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The Oversanitization Of America: Are Antibacterial Products Helping Or Hurting?

“Kill those bugs!” appears to be a slogan that germ-phobic Americans have fanatically adopted. And merchants have responded with zeal.

If you visit the soap, detergent, or health and skin-care aisle of any store, you’d swear that malicious monster bacteria are on the loose and they are on the hunt for your family members. Product labels touting extra-strength bacterial fighting agents conjure up images of filthy disease-breeding germs that have to be stopped! Of course, the makers of these products are simply meeting the feeding frenzy of misguided consumers who are intent on spraying, squirting, and smearing all forms of antibacterial agents in and around their homes as well as on themselves and their kids.

Antibacterial products are designed to remove diseasecausing organisms from external surfaces before they can enter the body. But we’re learning that, in the case of a large group of these products, this is not a healthy approach to keeping disease at bay for a number of reasons. Most important, there’s growing evidence that certain antibacterial products may well be contributing to the alarming problem of bacterial resistance that was initially linked to our indiscriminate and improper use of antibiotics.

Antibacterials are in a separate category from antibiotics,but both are lumped under the umbrella term of antimicrobials. It’s been a well-known fact for years that this country’s wayward use of antibiotics has created mutant strains of bacteria—including those that cause meningitis, pneumonia, children’s middle-ear infections, and blood infections—that are now resistant to at least one antibiotic. In fact, tuberculosis has been shown to be resistant to many antibiotics and frequently does not respond to treatment.

Quite logically, consumers’ fear of this situation and the urge for “protection” has resulted in the persistent and arbitrary use of antibacterial products. But, ironically, in our unwitting need to build germ barriers by applying antibacterials— and buying items impregnated with them (such as cutting boards, high chairs, toys, and mattress pads)—we are contributing to the problem on several levels according to emerging new research.

Stuart Levy, M.D., could be considered America’s resident expert on the entire sweeping subject of antibiotics and antibacterial agents. As director of the Center for Adaptation Genetics and Drug Resistance at Tufts University Medical School, Dr. Levy is a scientist on a campaign to reduce the indiscriminate use of them. But the issue of antibacterials is one that is fairly new on the scene. For instance, in 1992, he released The Antibiotic Paradox, a book detailing antibiotic misuse. He didn’t address antibacterial agents at the time, as they hadn’t emerged on the consumer scene. In the ten years since, antibacterials have become a ubiquitous presence in most American homes. This time, Dr. Levy dedicates an entire chapter to the subject in his newly released and updated second edition.

He emphasizes that antibacterial products can be divided into two groups: one includes a group that’s considered safe to use. And the other is the cause for alarm. The safe group is referred to as non-residue-producing antibacterial agents and includes the sorts of products that many of us carry around in our cars or purses to clean our hands when soap and water are not available. They are products with ingredients that immediately kill bacteria and then quickly evaporate. These include antibacterials made from alcohols, ammonia, hydrogen peroxide, and chlorine bleach.

The real culprits are in the second group, termed residueproducing agents which are chemicals that linger on surfaces or products impregnated with them. These long-lasting residues will continue to kill benign bacteria and increase the growth of resistant strains long after target bacteria have been removed.

The most widely used among these are triclosan, triclocarbon, and benzalkonium chloride. (A full list can be accessed at the Web site “Alliance for Prudent Use of Antibiotics” at These are the residue-producing chemicals that are used not only in toiletries and detergents, but also incorporated into toothbrushes, pens, and children’s products.

Antibacterial agents are a concern on three different fronts. First, there’s the controversial issue of whether using them in the home conclusively contributes to antibiotic resistance. Constant use of these disinfecting agents tends to disrupt the normal bacteria that act as barriers against invading pathogens. In turn, this could eventually lead to pathogens that are treatment resistant. For example, the bacteria that give rise to ear infections and pneumonia can exist on the outside of our bodies. Theoretically, if these germs are consistently exposed to low levels of antibacterial agents that are spread around our homes, the germs might not be killed and may instead mutate into stronger strains resistant to treatment.

Laboratory research has proven that this is a possibility although the phenomenon has not been duplicated on the home front. Dr. Levy believes it’s simply a matter of time. “We have not seen [the emergence of antibiotic resistance] yet in the home but it’s a potential that may well be real because there’s nothing that’s been in the laboratory that hasn’t eventually occurred outside in a worse situation.”

Nonetheless, Dr. Levy is quick to point out that there is a place for the residue-producing antibacterial products when severely immunecompromised people are at home. “My suggestion is to reserve [these] products for when you need them and that is for a vulnerable patient…a patient who comes home from the hospital whose immune system is down…for elderly diabetics, for AIDS patients…for people who really need them.”

Further, if you need to use residue-producing antibacterial products for these purposes, Dr. Levy cautions that they be applied “in a careful way” by spreading them for a period of minutes—not for the few seconds that we usually take to wash surfaces.

Another concern about the indiscriminate use of residueproducing antibacterial products, according to Dr. Levy, is the issue that’s termed the “hygiene hypothesis” which is a theory originating in Europe. “If you try to keep your house too sparkling clean—especially with infants—they then don’t come in contact with the good bacteria that allows their immune system to mature correctly. We have antibacterials circulating in the house in little fine films all over. What kind of microbiology is going to live there and is it going to be the right kind to allow the immune system to mature as it has for centuries?” He believes the answer is “no.” Research shows there is a higher percent of allergies, asthma, and eczema among kids who have been raised in super sanitary conditions.

Moreover, the use of the residue-producing antibacterials poses a severe threat to our environment as these chemicals have been found in surface waters, sewage treatment plants, the bile of fish, and even breast milk! As an environmentalist, Dr. Levy fears the repercussions of this situation. “On one hand, it says that products we use in the home and for ourselves don’t just miraculously disappear… Sewage disposal…can’t get rid of these chemicals so they will have a life afterwards. They will then hit bacteria microbes down the way. How do we know what effect they’re going to have eventually on ecosystems which rely on a mixture of bacteria?”

As conscientious consumers we can avoid buying the residueproducing antibacterial products for everyday use—the chemicals should be listed on the product labels. Moreover, Dr. Levy says there is no evidence that routine use of these chemicals imparts a health benefit. Scrubbing with plain old nonbacterial soap and water removes virtually all the bacteria.

Disclaimer: This column is for information only and no part of its contents should be construed as medical advice, diagnosis, recommendation or endorsement by Ms. Ephraim.© Rebecca Ephraim. All rights reserved. Reprinted with permission.