The extent to which this has occurred suggests that change is unlikely to happen unless we also work to change hygiene perceptions. There is need to develop consistent and more accurate public messaging to ensure that people better understand the issue related to use of antimicrobial agents.

Notes

1. In reality, any “stressful” exposure (cold heat, desiccation acid, alkali, microbiocides etc) causes bacterial populations to deploy protection mechanisms ensuring their survival, including mechanisms which reduce susceptibility to antimicrobials, but not necessarily resistance. One study demonstrated that antibiotic resistance genes are induced by exposure of bacteria to natural substances, common to a domestic setting. Of 35 products tested (9 herbs and spices, 19 food and drinks and 7 household products), 24

(69%) of the items inhibited growth of bacteria 22 (63%) of the items induced gene expression. Mustard, chilli and garlic were shown to be powerful gene inducers. None of these made hygiene claims.14

2. Effects of antimicrobial agents on microbial populations vary significantly according to their chemical properties, the widely differing biochemical mechanisms by which bacterial become resistant to different antimicrobials, whether the change in susceptibility is likely to be permanent i.e. passed on to subsequent generations) or whether it is only temporary (i.e. susceptibility is restored once the “stress is removed).

3. In September 2016, FDA issued a final rule on effectiveness and safety of antibacterial soaps, which will come into effect September 2017. FDA concluded, based on lack of scientific evidence for the effectiveness of antibacterial soap, that the risk posed by the use of antibacterial soap outweighs its benefits; thus consumer antiseptic products containing one or more of 19 ingredients, including triclocarban, and triclosan, can no longer be marketed. See: US Food and Drug Administration. Safety and effectiveness of consumer antiseptics; topical antimicrobial drug products for over-the-counter human use. https://www.federalregister.gov/documents/2016/09/06/2016-106 21337/safety-andeffectiveness-of-consumer-antiseptics-topical-antimicrobial-drug-products-for. 2016.108 7.

4. Following an opinion of the European Chemicals Agency (ECHA) delivered under the Biocidal Product Regulation (EU) No 528/2012, the Commission has adopted the Commission Implementing Decision (EU) 2016/110 to ban triclosan for its biocidal use as a disinfectant for human hygiene (e.g. hand soap disinfectants), as the evaluation of this use showed unacceptable risks to the environment. http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32016D0110&from=EN

5. Although hygienic cleaning of surfaces as part of daily or weekly routines produces a reduction in contamination levels, microbes are constantly being shed or spread into the environment, from sources such as people (infected or colonized), domestic animals, contaminated air, food and water. This means that contamination levels can return to precleaning levels within as little as 1-2 hours.86

6. In their review,71 Bloomfield, Carling and Exner review 10 laboratory or field, studies which demonstrate that significant bacterial or viral pathogenic contamination can remain on surfaces after detergent-based cleaning or wiping, and that this is subsequently transferred to the hands, or spread to other surfaces via hands and cleaning utensils.

7. These studies are reviewed in a 2016 research paper by Arbogast JW, Moore-Schiltz L, Jarvis WR, Harpster-Hagen A, Hughes J, Parker A. Impact of a Comprehensive Workplace Hand Hygiene Program on Employer Health Care Insurance Claims and Costs, Absenteeism, and Employee Perceptions and Practices. Journal of Occupational and Environmental Medicine. 2016 Jun;58(6):e231.

Appendix 1

1.1 Germ Warfare - Household cleaner help bugs dodge antibiotic weapons.New Scientist Dec 1997Disinfectants in homes and hospitals may help bacteria develop resistance to antibiotics – a new study suggests. Antibiotic resistance often arises when bacteria develop mutations that alter their permeability – or their ability to pump out toxins. This can allow them to tolerate antibiotics which would otherwise kill them. Widespread use of antibiotics kills off susceptible bacteria allowing resistant strains to become more dominant. A study was carried out at TUFTS University USA, to find out whether cleaning products kill germs as manufacturers claim. It was found that some bacterial mutants could tolerate a household disinfectant called Pine-sol, of which the active ingredient is pine oil. They also found that

these bacteria that survived pine-sol could withstand concentrations of antibiotics eight times higher than the original bacterial strain could tolerate. The researcher said that a 2 to 8 fold increase in resistance does not warrant widespread alarm. She plans to find out whether kitchen bacteria harbour enough of the resistant bacteria to allow resistant strains to evolve. A study by other experts showed that antibiotic resistant strain of S. aureus and other common bacteria in hospitals are just as susceptible to disinfectants as non resistant strains, but they believe that the connection needs further studies. What would cause alarm is if the antibiotic resistant strains we find in hospitals were resistant to disinfectants.

1.2 Germ warfareMay 1998Ominous ads showing us germs lurking in every room in the house have us grabbing for those germ killing soaps, body washes etc. Companies have spawned nearly 200 antimicrobial products, nearly one for every phobia. Take it easy says Dr Levy from Tufts University Boston USA.U se of bug-killers contributes to the growth of resistant strains. Then when you really need to kill a disease – causing microbes, you can’t. Levy believes that the use of soap and sprays which contain chemicals like triclosan can contribute to emergence of resistant bacteria Bacteria are not all bad. Harmless bacteria can displace dangerous ones. Antibacterial products kill helpful ones and make room for bad bugs to multiply in hospitals. The concern is that the same thing can happen at home. When you really need an antiseptic – to clean up mouse poop – avoid those that leave a residue which continues to wipe out bacteria – good ones include common household items such as alcohol, ammonia and hydrogen peroxide. I don’t think healthy households need antibacterials. They should only be use in households where someone is very sick

1.3 Common disinfectant could breed superbugsEHH Daily News April 1998Put a germ killing agent in toothpaste and soap to keep kids and adults safe from infections – right? Wrong - a student from Tuft University said triclosan, a compound widely used in kitchen sponges, soaps and plastics and fabrics is capable of forcing the emergence of superbugs which it cannot kill. A study carried out at TUFTS showed some bacterial mutants which could tolerate triclosan - but she said that this did not necessarily mean this could occur in nature. Daily use of triclosan may be unwise. She said “We did find triclosan resistant bacteria in the lab but we have not looked for them in the real world but the point is that we have shown there is the potential”

1.4 The danger of our super-clean homesThe Express March 1998Hygiene fixation could lead to a new breed of killer bugs we can’t fight. Are we becoming too hygienic for our own good and creating a new generation of supergerms. The more we clean our homes the harder the bacteria fight to survive. The article investigates the threat of the new supergerms. An antimicrobial range of toys was launched in America recently. These contain an antibacterial agent which inbits the ability of germs to function and grow. The toys are likely to be in UK shops by May. Queues of anxious mothers will undoubtedly buy them thinking they are protecting their children. But are they really? Or is our modern obsession with antibacterial kitchen and bathroom sprays, soaps, shower and bath gels actually enmdangering all of us. The horrifying theory is that the more you zap bacteria with chemical agents, the more chance they will develop immunity. Bigger stronger and more

virulent bacteria will result – the supergerms. One expert said ‘the idea is quire plausible”. , if you kill bacteria, the survivors get stronger and develop resistance. A worrying sign that bacteria are beginning to resist antiseptics is the greater levels that are needed to kill them said an FDA microbiologist. . A catering expert said she believes that, as a nation, we are unhealthily obsessed with hygiene. The cleaner our food gets, the more we suffer from it. But an expert from the Antimicrobial Research Centre at Leeds University insist we do not need to panic. Bugs resistant to antibiotic have developed because they have overcome the levels of drugs in the blood stream. But the concentration of external sprays is much higher and the bugs are less likely to put up the necessary resistance. But he argues for prudent use .

1.5 Bug busters turn British homes into health hazardThe Observer April 1998Toys, toothpaste and kitchenware’s containing antibacterial chemicals are turning our homes into havens of ineradicable disease-producing bacteria. World expert Stuart Levy of Tufts University Boston warns that the current fad for domestic products with current fad of germ- killing agents poses serious health risks. Antibiotic resistant TB is already a problem. It appears that domestic use of antibacterial products also raises concerns. Goods such as high chairs, chopping boards, and dishcloths impregnated with antibacterial agents have appeared in stores in the last year. ‘Microban utensils containing triclosan have sold well, but these products will not ward off bacteria forever’ says Levy. Most microbes in our homes are harmless and by colonizing parts of our homes they keep harmful microbes at bay. Indiscriminate use of antibacterial products kills off these harmless bacteria and opens the door to harmful ones. We will find ourselves co-habiting with bacteria that are highly resistant to antibacterial and possibly antibiotics. Levy says. Then when we really need to disinfect our homes and hands perhaps when someone has come home from hospital, we will encounter mainly resistant bacteria.

What is a germ? – Germ is the popular term for microorganisms such as a bacteria or virus which causes disease

1.6 Superbug threat to cleaner homesDaily Express Nov 1998Overuse of household good containing disinfectants could be creating a new breed of superbugs scientists warned. Experts have warned that products such as chopping boards, cloths and mops impregnated with low levels of disinfectant may be creating bugs that are resistant and could threaten our health. Lab tests have already shown a link between resistance to antibiotics and disinfectants, but more research needs to be done.. An expert said that guidelines need to be drawn up on correct use of disinfectants. Very low levels may kill some but not others. If microbes become resistant and spread widely this poses a real threat to humans. It needs to be investigated before the problem builds up. ‘To prevent creation of superbugs, people should use good quality disinfectants in the correct dose’ said an expert. There is nothing wrong with using soap water and a scrubbing brush’ he said. There is no substitute to using a product like bleach to clean the kitchen. If you wipe the surfaces properly and let them dry it will kill the bacteria. What worries me is that some products contain very low levels of disinfectants and that bacteria could survive them and become resistant. A spokesman for Microban range of chopping boards etc warned of the

dangers of not using disinfectants.. Stopping the use of antibacterials whilst food poisoning is increasing would be dangerous

1.7 “Antibacterial soaps may create new problems USA Today Sept 1998In the ongoing battle against menacing bacteria, scientists are raising a new concern: the widespread use of antibacterial soaps may cause problems worse that the aim to cure. A report from Tufts says a substance, triclosan, used in these soaps and in plastic toys and other antibacterial products behaves a lot like an antibiotic and could encourage bacteria to mutate in a way that makes them impervious to antibacterials including antibiotics. Prior to this work it was thought that triclosan was a general biocide, much like alcohol or peroxide which worked by destroying the membrane walls of bacteria. In such non specific killers said Professor levy, we don’t have to worry about resistance emerging, but we found that triclosan has a target. That put everybody back on their heels – it wasn’t supposed to have a target. If like antibiotics, triclosan has a target, that means that means that bacteria can evolve into forms which can resist triclosan effects.

Industry representatives urged caution ‘there are so many things that are not known as to what the research may mean” ‘Jumping to conclusions that by using antibacterial products we are going to end up with germs that are going to overrun the world is fodder for science fiction, but it’s not borne out by any research we have today’. But an expert said that the report and the questions it asks need to be taken seriously. Spraying antibiotics around in the environment, whether as soap additives, as additives to animal feeds or given to children are behaviours that are going to come back to haunt us. ‘They will create selection pressures to force the evolution of bacteria into superbugs’.

Another source of concern is soaps. In a recent report, NIEH said that an ingredient in many bubble baths and soaps cause cancer in mice – although not found to cause cancer in humans. The report alerts us to the potential and need to assess the overall risks to humans

Parents who have stocked their kitchens and bathrooms with these products, should not feel guilty that they have done anything wrong. But now that this information has come to light , he advises parents to switch products to those that are free of DEA and antibacterial. The industry disagrees “ whilst the potential health risk from antimicrobials are theoretical, the benefits are clear. They reduce the microbial flora, and in so doing they reduce the incidence of disease. Triclosan has been used in various forms for the last 30 years without causing and know antimicrobial resistance to develop’. But levy says the same could be said of antibiotics. Much needs to be learned about the effects of these products on microbes. We have not looked for resistant microbes in households, and cautions that his recent study is a lab experiment. ‘Maybe it does not happen in the world but given enough time and drug why shouldn’t it select resistance – as do antibiotics’.

1.8 Antibacterial cleaners are creating new super bugsDaily Mal April 1999 ‘Scientists’ shock warning over home hygieneHousehold cleaners designed to kill germs are doing more harm than good it is claimed. Instead of making the home bacteria free, the increasingly popular hygiene aids are creating a generation of potentially deadly super bugs. The more consumers buy such products in the belief they offer protection, the greater the risk, they warn. A study has shown how a

common antibacterial agent used in homes for more than 30 years can spread resistance to antibiotics. Triclosan is an all purpose disinfectant found in a range of products including toys, toothpaste and cosmetics. Drug resistant superbugs have made many antibiotics useless, but triclosan was thought to be safe. But a report in Nature, warns that overuse can cause resistant strains. Scientists have shown that how the chemical makes strains of E. coli – a major cause of food poisoning – resistant to antibacterial agents. The discovery has raised concerns about how widely triclosan is used in the home.

A study by the Consumers Asscn found that half of all households have bought an antibacterial product including chopping boards, washing up liquids and kitchen utensils – mostly containing triclosan. More than half of people believe that antibacterial agents could make surfaces and hands sterile. About 60% said they felt more confident about home hygiene if they used these products. The consumers asscn said that at least 13 household cleaning products claim to kill Salmonella, Listeria and E.coli whilst others claim to wipe out cold and flu viruses. Fairy Liquid and Dettox etc have all been sold with antibacterial agents. Health Which says our research and that published in Nature show that there are good reasons not to buy these products.. We like to see closer monitoring of this market. Ultimately this is a market we could do without. Food poisoning is on the rise with cases doubling between 1987 and 1997. Although companies have been quick to introduce these products containing built in germ-killers, washing hands with soap and water can kill most bacteria found in the kitchen

1.9 Microbiocides in the kitchenPublic Affairs UK April 1999Essential hygiene – Weapon or public health threat. Scientists are worried that the increasing, and some say, indiscriminate use of antibiotics to combat germs might lead to ever more resilient or resistant strains of bacteria against which we have no protection. Their concerns are mostly to do with hospitals, but similar biocidal agents are rapidly being introduced into the home in the form of antibacterial coatings of kitchen utensils and equipment. New Scientist in 1998 suggested that disinfectants in hospitals and home may help bacteria to develop resistance, not just to the disinfectants themselves but also to antibiotics. After 30 years of use in numerous applications, there has been no reported resistance to triclosan a widely used agent. Growth of use in the domestic kitchen might just lead to the surpassing of a critical mass and then trigger the very thing that disinfectant protection was designed to avoid.

A study at Tufts University, USA study found bacterial mutants which could tolerate and grow in nutrient medium spiked with a household disinfectant called Pine-sol. In which the active ingredient is pine oil. Microban is the brand name for a range of products impregnated with antibacterials compounds such as kitchenware - and antibacterial dishwashing liquids have also been added to the range of antibacterial products now being marketed. The active ingredient of many of these products is triclosan. The safety of these products is not disputed and it is effective against many bacterial strains including those that cause food poisoning. One of the issues being debated is to what extent do these products do or do not encourage or discourage safe food handling - as the claims that it is “self sanitizing “ could be misleading and subvert essential protocol’s such as washing hands between handling different foodstuffs. The reported number of food poisoning incidents is the UK is around 1000,000, but in reality is probably more. The consumer has the ultimate

say in endorsing these products by choosing whether or not to buy them and writing to manufacturers to let them know why. Not buying antimicrobial protection is not tantamount to condemning your family to infectious disease, it is keeping ahead of attempts to exploit fear of hygiene. On the issue of keeping work surfaces germ free, washing with soap and water and drying is still the safest method. The existence of food associated pathogens on kitchen surfaces is almost inevitable but critically if the correct procedures for preparing and cooking food are followed this will obviate the need for further antimicrobial gear.

1.10 Fuelling the ‘superbug’The financial Times Nov 1999Increasing use of antibacterial cleaners is making us more vulnerable to germs. Manufacturers of antibacterial soaps would, like us to believe that our households are full of deadly bacteria poised to invade our systems. Unless we wipe down our kitchen surfaces and bodies with their products, they say Salmomella, E coli and Staphylococcus and other bacteria will attack. This is poppycock according to growing number of scientists who say that antibacterial, products are a bad idea. Evidence is growing that antimicrobial products add to antibiotic resistance. Scientists warn of a pending medical disaster as bacteria defy existing antibiotics. Superbugs as they are known are showing up with increasing frequency. Some strains of Staphylococcus – deadly bacteria that have been controlled for decades by antibiotics now show little response to vancomycin

Ironically all the news about superbacteria is fuelling the demand for antigerm cleaners. It is a dangerous trend say researchers. With antibiotics – now in the form of antigerm cleaners – now in the hands of the public, scientists say the threat from antibiotic resistance bacteria is compounded. A study in nature found that triclosan found in most antimicrobial products, can cause some bacteria to mutate. People are no longer just consuming these products says Stuart Levy. ‘They are now spreading them around the home. People can go too far in the quest for cleanliness’. Studies sin the UK show that living in an overly clean home can compromise our health. Members of sterilised households may be at greater risk of allergies. On the other hand basic levels of hygiene to keep bacterial; levels uer control is important. Washing your hands with plain old soap and water can go a long way. Antimicrobial soaps are not regulated as pharmaceutical or food products. Yet their medical and environmental impact may be a significant way to keeping infections at bay. For added certainty a little bleach may be used. The trouble is that people may be using them in less than effective doses so they are killing some but not others. We don’t know how much residue they are leaving and how long they are effective. As a result some of the bacteria may survive and those with a genetic basis that makes them more resistant or stronger can still multiply. Antibiotic resistance can develop locally in a specific household and the spread to the community.

By oversterilising the skin we may also be giving more dangerous bacteria an open door into our systems. Researchers are even more worried about the growing number of toys impregnated with antibacterials which can go into our mouths. Antibacterial soaps are appropriate in some situations say scientists. Patients who are just home from hospital where such products are routinely used, or people with immune systems which are compromised may benefit from their use. Scientists advise consumers to save the products for those situations.

1.11 Soaps that fight germs may help to create superbugsThe Express June 2000Soap advertised as being powerful in fighting bacteria may be no more effective than common brands according to leading doctors. They could actually pose a menace by encouraging growth of resistant superbugs says the American Medical asscn. The doctors stopped short of recommending that consumers avoid using the popular soaps, lotions and mouthwashes advertised as fighting microbes, but expressed strong doubts about their usefulness. One expert said ‘There is no evidence that they do any good, and reason to suspect they could contribute to a problem by helping to create antibiotic resistant bacteria. Washing with plain soap might be just as effective in battling illness. The CTFA say that the public should not be deterred from using antibacterial products. They could kill or inhibit the growth of bacteria that cause skin infections, intestinal illnesses, or community-transmitted diseases. The AMA’s view was based on untested scientific theory.

1.12 Antibacterial products: cause for concernStuart Levy; Tufts University , Boston USA June 2001http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.359.2397&rep=rep1&type=pdfThe recent entry of products containing antibacterial agents into healthy households has escalated from a few dozen products in the mid-1990s to more than 700 today. Antibacterial products were developed and have been successfully used to prevent transmission of disease-causing microorganisms among patients, particularly in hospitals. They are now being added to products used in healthy households, even though an added health benefit has not been demonstrated. Scientists are concerned that the antibacterial agents will select bacteria resistant to them and cross-resistant to antibiotics. Moreover, if they alter a person’s microflora, they may negatively affect the normal maturation of the T helper cell response of the immune system to commensal flora antigens; this change could lead to a greater chance of allergies in children. As with antibiotics, prudent use of these products is urged. Their purpose it to protect vulnerable groups

1.13 Do antibacterial contribute to the development of antibiotic resistance?Drugs and bugs on the web NELI, 2003http://www.antibioticresistance.org.uk/ARFAQs.nsf/c142977c99209f3680256c91003fdf4a/35f51ae3b3d45bc580256cb400514061?OpenDocumentThe Alliance for Prudent use of Antibiotics has a clear answer to this question as well as details of scientific studies in this area. In summary, the non-residue producing antibacterials such as alcohol and peroxides are not thought to cause resistance as they have such a rapid killing effect. However, when the residue-producing antibacterial are used in low level concentrations (e.g. those used in some household products), it has been suggested that they may contribute to the development of antibiotic resistance although much more research is needed to determine the potential role of these agents in the development of antibiotic resistance

Aiello AE, Marshall B, Levy SB, Della-Latta P, Larson E. 2004. Relationship between Triclosan and Susceptibilities of Bacteria isolated from Hands in the Community antimicrobial agents and chemotherapy, Aug. 2004, p. 2973–2979

The possible association between triclosan and bacterial susceptibility to antibiotic was examined among staphylococci and several species of gram-negative bacteria (GNB) isolated from the hands of individuals in a community setting. The absence of a statistically significant association between elevated triclosan MICs and reduced antibiotic susceptibility may indicate that such a correlation does not exist or that it is relatively small among the isolates that were studied. Still, a relationship may emerge after longer-term or higher-dose exposure of bacteria to triclosan in the community setting.

1.14 Strange but True: Antibacterial Products May Do More Harm Than GoodScientific American June 2007https://www.scientificamerican.com/article/strange-but-true-antibacterial-products-may-do-more-harm-than-good/

Antibacterial soaps and other cleaners may actually be aiding in the development of superbacteria. Hygiene—keeping both home and body clean—is one of the best ways to curb the spread of bacterial infections, but lately consumers are getting the message that washing with regular soap is insufficient. Antibacterial products have never been so popular. Body soaps, household cleaners, sponges are now packing bacteria-killing ingredients, and scientists question what place, if any, these chemicals have in the daily routines of healthy people. Traditionally, people washed bacteria from their bodies and homes using soap and hot water, alcohol, chlorine bleach or hydrogen peroxide. These substances act non-specifically, meaning they wipe out almost every type of microbe in sight—fungi, bacteria and some viruses—rather than singling out a particular variety.

Unlike these traditional cleaners, antibacterial products leave surface residues, creating conditions that may foster the development of resistant bacteria, Levy notes. For example, after spraying and wiping an antibacterial cleaner over a kitchen counter, active chemicals linger behind and continue to kill bacteria, but not necessarily all of them. When a bacterial population is placed under a stressor—such as an antibacterial chemical—a small subpopulation armed with special defence mechanisms can develop. As bacteria develop a tolerance for these compounds there is potential for also developing a tolerance for certain antibiotics. This phenomenon, called cross-resistance, has already been demonstrated in several laboratory studies using triclosan, one of the most common chemicals found in antibacterial hand cleaners, dishwashing liquids and other wash products. When bacteria are exposed to triclosan for long periods of time, genetic mutations can arise. which can endow the bacteria with resistance to ioniazid. These effects have been demonstrated only in the laboratory, not in households and other real world environments, but Aiello believes that the few household studies may not have been long enough. "It's very possible that the emergence of resistant species takes quite some time to occur…; the potential is there.

"What is this stuff doing in households when we have soaps?" asks an expert. “These substances really belong in hospitals and clinics, not in the homes of healthy people”. “Of course, antibacterial products do have their place. Millions of Americans suffer from weakened immune systems, including pregnant women and people with immunodeficiency diseases” says another expert ”For these people, targeted use of antibacterial products, such as triclosan, may be appropriate in the home. In general, however, good, long-term hygiene means using regular soaps rather than new, antibacterial ones, experts say.

1.15 Our immunity is at risk from our cleanlinessEssential baby - March 2014http://www.essentialbaby.com.au/life-style/family-home/our-immunity-is-at-risk-from-our-cleanliness-20140302-33upuThe cleaner the better? Not necessarily. Are our homes too clean for our own good? It's called the hygiene hypothesis: the idea that although a cleaner environment has improved

our health in some ways, it has also messed with our immune system, contributing to increased allergy and autoimmune disease. But it's not as simple as just being ''too clean'', says an expert. ''It's less about clean kitchens and bathrooms and more about changes to living conditions - like less crowded housing, better public health measures, less infectious disease and less contact with large animals. These have reduced our exposure to certain microbes in early childhood and this may have skewed our immune systems,".

But while squeaky clean kitchens may have little to do with the increase in allergy, there's another way in which our fixation with super-cleanliness could eventually do more harm than good. "There's evidence that repeated exposure to products containing household disinfectants - but not hospital grade disinfectants - makes bacteria more resilient and less susceptible to killing by both disinfectants and antibiotics," says microbiologist Cheryl Power, of the University of Melbourne's Department of Microbiology and Immunology. "This has implications for treating possible infections with these micro-organisms because they may be harder to kill both in the environment and in people who are infected," she says."I wouldn't argue with using anti-bacterial in hand washes, especially if someone is sick with gastro or a cold, but I would argue that their inclusion in many other products, such as dishwashing sponges, is not only unnecessary, but potentially counterproductive. For cleaning the kitchen, hot water and soap are just as effective as anti-bacterial products."

1.16 After claims they're ineffective and even fuel the rise of superbugs... Could using an antibacterial soap be BAD for you?DAILY MAIL 20 September 2016 http://www.dailymail.co.uk/health/article-3797535/Is-antibacterial-soap-BAD-you.html

U.S. authorities have now banned certain chemicals used in the soapsThe Food and Drug Administration, which oversees the safety and efficacy of cleaning products in the U.S., has banned the use of 19 common active ingredients in antibacterial soaps. Whether it's a splodge of hand gel after a commute or a squirt of cleaning spray on kitchen counters after cooking, chances are you are one of the millions who uses some form of antibacterial product. They have become a handbag and household staple — sales of germ-killing cleaners hit an estimated £239 million in 2013.

But do they really help protect us from getting ill and spreading germs? And could they actually be bad for us? These are questions raised by the decision earlier this month by U.S. authorities to ban certain chemicals used in the soaps, with some British experts saying the same should happen here. FDA has banned use of 19 common active ingredients in antibacterial soaps. – including bar soaps, liquid soaps and body washes (products that don't use the ingredients aren't banned, nor are hand gels). FDA says there's no scientific evidence these chemicals are better than plain soap and water at killing germs, and manufacturers had not demonstrated their safety for long-term use.

Furthermore, it cited research suggesting these could also be making bacteria resistant to antibiotics. Most people would associate antibiotic resistance with over-prescribing by doctors, but emerging evidence suggests antibacterials are also a risk. This was confirmed by a new study by University of Oregon where dust samples were found to contain high levels of anti-microbial chemicals also contained genes linked to antibiotic-resistant bacteria. In particular, they found triclosan affected a gene in the bacteria that helps make it resistant to several antibiotics, reported the journal Environmental Science and Technology.

So as the bacteria learn to resist the antibacterial chemical, they become resistant to antibiotics that work in a similar way. This has raised concerns that widespread use of triclosan (it's also used in kitchenware, furniture and toys) could lead to growing resistance in bacteria.

Mark Webber, a senior research fellow at the University of Birmingham who researches anti-microbial action, says his work shows that 'if we expose bugs to triclosan in a lab, they can become resistant to it, but worryingly also to some antibiotics'.

Jean-Yves Maillard, a professor of pharmaceutical microbiology at Cardiff University, suggests this may be because people don't scrub for long enough. It's a more complicated story with alcohol-based sanitizers, which kill germs by attacking their outer membrane. These are less of a risk for antibacterial resistance because they kill bacteria in a different way from antibiotics.

Given the FDA action, is it time to ban antibacterial ingredients in Britain, too? Chemicals used in hygiene products are regulated by two different EU bodies. One has already decided to ban triclosan and triclocarban in products such as washing powders and cleaning sprays — though their use is being phased out, not stopped overnight. With cosmetics (which under EU definition includes hand soap), triclosan and triclocarban are allowed in set amounts, but some UK experts believe that there should be a wider ban on antibacterial ingredients generally. An expert in molecular microbiology, says: 'I am alarmed by the rise in resistance from widespread use of these products. 'There is a problem with using things that are 'antibacterial' for everything when they should be reserved for treating diseases in hospital.' He says if he had to use an antibacterial product, he would 'use an alcohol-based one and does not contain triclosan'. There is little need to have antibacterial products - their use is nonsensical. Soap and water is fine. If we need to wipe surfaces at home we use bleach, which kills bacteria and doesn't cause resistance.'

COMMENTS When I was a child it was a bar of Lifebuoy soap and a galvanised bath in the kitchen for

my weekly bath. I seem to have survived to my eighties and seem to still be going strong! I wonder how my children managed to get to adulthood without all these antibacterial

things, only need soap and hot water. I don't use them but I rarely get ill and haven't had a flu or cold for over 15-20 years so I'm

probably not the person to ask... then again....

1.17 Antibacterial cleaners – can they do more harm than goodHealth positive 2017https://healthpositiveinfo.com/antibacterial-cleaners-harmful.htmlAntibacterial Soap Dangers: The chances are that you probably own antibacterial cleaners, whether they are in the form of hand soap or cleaners for your kitchen and bathroom. But are these cleaners actually doing more harm than good? Are you aware that there is some current antibacterial soap ban?Why Do We Need to Kill Bacteria? It’s true that some bacteria can cause disease, illness, and food poisoning; many antibacterial cleaners promise to kill around 99% of bacteria, which helps to explain why they are so popular. After all, we all want to protect ourselves and our family from getting ill. But why are antibacterial cleaners bad for health? Currently, the FDA is currently looking into two of the major ingredients of antibacterial products: triclosan and/or triclocarban. Lab

studies show that triclosan and triclocarban disrupt hormones and can encourage the growth of drug-resistant bacteria (superbugs). FDA also stated that there are no extra health benefits to using antibacterial soaps over regular soap and water. Another long term result of using antibacterial products is that they make bacteria more resistant. This means that, over time, these antibacterial products will no longer be able to kill the germs they set out to kill in the first place.Antibacterial Soap vs Regular Soap : The truth is that you don’t need to make your home sterile to protect yourself and your family. Human beings in fact need a small amount of constant exposure to bacteria in order to keep our immune systems functioning properly. Bacteria is all around us, and being exposed to small amounts of it is what our body needs in order to build up its defences against stronger bacteria. Studies have shown that sterile environments in childhood can actually lead to more allergies and other problems later in life.The American Medical Associated (AMA) has warned against extensive use of such antibacterial cleaners for these reasons. When it comes to killing germs, simple measures like thoroughly washing your hands often (with traditional/ regular soap rather than antibacterial soap) are a good way to protect against germs.

1.18 Antibacterial cleaning productsBetter health Channel 2017https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/antibacterial-cleaning-products

Overuse of antibacterial cleaning products, including disinfectants in the home, may be producing strains of bacteria that are resistant to multiple antibiotics. As a marketing strategy, media advertisements suggest that bacteria in the home are harmful and must be eliminated by using any number of the antibacterial or antimicrobial products available.

These cleaning products are no more effective at preventing infection in the home than good personal and household hygiene using ordinary soap, warm water and plain detergent. Avoid using antibacterial or antimicrobial products unless you have a specific medical reason to do so.

Household products labelled as antibacterial, antiseptic or antimicrobial include: soaps and detergents, hand lotions, disinfectants, cleaning cloths, surface sprays, garbage bags and plastic wrap, textiles and carpet underlay. Many of these products contain antibacterial agents such as triclosan. These ingredients are valuable in hospitals and other healthcare settings, but their effectiveness could be compromised by unnecessary domestic use. Widespread use in the home could make some bacteria resistant to these antibacterials..

There are several issues involved:  There may not be enough of the antibacterial or antimicrobial agent in these cleaning

products to destroy bacteria completely. 

When exposed to antibacterial or antimicrobial cleaning products, most bacteria will die, but some may survive and multiply. These can become resistant to antibiotics and disinfectants. 

Resistant strains of bacteria can lead to increased infection risk in the community, and in hospitals and other healthcare settings. 

Disinfectants are often not used correctly. Antibacterials such as triclosan can enter the environment and accumulate over time, leading to antibiotic resistance. WHO refers to antimicrobial resistance as “a looming crisis in which common and treatable infections are becoming life threatening”.

Most bacteria actually help humans. For example, intestinal bacteria help us to digest food. The ‘good’ bacteria that naturally live on and inside our bodies help us stay healthy by keeping the numbers of ‘bad’, disease-causing bacteria under control. When you use antibacterial or antimicrobial cleaning products, good bacteria are also killed. This could be harmful if the bad bacteria get the upper hand.  Soap and water is just as effective as antibacterial cleaning products. Healthy households do not need antibacterial cleaning products. Effective hand washing with soap, and household cleaning using warm water and a plain detergent, is the cheapest way to get rid of germs. Avoid antibacterial or antimicrobial products – they are more expensive, no more effective at cleaning and their widespread use may pose a wider health risk.1.19 Antibiotics and biocidal cleaners may spread multidrug resistance in MRSA American Society for Microbiology Press release 2017https://www.asm.org/index.php/newsroom/item/6824-antibiotics-and-biocidal-cleaners-may-spread-multidrug-resistance-in-mrsaAntibiotic use on people or pets, and use of biocidal cleaning products such as bleach, are associated with multidrug resistance in MRSA in the home. Contamination of the home environment may contribute to reinfection of both humans and animals with MRSA, and to subsequent failure of treatment. In a new study, samples were collected from the home environments and companion animals of households over a 14 month period. They tested whether household-wide efforts to eradicate MRSA—which included daily use of nasal mupirocin ointment and chlorhexidine body wash—were successful in reducing recurrence of MRSA among adults and children previously been diagnosed with a MRSA skin or soft tissue infection. They repeated sampling in 65 homes three months after the residents had been treated for MRSA, or, as a control, after they had been educated about MRSA. “Based on the evidence, we strongly suspect that environmental contamination of the home with MRSA contributes to recurrence,” said Mr. Shahbazian. The investigators also suspect that household-wide selective pressures on the home environmental reservoir of MRSA promote persistence of multidrug resistant strains. “We hypothesize that infected or colonized people and companion animals shed MRSA into the home environment,” which then re-infect household members. 

1.20 Antibiotics, biocidal cleaning products linked to multidrug resistance in MRSANovotaste R&D Team September 2017 http://www.novotaste.com/antibiotics-biocidal-cleaning-products-linked-to-multidrug-resistance-in-mrsa/Antibiotic use on people or pets, and use of biocidal cleaning products such as bleach, are associated with multidrug resistance in methicillin-resistant Staphylococcus aureus (MRSA) in the home. This contamination of the home environment may contribute to reinfection of both humans and animals with MRSA, and to subsequent failure of treatment. The research is published September 22nd in Applied and Environmental Microbiology, a journal of the American Society for Microbiology.

1.21 Antibiotic resistance linked to common household disinfectant triclosan. Science Daily July 2017https://www.sciencedaily.com/releases/2017/07/170703085348.htm

Scientists from the University of Birmingham and Norwich Research Park have discovered a link between a major mechanism of antibiotic resistance and resistance to the disinfectant triclosan which is commonly found in domestic products. Researchers made the unexpected finding that bacteria that mutated to become resistant to quinolone antibiotics also became more resistant to triclosan. The scientists showed that the quinolone-resistance mutation altered the way the bacteria package their DNA inside a cell and that these mutants had also turned on various self-defence mechanisms -- together these gave triclosan resistance.Quinolone antibiotics are an important and powerful group of human medicines, and this new discovery raises concerns that the use of triclosan can give antimicrobial resistance.The research, carried out at the Institute of Microbiology and Infection at the University of Birmingham in collaboration with The Quadram Institute and John Innes Centre based at Norwich Research Park, was published today in the Journal of Antimicrobial Chemotherapy.

1. Mark A. Webber, Michelle M. C. Buckner, Liam S. Redgrave, Gyles Ifill, Lesley A. Mitchenall, Carly Webb, Robyn Iddles, Anthony Maxwell, Laura J. V. Piddock. Quinolone-resistant gyrase mutants demonstrate decreased susceptibility to triclosan. Journal of Antimicrobial Chemotherapy, 2017; DOI: 10.1093/jac/dkx201

1.22 Common disinfectant found in soap and toothpaste could be causing antibiotic resistanceDaily mail July 2017http://www.dailymail.co.uk/health/article-4664840/Soap-ingredient-causing-antibiotic-resistance.html#ixzz4yEleu6yj 

Antibacterial ingredient triclosan is found in soap, toothpaste and children's toys British scientists found that the chemical could cause resistance to antibiotics Chemical could cause bacteria to become immune to quinolones, research finds Quinolones are antibiotics used to treat urinary tract infections and pneumonia

A common ingredient of soap and toothpaste could be causing antibiotic resistance and fuelling the spread of superbugs, according to new research. Researchers found that triclosan, a chemical found in soap, toothpaste and cleaning products, could be making bacteria more immune to antibiotics. A new British study found that bacteria exposed to triclosan could become more resistant to a group of antibiotics known as quinolones.Quinolones are a common antibiotic used to treat urinary tract infections, sinusitis, bronchitis and pneumonia. The warning comes just a year after the use of triclosan in antibacterial soap was banned by the US Food and Drug Administration (FDA).

Scientists have now discovered another possible cause behind the rise in antibiotic resistance: triclosan, an additive found in some soaps, detergents, disinfectants, deodorants, or cosmetic products.

1.23 Antibiotic resistance linked to common household disinfectant triclosan. Healthy Bacteria Aug 2017http://www.gesunde-bakterien.de/en/rise-in-antibiotic-resistance-caused-by-triclosan-in-household-and-cosmetic-products/Scientists have now discovered another possible cause behind the rise in antibiotic resistance: triclosan, an additive found in some soaps, detergents, disinfectants, deodorants, or cosmetic products. In a series of tests, a team headed by Mark Webber from the University of Birmingham detected that bacteria which develop mutations to protect themselves from antibiotics also became resistant to triclosan. In the reverse case, any organism exposed to triclosan might also develop resistances to antibiotics. In a first test, the scientists were able to prove that E.coli bacteria – after extended exposure to triclosan – developed resistance to the agent. In any case, the use of antimicrobial agents in personal and domestic cleaning products is unnecessary and harmful for the natural diversity of

healthy bacteria. Triclosan, in particular, is controversial as it is considered potentially carcinogenic. Many scientists and physicians have called for the agent to be banned.

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