On September 1, 2016, the FDA issued a ruling that bans the use of 19 chemicals, including triclosan and triclocarban. “There’s no data demonstrating that over-the-counter antibacterial soaps are better at preventing illness than washing with plain soap and water,” the FDA said in a press release that was released after the ruling was announced. Companies using these agents had a year to take these chemicals out of their antibacterial soaps or take these products off the market. So, where are we now? And why is it recommended to avoid antibacterial soaps with triclosan?
The 19 chemicals that are banned are the following: Cloflucarban, Fluorosalan, Hexachlorophene, Hexylresorcinol, Iodine complex (ammonium ether sulfate and polyoxyethylene sorbitan monolaurate), Iodine complex (phosphate ester of alkylaryloxy polyethylene glycol), Nonylphenoxypoly (ethyleneoxy) ethanoliodine, Poloxamer-iodine complex, Povidone-iodine 5 to 10 percent, Undecoylium chloride iodine complex, Methylbenzethonium chloride, Phenol (greater than 1.5 percent), Phenol (less than 1.5 percent) 16, Secondary amyltricresols, Sodium oxychlorosene, Tribromsalan, Triclocarban, Triclosan, and Triple dye.
When did the market for antibacterial cleanser begin?
Historically, antibacterials were commonly found in healthcare environments and hospitals as hand sanitizers to slow the spread of germs. However, starting in the 1990s, the general population became exposed to the wide availability of antibacterials commonly found in soap, body washes, detergents, and household cleaning agents. About 75% of antibacterial hand washes contain antibacterial-agents containing triclosan.
Why ban antibacterial consumer products?
The FDA proposes concern for antibacterial consumer products in December 2013. The FDA proposed a rule that would require manufacturers of antibacterial soaps and washes to provide substantial data demonstrating the safety and effectiveness of antibacterials containing agents such as triclosan or triclocarban. The latest data suggests that the risks associated with long-term, daily use of antibacterial soaps may outweigh the benefits. Since the FDA made that announcement in 2013, many companies began to phase out these banned chemicals. Of note, the popular antibacterial Dial soap is still using triclosan as its active agent. Companies began replacing the banned chemicals with benzalkonium chloride, benzethonium chloride or chloroxylenol (PCMX). The FDA is demanding proof for better efficacy with these chemicals as well- demanding for companies to show that products with these chemicals are better than simple soap and water for 20 to 30 seconds.
Here are the 3 prominent concerns with antibacterial soaps:
- Killing off good bacteria and creating worse bacteria: Let’s first understand the technicalities of antibacterial soaps. There are 2 types of antibacterials- non-residue producing (antibacterial agents that evaporate such as chlorine, alcohol, peroxide) and residue producing (substances that leave residue to have prolonged action such as triclosan, benzalkonium chloride). Non-residue producing agents such as alcohol and bleach kill bacteria quickly since they globally kill bacteria immediately and effectively. On the other hand, residue-producing agents such as triclosan tend to target specific parts of the bacteria and thus could lead to more resistant bacteria or triclosan-mutant bacteria. With this understanding in mind, the concern is that we are killing off potentially good bacteria and possibly increasing the production of worse, resistant bacteria. Avoid antibacterial soaps with triclosan, and instead opt to use soaps that use alcohol as its active ingredient.
- Triclosan is bad for both the body and the environment. A good percentage of antibacterial hand washes contain triclosan, an ingredient of concern to many environmental groups. Triclosan gets washed away and ends up in our sewage plants and water sources. Bottlenose dolphins off the coast of Florida and Carolinas were found to contain traces of triclosan, and it was found in the bile of other fish. Animal studies have shown that triclosan may alter the way hormones work in the body. Even though animal studies are dissimilar to human studies, the FDA notes the hormone concern and considers it a possible serious risk. In addition, laboratory studies demonstrate the possibility that triclosan contributes to making bacteria resistant to antibiotics. Resistant bacteria are a huge concern because that means certain antibiotics may not kill off bacteria as they should.
- Increasing our risk of allergies. Many of us have hand sanitizer gels, wipes, soaps and body washes in our own homes. As previously mentioned, using antibacterials regularly means that we may be killing off our good bacteria. This could lead to an increased allergy-risk by supporting the hygiene hypothesis, which proposes less bacteria allows for less appropriate stimulation of our immune system leading to an imbalance allowing our immune system to become altered and more sensitized to our own bodies.
What are the choices besides antibacterial products?
- 70% alcohol, bleach or peroxide is the best at killing bacteria because each attacks the entire component of bacteria and not a specific part of bacteria. Thus, these non-residue-producing agents are the better antibacterial agents, so look for these as the active ingredients in your next hand sanitizer if you choose to continue using a hand sanitizer.
- Outside of hospitals and healthcare environments, the CDC recommends the old-fashioned hand washing: wash your hands with conventional soap and water. Remember that alcohol from hand sanitizer kills bacteria, but it doesn’t physically remove dirt or anything else you may have touched. A 20 to 30 second hand wash with soap is best at removing both the dirt and bacteria.