Antibacterial products: can you be too clean?

By Elissa Sonnenberg, MSEd

In a world full of runny noses and hacking coughs, products with labels like "antibacterial" and "antimicrobial" regularly dispense hopes of germ and illness-free lives to their users. But as the variety of germ-fighting products continues to rise—including antibacterial scissors, pens, and even underwear—medical experts continue to disagree over their benefits and potential long-term effects.

Nearly 700 new antibacterial products for home use—almost half of the household cleanser market—have been added to store shelves in the last decade, according to the Journal of Pediatric Infectious Diseases. "People are realizing the importance of sanitizing their environment, particularly their hands," says Wink Weinberg, MD, chief of infectious disease service at the Southeast Permanente Medical Group.

Dr. Weinberg maintains that consumers' heightened awareness of keeping clean to avoid common contagious conditions has helped drive the number of antibacterial products up, while driving the number of infectious diseases down. Still, he says, the focus should remain clear. "The important thing in preventing infection is lowering the amount of bacteria on your hands," says Dr. Weinberg, who is also the author of No Germs Allowed!: How to Avoid Infectious Diseases at Home and on the Road.

Other experts say it's important to balance the need for cleanliness with the fact that all germs aren't created equal. "For most of us, the germs we carry are not harmful and in fact they can be protective," says Elaine Larson, RN, PhD, professor of pharmaceutical and therapeutic research at the Columbia University School of Nursing.

She does, however, recommend using antibacterial cleaning products in households where members are:

• Infants
• Elderly
• Suffering from colds, diarrhea, or other infectious diseases
• Immunosuppressed (AIDS, undergoing cancer treatment)

In addition, certain types of antibacterial cleansers can be clear winners for everyone. "Waterless products are extremely helpful in situations where you can't get clean running water or can't get to a sink," Dr. Larson maintains. Dean A. Blumberg, associate professor of pediatric infectious diseases at UC Davis Medical Center, agrees. "There's a lot of good science to back up that (alcohol-based hand rubs) are more effective than soap and water to decrease microbial count," he says. Alcohol-based products formulated with emollients offer moisturizing benefits to the skin as well.

As for the ever-widening range of non-soap antibacterial products, like toothpastes and cutting boards, while they may sound appealing, there is no scientific proof they are effective—and they may lead to an unhealthy, false sense of security. "I think they are a complete waste," says Dr. Larson. "They just appeal to people's germ phobias."

Repetitive hand-washing, which includes lots of friction and increased skin shedding, can aggravate some sensitive skin conditions—like eczema and psoriasis—and cause others, cautions Dr. Larson. She adds that nurses, who must wash their hands very frequently, suffer from many skin problems and are likely to harbor unhealthy bacteria because of it. "(For nurses,) we try to find products that are milder for the skin and still effective in killing bacteria."

Still, the biggest drawback to using antibacterial products isn't their damaging effects to skin, but their potential long-term effects, says Dr. Blumberg, who is also a member of Alliance Working for Antibiotic Resistance Education (AWARE). "The major concern is that if these products are used widely, that resistance may develop to these products, which may produce cross-resistance to antibiotics used to treat people," he says.

A recent article in the journal Emerging Infectious Diseases urged prudent use of antibiotic cleaning products not only because of that theory, but also because they may potentially alter harmless human bacteria and lead to changes in the immune system.

Dr. Weinberg strongly disagrees. "It's ridiculous to think that antibacterial products have anything to do with (antibiotic resistance) at all," he says. "They've never been shown to do any harm." He adds that current antibiotic resistance problems stem from over-prescription of antibiotics for viral, not bacterial, infections. "I know of no risk or downside to using antibacterial products," Dr. Weinberg maintains.

Experts do agree that when it comes to avoiding disease-causing germs, proper hygiene means more than any product label. Explains Dr. Weinberg: "It's important for everybody who wants to decrease their chance of getting common infections to wash their hands more frequently and clean surfaces more frequently."

Dr. Weinberg offers these tips to help avoid the most common infections:

• Hand-washing: Wash hands thoroughly with soap and water, and dry them just as thoroughly with a disposable towel. Teach children to do this often, especially before eating, after going to the bathroom, and after school.
• Preparing food: Besides cooking meats completely, make sure the surfaces on which they are prepared are washed scrupulously and dried with a disposable towel.
• Keeping your distance: Follow the three-foot rule when near flu-sufferers, who should cover their mouths and noses when coughing and sneezing, then follow-up with proper hand-washing.