News

Oct 22, 2024

The Hidden Risks of Antibacterial Soap

Antibacterial soap is a staple in many households and healthcare facilities. However, the U.S. Food and Drug Administration (FDA) banned 19 active ingredients previously common in consumer

Antibacterial soap is a staple in many households and healthcare facilities. However, the U.S. Food and Drug Administration (FDA) banned 19 active ingredients previously common in consumer antibacterial soaps in 2016, due to concerns over safety and effectiveness.

The ban included two of the most commonly used ingredients, triclosan (TCS) and triclocarban (TCC). TCS has been linked to a variety of health issues, including thyroid dysfunction, developmental problems, and weakened immunity. However, these findings resulted from animal studies, and the potential risks of TCS to human health remain unclear.

Antibacterial soap contains active chemicals which are added to kill bacteria.

According to the Centers for Disease Control and Prevention (CDC), antibacterial and plain soap are equally effective at removing bacteria from the hands.

Regular soap is not designed to kill bacteria. It loosens and lifts bacteria from your hands so that the bacteria is easier to wash away with water. Antibacterial soap also has this effect but includes agents like TCS and TCC.

The FDA states that there isn't enough evidence to prove that antibacterial soap is more effective at preventing illness than regular soap and water. It may also pose some health risks, such as bacterial resistance or hormonal effects.

There are also concerns that antibacterial soaps may create a false sense of security in those who use them potentially leading to less frequent and thorough hand washing. Antiseptic agents can strip away natural oils and make your hands dry, as well as diminish the amount of healthy bacteria over time. Some soaps may contain three microbial agents the FDA hasn't banned which may have additional potential health risks.

Out of the 19 agents listed in its ruling, the FDA cited TCS and TCC as the two most commonly used active ingredients in the United States. Both have antibacterial and antifungal properties that manufacturers have long used in their products. TCS and TCC are also found in numerous consumer products, including:

By 2000, TCS or TCC could be found in nearly 75% of liquid soaps, and 29% of bar soaps sold in the United States.

To stop marketing claims that antibacterial soaps are beneficial to human health, the FDA decided to ban other antibacterial agents, in addition to TCS and TCC.

These include:

However, the FDA ruling does not apply to three antimicrobial ingredients: benzalkonium chloride, benzethonium chloride, and chloroxylenol.

These are still used in antibacterial soaps, despite some potential health concerns, and may be linked to:

The FDA issued its ruling not only because manufacturers could not provide evidence that their products were more effective than plain soap and water but also because it is unknown how safe they are to use over the long term.

With the widespread use of antibacterial agents in consumer products, FDA officials became concerned that the cumulative effect of exposure may only be realized years later.

This is not to suggest that there has been any proof that antibacterial agents are "harmful," but that clinical evidence of their long-term safety remains unknown.

Antibacterial agents used in soaps are not fully neutralizing, meaning some germs escape. For this reason, the FDA expressed concerns that ongoing use of the products may enable bacterial strains resistant to antibiotics to increase rapidly.

In essence, by stripping away all but the strongest bacteria, these agents may create strains that can resist the treatments (antibiotics) meant to control them.

Some antiseptics, such as benzalkonium chloride and benzethonium chloride, are associated with hypersensitivity to allergens.

They are also been linked to contact dermatitis in some studies.

Trace amounts of some agents, like TCC, are retained in the body after use. A small study by researchers at the University of California, Davis found that participants asked to wash with bar soap containing 0.6% TCC absorbed roughly 0.6% of the agent through their skin. Although TCC leaves the body in urine, urine analyses showed trace amounts of TCC remained in some participants.

Scientists are concerned that TCS and TCC are both mild endocrine disruptors, meaning they have the potential to interfere with the way certain hormones work.

There are no studies that have shown this effect is harmful to humans. However, a 2017 study from China reported that infants born to mothers who used TCS-containing soap had elevated levels of the male hormone testosterone in their umbilical cord blood.

Although these elevations did not appear to have caused harm in the infants, the findings suggest that TCS's impact on the endocrine system may be greater than presumed.

Antibacterial soap kills good and bad bacteria. It is not recommended to use for washing private parts because it may change the natural balance of the vaginal microbiome. This bacterial community serves to maintain the proper vaginal pH and limit harmful bacteria.

Antimicrobials can decrease the presence of protective bacteria and increase susceptibility to vaginal infections, including bacterial vaginosis.

They can also cause dryness and irritation.

Most healthcare providers recommend using unscented mild soap and water, or just water, instead of antibacterial soap or washes.

These findings are not definitive or suggest that you can get antibiotic resistance or allergies by using antibacterial soap.

The FDA asserts that antibacterial soaps, washes, cleansers, foams, and hand gels are no more effective than plain soap and water.

In response to the ruling, many manufacturers removed TCS and TCS from their products and dropped the word "antibacterial" from their labels and marketing.

The FDA ruling did not include three antimicrobial agents still used in soaps: benzalkonium chloride, benzethonium chloride, and chloroxylenol. Many environmental and health organizations have recently raised concerns about their potential health risks and have urged the FDA to make a final decision on whether to continue to allow their use.

As fast and convenient as hand sanitizer may seem, washing your hands with soap and water is still the best way to prevent common bacterial infections.

However, it is important to do so correctly. Washing your hands for at least 20 seconds is recommended by both the CDC and the World Health Organization (WHO).

When teaching your children how to wash their hands, tell them to sing the "Happy Birthday" song twice, which takes roughly 20 seconds.

Finally, check that toothpaste, mouthwash, or other cosmetics you use do not contain triclosan, triclocarban, or any other banned ingredient.

If you're uncertain if an ingredient in a soap or other cosmetic product is safe, call the FDA at 1-888-INFO-FDA (1-888-463-6332).

Antibacterial soap may not be as effective as regular soap and water, according to the FDA. It's also unknown how various ingredients used in antibacterial soap may affect human health in the long term. For this reason, the FDA has banned at least 19 antimicrobial ingredients.

It may be tempting to use products that claim to remove "99.9% of bacteria," but don't be misled by marketing that may or may not be true. Wash your hands with regular soap and water, as needed, to prevent illness and reduce the transmission of infection.

U.S. Food and Drug Administration. FDA issues final rule on safety and effectiveness of antibacterial soaps.

Papavasilopoulos R, Kang S. Bibliometric analysis: The effects of triclosan on human health. Toxics. 2022 Sep;10(9):523. doi:10.3390/toxics10090523

Centers for Disease Control and Prevention. Frequent questions about hand hygiene.

U.S. Food and Drug Administration. FDA issues final rule on safety and effectiveness of antibacterial soaps.

U.S. Food and Drug Administration. Antibacterial soap? You can skip it, use plain soap and water.

Halden R. On the need and speed of regulating triclosan and triclocarban in the United States. Environ Sci Technol. 2014 Apr;48(7):3603-3611. doi:10.1021/es500495p

U.S. Food and Drug Administration. Safety and effectiveness of consumer antiseptics: Topical antimicrobial drug products for over-the-counter human use.

Green Science Policy Institute. FDA urged to rule on controversial hand soap ingredients.

Arnold WA, Blum A, Branyan J, et. al. Quaternary ammonium compounds: A chemical class of emerging concern. Environmental Science & Technology. 2023;57(20);7645-7665. doi.org/10.1021/acs.est.2c08244

Arnold WA, Blum A, Branyan J, et. al. Quaternary ammonium compounds: A chemical class of emerging concern. Environ Sci Technol. 2023;57(20);7645-7665. doi.org/10.1021/acs.est.2c08244

Schebb NH, Inceoglu B, Ahn KC, Morisseau C, Gee SJ, Hammock BD. Investigation of human exposure to triclocarban after showering and preliminary evaluation of its biological effects. Environ Sci Technol. 2011;45(7):3109-15. doi:10.1021/es103650m

Wang C, Chen L, Zhao S, et al. Impacts of prenatal triclosan exposure on fetal reproductive hormones and its potential mechanism. Environ Int. 2018;111:279-86. doi:10.1016/j.envint.2017.11.007

Huang B, Fettweis JM, Brooks JP, et. al. Exposure to antimicrobials can decrease the prevalence of lactobacilli and increase susceptibility to vaginal infections. Clinics in Lab Med. 2014;34(4):747-761.

Green Science Policy Institute. FDA urged to rule on controversial hand soap ingredients.

Vermeil T, Peters A, Kilpatrick C, Pires D, Allegranzi B, Pittet D. Hand hygiene in hospitals: anatomy of a revolution. J Hosp Infect. 2019;101(4):383-392. doi:10.1016/j.jhin.2018.09.003

Centers for Disease Control and Prevention. Show me the science - How to wash your hands.

By Kristina Herndon, RNKristina Herndon, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.