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Here's the dirt on antibacterial soapsPatricia Carroll, RN,BC, CEN, RRT, MS
Nursing Research Answers Questions About Antibacterial Soaps
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Of all the soaps on the shelf today, 76% of
liquid soaps have an antibacterial ingredient,
as do 29% of bar soaps1 -- does that
mean they're better for you? Nurse researchers
investigated and now we have some answers. Comparing Soaps in the Community One of the first challenges evaluating
whether antibacterial soaps are better for
everyday consumers is finding research conducted
outside the hospital. Researchers from Columbia
University's School of Nursing conducted a
Bacterial counts on study participants' hands were measured. Interestingly, those who washed with antibacterial soap did not show an instant drop in the number of bacteria on their hands. At the end of the year, both groups showed a significant drop in bacterial counts on their hands, regardless of the type of soap used. But, what does that mean? Do fewer bacteria mean fewer infections? That's really the bottom line. You can measure bacteria till the cows come home, but if those bacteria don't make people sick, then it's interesting, but doesn't mean much to you and me and our shopping carts. Where do Infections Come From? Most of the tests of antibacterial soaps measure, logically, bacteria, but the typical infections we get at home aren't bacterial -- they're viral. An antibacterial soap won't do anything about that. Colds, influenza, many "stomach bugs" are caused by viruses. A different study, also from the Columbia University School of Nursing, tested hands of 224 healthy homemakers in Manhattan to see what bacteria were present.3 Some researchers have expressed concern that the normal "good" bacteria that reside on our hands (just like in other parts of the body, such as the intestine and the vagina) are being changed by the widespread use of antibacterial soaps and that this could allow more dangerous bacteria to emerge. These researchers found that the nature of bacteria on people's hands in the general population has not changed significantly over the past few decades. However, the general population has more bacteria on their hands than do health care professionals, probably because they do not wash their hands as frequently or pay as careful attention to handwashing as we must. The Dirty Little Secret So, it's looking like there isn't a significant difference between antibacterial soaps and plain old soaps when it comes to reducing bacteria on the hands -- they both work. But, that means the hands have to be washed. A researcher from McDaniel College4 hid in a stall in a women's bathroom on campus to evaluate the handwashing habits of 100 women after they exited a bathroom stall. Since I'm sure you're dying to know, here were the results:
And the most interesting? When someone else was at the sink, only 9% of women left without washing compared to 45% who skipped washing when they were alone. Peer pressure works. But -- think about it....do you want to touch the handle to open the door and leave the bathroom with your freshly-washed hands? I use a paper towel. How to Get an A in Handwashing Last year, the CDC released an update of the 1985 handwashing guidelines5. Here's what the experts say:Alcohol-based no-water hand rubs work if your hands aren't visibly soiled. The advantage to these in the hospital is that you don't need a sink, and they work quickly. The advantage to these for you and me in real life is that we don't need a sink, and they work quickly. I keep a small bottle in my purse and another in my glove compartment. If I'm eating on the go (which is often) -- I squirt the liquid in my hands, rub them together, and at least I've cleaned up -- works great before eating on an airplane, for example. For routine, everyday handwashing, you can choose between antibacterial and non-antibacterial soap. There is no clear advantage for either soap, and there's no price differential. Some people may find that antibacterial soap is more irritating -- if that's the case, switch back to regular soap. One winter when my eczema was bad, I washed my hands at home with Oil of Olay designed as a facial wash. It was the most gentle cleanser I could find. This is the Way We Wash Our Hands When using a rub without water, apply the liquid to one hand's palm, then rub your hands together, making sure to rub all surfaces. Keep rubbing until your hands are dry. For soap (of your choice) and water:
My choice? I stay away from the antimicrobial soaps. When I worked with transplant patients in the hospital, I believe it did make a difference -- their immune systems weren't up to snuff. But at home, unless you have special health needs, don't worry about what soap you use -- just be sure to wash your hands regularly, rub your hands together vigorously and count to 15 before you rinse. That will put you one step ahead of the germs.
The Research 1. Perencevich EN et al: National and regional assessment of the antibacterial soap market: a step toward determining the impact of prevalent antibacterials soaps. American Journal of Infection Control 2001;29:281-283. 2. Larson E et al: Short- and long-term effects of handwashing with antimicrobial or plain soap in the community. Journal of Community Health 2003;28(2):139-150. 3. Larson EL et al: Microbial flora of hands of homemakers. American Journal of Infection Control 2002;31:72-79. 4. Drankiewicz D et al: Handwashing among female college students. American Journal of Infection Control 2003;31:67-71. 5. CDC: Guidelines for hand hygiene in healthcare settings. MMWR 2002;51(No. RR-16).
Written: September 2003
Reviewed: May 2004
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