Why You Should Think Twice Before Using Antibacterial Soap

If you're like millions of Americans, you use antibacterial soaps or other products on a regular basis. So do hospitals, doctor's offices, and many health care venues.

It's notable then that the U.S. Food and Drug Administration announced Apr. 30 that they may begin requiring extra safety data on antibacterial hand soaps and sanitizers that are used in healthcare settings. Otherwise, the FDA suggested that it may pull some products from the market.

Under the newly proposed rule, the agency would evaluate whether existing over-the-counter antibacterial soaps and gels designed for clinical providers are "safe and effective" -- specifically, ensuring that products don't cause birth defects or lead to antibiotic resistant super germs. The move comes after some in the scientific and medical communities have expressed concern about the risks of such items, especially for those who must use the products regularly.

"Today healthcare professionals use antiseptic products much more frequently than they used to, in some cases up to 100 times per day," said Dr. Theresa Michele, FDA Director of the Division of Nonprescription Drug Products, in the official release. 

The agency said that it is "particularly interested in [...] the long-term safety of daily, repeated exposure to [common] ingredients." Sound familiar? That's because the FDA initiated a similar investigation into the general consumer versions of these products in 2013. That study will conclude later this year.

Since the average person doesn't use antibacterial soaps or gels nearly as often as their doctor, should we be concerned about the most recent FDA review?

Although I don't have a need to use antibacterial preparations as often as those working in clinical environments, I do want the occasional satisfaction of a spritz of hand sanitizer. I even feel good about it when I'm working in my other capacity in the special events industry, like I'm limiting my 'take home' contact with the hundreds of individuals I interacted with during a given party. (And hopefully also limited my guests' chances of catching a cold from their vicarious contact with everyone else through me.) 

But is it good for our health? Or, in the FDA's parlance: Is my lower-than-clinical exposure level safe for in the long run?

According to Dr. Allison Aiello, the answer is clear: absolutely not. 

"The potential risks definitely outweigh the benefits, which are none," said Aiello without equivocation to TIME when asked recently about antiseptic soap use. 

An epidemiologist at the Gillings School of Public Health at the University of North Carolina, Aiello has long crusaded against these products, especially those containing the chemical triclosan. About half of liquid hand soaps in the US, along with a whole slew of other products, contain antibacterial chemicals like triclosan or triclocarban. In fact, it's hard to buy a household items like dish racks, toothpaste, hand soap, and even some clothing (under than name Microban) without running into these antimicrobial and antibacterial pesticides.

This should be mildly alarming, considering the results of a 2007 study for which Aiello was a lead author. Her team concludes:

"Several laboratory studies demonstrated evidence of triclosan-adapted cross-resistance to antibiotics among different species of bacteria. [...] The lack of an additional health benefit associated with the use of triclosan-containing consumer soaps over regular soap, coupled with laboratory data demonstrating a potential risk of selecting for drug resistance, warrants further evaluation by governmental regulator regarding antibacterial product claims and advertising." 

In other words, after systematically reviewing 27 studies of antiseptic soaps containing the active ingredient triclosan, Aiello and her partners believe that some antibacterial soaps may be making antibiotic resistance super bugs. (They also suggest that manufacturers like Dial and Softsoap may be fleecing consumers with inflated claims on their products effectiveness in the process. But we'll come back to that later.)

This should give us pause in our household germ-killing spree. Globally, bacteria have become more resistant to antimicrobials, according to the World Health Organization. So much so that the WHO said the problem "threatens the achievements of modern medicine."To emphasis the point, in mid-May, the Centers for Disease Controlwarned of a strain of typhoid that has become resistant to multiple antibiotics.

Given the impact that resistance can have on the success of medical treatments, perhaps we should lay off the hand sanitizer. But that's not the only reason.

Some antiseptic soaps may also promote tumors. 

A different study, released in Nov. 2014, found that triclosan promoted tumor growth. Researchers in San Diego exposed mice to the pesticide and reported that mice grew "more tumors, bigger tumors and more frequent tumors" than those rodents with no triclosan contact. They also pointed to liver scarring. 

Study author Robert Tukey, professor of chemistry, biochemistry, and pharmacology at University of California, San Diego, described the results as "on the extreme end of a tumor promoter and [triclosan] does so very rapidly." Similar to Aiello, Tukey also notes that he would not personally use antibacterial products with triclosan.

Other reports imply that triclosan causes decreased thyroid hormone levels, as well as changing our ability to respond to estrogen and testosterone. 

But I only use hand sanitizer occasionally, so my exposure level is too low to worry about this, right? 


Criticism of these animal studies often comes from those that claim that the rodents have been introduced to very high concentrations of the chemical that don't adequately mimic hand washing. But what about tooth brushing, hair washing, putting on exercise clothing, and handling your kitchen cutting board? All of these products may contain triclosan or close variations of the antimicrobial pesticide, potentially leading to higher exposure than anticipated. In fact, triclosan is the most ubiquitous consumer antibacterial. It's been found in 97 percent of breast milk samples in the US as well as the urine of 75 percent of Americans over age six. It also shows up commonly in the environment; it's one of the seven most frequently found compounds in US streams. 

You don't have to believe these studies though; you can read the FDA's own recommendations on antibacterial soaps.

Surprisingly, the FDA isn't very supportive of antibacterial soaps either. An agency consumer update issued in Dec. 2013 identifies hormone disruption, antibiotic resistance, and other concerns for antiseptic products: 

"[A]ntibacterial soap products contain chemical ingredients, such as triclosan and triclocarban, which may carry unnecessary risks given that their benefits are unproven. [...] A large number of liquid soaps labeled 'antibacterial' contain triclosan, an ingredient of concern to many environmental and industry groups. [...] Moreover, recent data suggest that exposure to these active ingredients is higher than previously thought, raising concerns about the potential risks associated with their use regularly and over time." 

If this makes you wonder why any of these products are approved for sale at all, you're not alone. The European Union banned triclosan from materials that come into contact with food in 2010. Minnesota banned the chemical completely last year. But one only has to read the saga of Colgate's successful five year, multi-attempt process to get the FDA's blessing for triclosan-containing Colgate Total to begin to see the problems with our regulatory system.

As ATTN: has discussed before, our regulators allow manufacturers to use untested chemicals on the public as a matter of course. As a country, we "have created a system where we are testing these chemicals out on the human population," says University of Massachusetts Amherst professor Thomas Zoeller. 

"I love the idea they are all safe," Zoeller commented to the Chicago Tribune. "But when we have studies on animals that suggest otherwise, I think we're taking a huge risk." 

Given the uncertainty, are antibacterial soaps even necessary? 

You probably saw this coming. According to the FDA, antibacterial soaps are not any more effective than regular soap and water. 

The main difference between antimicrobial products and regular soap is that antimicrobials kill the bacteria outright via additives, like pesticides or alcohol. Meanwhile, plain soap works by helping to loosen the grip of bacteria on your hands as you scrub when following good hand washing technique. Surprisingly, that's why washing with water alone -- as long as you scrub -- is also an effective way of cleaning your hands.  

That means that companies are fleecing us with more expensive, antimicrobial versions of regular products as well as selling us products that we don't necessarily need: like alcohol-based hand sanitizers.

I like my CleanWell for times that I can't wash my hands. And since it doesn't have triclosan or other pesticides in it, that's likely not a problem. But I'd be better to focus on washing my hands properly -- going for a full 30 seconds of scrubbing action -- or on making sure my bar soap at home isn't sitting in a puddle of water that's causing it to get contaminated by germs.

Making sure our soap is actually clean, and reminding ourselves that a little bacteria is fundamental to the formation of our immune system, will go a lot further toward protecting our health than using antibacterial cleaners. It was also apparently protect us more than the FDA, who has known for years that triclosan-containing products might be dangerous.