Watch what you put on your hands

HYGIENE MINDED: Handwashing with soap was higher among children than in adults at the end of the study period. Photo: R. Ashok
Triclosan-based antibacterial products such as handwash and hand sanitisers are no more effective than soaps

It’s in your soap, handwash, talcum powder and even in the wall paint. In a world obsessed with cleanliness, antimicrobial agents like triclosan have been touted as the panacea for a disease-free world. However, their usage remains controversial: experts say indiscriminate usage of antimicrobial agents like triclosan over the years has led to bacteria developing resistance to them, leading to the need for stronger chemicals. Are we setting ourselves up for a world of superbugs by putting them in anything and everything?

No miracle guard, this

Last week, the U.S. Food and Drug Administration announced that effective September 2017, it would prohibit the sale of non-medical soap containing triclosan or 18 other ingredients marketed as antimicrobials, as it did not find these products to be any more effective than ordinary soaps.

Opinion is divided among experts: while some feel the move was long called for, physicians weigh in that such antibacterial products continue to be useful in certain situations.

Triclosan was initially used for hospital environments, but its use spread as a miracle guard against infection. “Triclosan is being used in toothpaste, handwash, talcum powder, etc. because companies thought it was a panacea for all, without understanding that with indiscriminate usage, bacteria can developed a resistance to the chemical,” says Dipshikha Chakravortty, associate professor, Department of Microbiology and Cell Biology, Indian Institute of Science, Bengaluru.

Asha Benkappa, director of Indira Gandhi Institute of Child Health, Bengaluru, says these products are a “gimmick” as the body has its own self-cleaning bacteria, commensals, which keep the skin clean. “Antimicrobial agents in soaps and handwashes are not required. By using antimicrobial agents indiscriminately you are removing useful commensal bacteria which help to ward off infection,” she says, adding, “Regular soap is gentle on our skin and helps maintain commensols.”

Soap is good enough

Dr. Chakravortty also feels scrubbing with soap and water is better than using hand sanitisers, as in the latter case, the dead bacteria remain on the skin: “Certain molecules, known as lipopolysaccharides, which are specific to gram-negative bacteria, and lipoteichoic acid, specific to gram-positive bacteria, get dislodged when the bacteria are killed by antibacterial agents. They remain on the surface of your hands and can get into your gut, causing other inflammatory complications. Scrubbing with soap and water is a hundred times better.” Using alcohol for disinfection was better as bacteria could not develop resistance to alcohol. A 2013 study published in Clinical Infectious Diseases also showed that antibacterial components were no more effective than ordinary soaps at preventing infectious diseases.

However, it would be unwise to disown antibacterial agents completely. Senior physician Kumar at K.C. General Hospital, Bengaluru, says antimicrobial agents are required in infection-prone situations. “Antimicrobials are recommended for sanitation workers, farmers working in the fields, or in the presence of someone with an infection,” he says. However, he adds, such products should be used in the right quantity, as overuse does not increase effectiveness.

(Originally published in The Hindu)

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