Handwashing does not often make the news. I’m still waiting for, “Crunchy Green Mom Caught Washing her Hands!” But a couple years ago, handwashing was front page.
The Food and Drug Administration (FDA) ruled against 19 super common antibacterial agents, including the ubiquitous Triclosan, that were in nearly every “antibacterial,” “antimicrobial,” or “antiseptic” hand wash. With these ingredients banned, entire product lines had to be reformulated or else no longer sold. What had been a huge and successful consumer market suddenly was stopped short.
The FDA oversees “articles intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease” as laid out in the Food, Drug, and Cosmetic Act of 1938. Since antibacterial hand washes kill germs that would otherwise make us sick, they fell under the classification of “drug.”
Prior to this ruling, it sounded like the perfect match, right? Germs make us sick. Antibacterial agents kill germs. Problem solved. Case closed.
But it wasn’t that simple. Not that it ever is.
Triclosan and its buddies raised the ire of the federal government for one primary reason and a couple of secondary ones. Primarily, they gave false hope. These ingredients lulled people in to a false sense of security that if they used an “antibacterial” product, they were free from germs and immune to sickness. It turns out, this wasn’t the case. They might, in fact, get even more sick.
The secondary reasons were found in the growing body of evidence that these antibacterial agents might also promote antibiotic-resistant superbugs, disrupt human hormones, and cause skin cancer.
The FDA was pretty nice about it. They gave manufacturers a year to provide proof that their antibacterial products were more effective than soap and water and safe for long-term daily use. The stakes were high. The manufacturers had a lot of financial reason to prove their products’ claims were true. Even so, they couldn’t do it.
Theresa M. Michele, MD, of the FDA’s Division of Nonprescription Drug Products summed up the findings in saying, “There’s no data demonstrating that these drugs provide additional protection from diseases and infections. Using these products might give people a false sense of security. If you use these products because you think they protect you more than soap and water, that’s not correct.”
So why am I writing about an ingredient that has already been debunked? Because I regularly get asked – usually by desperate parents fighting unending rounds of a stomach flu – if Dr. Bronner’s Castile Soaps or Sal Suds are antibacterial. As you’ve likely guessed, the answer is “No.” And they don’t need to be. Surfactants, such as Castile Soap and Sal Suds, remove germs and bacteria, as well as dirt and grease. Again, they don’t kill. They remove all manner of dirt and germs and grease and other ickies off of any surface. They effectively clean counters, cutting boards, sinks, door knobs, you…. They’re like the security force that surrounds the problematic intruders and escorts them out the door – or down the drain. Call them The Eliminators.
In contrast to soap and other surfactants, antibacterial agents kill germs, but do not remove them. Saying it another way, they kill but do not clean. Antibacterial hand cleansers or washes may have also contained some soap or detergent that would then remove the dead germs, but they would have removed them anyways. The antibacterial agents were superfluous.
Then there were the secondary, but personally more eyebrow-raising, concerns about potential promotion of antibiotic-resistant superbugs, hormone disruption and cancer. Let’s look at the first. “Antibiotic-resistant superbugs” refer to things like STAPH and MRSA, which are infections that take a stunningly massive quantity of novel antibiotics to get rid of.
Many a bottle of antibacterial hand wash shouted, “Kills up to 99.99% germs!” I couldn’t have stated the problem better myself. If it kills 99.99% of germs, then it doesn’t kill .01% of germs. And the .01% of the germs are those super-duper strong ones that aren’t easily killed. And these super strong, hard-to-kill germs now have the playing field to themselves. They have no other germs to compete with. While .01% is certainly a very small number, without competition they can grow and reproduce and strengthen and do their dastardly deeds with little to get in their way. This is not a good thing. In fact, this is such a not-good-thing, that on its website, the Center for Disease Control (CDC) calls “antibiotic resistance… one of the biggest public health challenges of our time.”
Waterless Hand Sanitizers
You’ve perhaps noticed that I have discussed only wash-off antibacterial cleansers. You’re very observant.
The FDA’s ruling did not apply to waterless hand sanitizers, and as of yet, they are still collecting research on the efficacy and safety of Triclosan et al in those ubiquitous gels and sprays. However, where the FDA is yet silent, the CDC recommends, “If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.” The CDC goes on to state that, while still not as good as soap and water, a 60% or greater alcohol concentration is better than any other active ingredient at killing germs in a waterless situation.
The antibacterial issue goes even further than hand cleanliness, though. At the height of the antibacterial craze, which arguably is still underway, Triclosan could be found in a dizzying array of consumer goods including socks, cutting boards, sheets, makeup, deodorant, cervical collars, first aid splints, ice cream scoops, mops, underwear, shirts, shorts, pencils, binders, scissors, calculators, humidifiers, ear plugs, hockey helmets, paint, foot warmers, wallpaper, escalator handrails, air filters, towels, pet bowls, baby carriers, cart covers, vacuums, food sealers, yoga mats, coolers, grout, concrete, dog washes, horse washes, furniture, toys, and who knows what else.
Everything on this list falls outside the FDA’s jurisdiction, so we can’t look to them for a ruling on their safety.
If we are surrounded by so great a cloud of Triclosan, how much is ending up inside us? This concern is called systemic exposure, where a substance crosses through the skin or is swallowed or inhaled and accumulates in the internal organs. Do products that contain Triclosan shed it during use? Does a cutting board transmit Triclosan into food? Do sheets transmit Triclosan through the skin? Or does any product outgas Triclosan which can then be inhaled? There isn’t research on this yet, although the government has recommended that more be done. In the meantime, the long-term testing continues on the consumer. I for one will excuse myself from this test.
What to do now
As we enter the time of year where we stay indoors and breathe on each other (otherwise known as “cold and flu season”), it becomes increasingly imperative that we wash our hands with soap and water. Early and often. And teach our children to do the same. Let me say this very clearly:
The single most important way to keep your kids healthy is to teach them to wash their hands well.
This goes for surfaces around us as well. Spraying them with a leave-on antibacterial spray (yes, I mean Lysol), or even a spray and wipe disinfectant, is not nearly as effective at removing germs, dirt, and grease with a soap and water spray.
You know those memes about things we didn’t have when we were kids? Waterless hand sanitizer is on that list. They came about sometime in between my childhood and my parenthood. When I was a kid, we just had soap and water. If our hands were dirty, we had to go to a sink and wash them. Turns out that’s the best way after all.