Manufacturers may be the only ones cleaning up
Awash in antimicrobial soaps and wipes, Americans seem to be fending off germs at every turn.
Rhode Island bought nearly 15,000 wall dispensers filled with alcohol-based hand sanitizer to combat a disease outbreak in its schools. Many supermarkets routinely offer wipes for sanitation-conscious customers.
At the entrance of a new Martin’s Food Market in Eldersburg, Md., shoppers can disinfect their grocery carts at the door. “I use them all the time -- I’m a germ freak,” Cindy Tack, 40, said as she wiped down the basket before sliding her son Ben, 3, into the seat. “And when I walk in the door at home, I wash my hands.”
“I think it’s overkill,” she confessed. “But having kids, and as I’ve gotten older, I’ve gotten more like that. They’re touching everything.”
This bacterial backlash is fueling the introduction of 200 to 300 new or redesigned antimicrobial products each year. Consumers spend more than $200 million annually on antimicrobial wipes alone, said Mike Richardson, an industry analyst at the Freedonia Group in Cleveland. “We’re expecting something close to double-digit annual growth for the next several years,” he said.
On store shelves, alcohol-based cleaners join a growing variety of antibacterial soaps and other products aimed at snuffing out microscopic life wherever people perceive a threat to health.
Yet Rolf Halden, an environmental scientist at the Johns Hopkins Bloomberg School of Public Health, contends that the onslaught of products has had no discernible effect on the rates of infectious disease in the United States.
“Not a blip on the radar screen. The money’s been spent, but the benefit is doubtful or absent,” said Halden, co-founder of the school’s Center for Water and Health. “The flood of antimicrobial products is driven by monetary profits and not by scientific evidence.”
Germ-fighting hand cleaners are not all created equal.
In a scrub-off, scientists prefer plain soap and water, when used properly. Next are the alcohol-based gels and wipes, which they describe as adequate alternatives when vigorous hand washing at a faucet isn’t possible. Studies have found that most hand sanitizers can reduce gastrointestinal illnesses in households, classrooms and dormitories.
Last are antibacterial soaps and related products, which, some research suggests, could generate problems for the environment and human health. And they don’t kill viruses that cause colds, flu and intestinal illnesses. These include the “noro” viruses that have sickened cruise ship passengers.
Although there’s debate about what people should use to clean their hands, there’s no debate about the health benefits of doing it properly. The federal Centers for Disease Control and Prevention calls it “one of the most critical control strategies” in managing a disease outbreak. Pathogenic viruses and bacteria pass among us via our hands and can infect us when we touch our mouth, nose and eyes.
The gold standard for hand cleaning, experts agree, is to wash vigorously with soap and warm water. Do it for 15 to 20 seconds -- two verses of “Mary Had a Little Lamb.”
The mechanics of rubbing all surfaces of the hands together loosens bacteria and viruses from the oils of the skin, suspends them in the soapy solution and rinses them away. Thorough drying with a single-use towel curbs transfer of any remaining germs. Use the towel to turn off the water and open the door.
“Plain soap is an antimicrobial,” Halden said. It kills bacteria by causing cell membranes to leak.
“The biggest problem with hand hygiene is people don’t do it,” said L. Clifford McDonald, a medical epidemiologist at the Centers for Disease Control and Prevention.
Timing matters. Wash before eating. Wash after using the bathroom, sneezing or coughing into your hands, handling raw meat or caring for someone who has an infection.
Two years ago, an observational study of 6,000 people by the industry’s Soap and Detergent Assn. found that 10% of women and 25% of men didn’t wash their hands after using the bathroom. Even fewer washed after sneezing or coughing into their hands.
If people don’t or can’t wash at the sink, experts say, it’s safe to use alcohol-based gels and wipes, which kill most viruses and bacteria. They degrade rapidly in the environment and have “a pretty good safety profile,” Halden said.
But they have their shortcomings. McDonald said the alcohol products didn’t work well on visibly dirty hands. They also won’t kill some bacteria that form protective spores, such as Clostridium difficile, which can cause a life-threatening form of diarrhea and colitis.
Using them to clean your hands after handling drippy packages in the meat department makes sense, McDonald said, but added that “alcohol is not generally a good surface disinfectant.” Shoppers would be better off using wipes to clean their hands after working with the cart than attempting to disinfect it first.
For some, such as Terry Powell, 60, the reason for using wipes on the grocery cart is simple if unscientific.
“My wife uses them,” he said, “and she tells me to use them.”
Alcohol-based hand gels are catching on with the public in part because they have become ubiquitous in medical settings, McDonald said.
The use of them by healthcare workers stems from a push to combat hospital-based infections. But the broader demand might be motivated by several factors, including marketing and a growing germophobia.
The media contribute to that perception, McDonald said, with coverage of outbreaks such as severe acute respiratory syndrome (SARS), anthrax and “now these very prominent food-borne outbreaks,” he said, referring to people who have been sickened or killed by produce contaminated with E. coli.
Kimberly Thompson, author of “Overkill: Repairing the Damage From Our Unhealthy Obsession With Germs, Antibiotics and Antibacterials,” said of the public demand, “The goal is to annihilate all germs.” But that isn’t possible, “and it’s not necessary or desirable.”
“We rely on bacteria and viruses as part of our environment,” said Thompson, a professor of risk analysis and decision science at Harvard University.
A panel of experts and industry representatives convened by the U.S. Food and Drug Administration in 2005 found “no firm scientific evidence that the flood of antimicrobial products we observe has any discernible benefit over the use of regular soap and water,” said Hopkins’ Halden, who served on the panel.
Part of the problem, he said, is that household antibacterial products are weak versions of those used in the healthcare industry. “We’re using a diluted product and giving it to everybody for every purpose, and the outcome is no measurable benefit.”
There’s also concern that the use of antibacterial soaps could encourage the evolution of bacteria resistant to antibiotics. Lab evidence suggests it could happen, but there is no proof yet that it has, Halden said.
What is clear is that two of the soaps’ ingredients -- triclosan and triclocarban -- have been found in fish, breast milk and wastewater. Halden said the chemicals might kill beneficial organisms in the soil and waterways.
Although there’s no scientific evidence they’re harming humans, he added, “nobody has looked.”
Brian Sansoni, spokesman for the Soap and Detergent Assn., said the chemicals were detectable in the environment because the detection technology was so “spectacular you can find anything just about anywhere if you look closely for it.”
“From everything we have seen, we feel it does biodegrade safely in the environment,” Sansoni said.
And the products do their job, he said. “We believe that antibacterial soaps are effective at eliminating or reducing germs on the skin that make us sick.”
Although soap and water are best, Sansoni said, “in those cases where people aren’t washing their hands enough, at least there’s that extra ingredient that we think can make a difference.”
The CDC’s McDonald agrees, to a point. Antibacterial soaps “do seem to kill more quickly, and seem to have more post-cleaning effect than soap and water,” he said. “Does that translate into a lower infection rate? We’ve never been able to show that.”
