Part III b): Soap and the antimicrobial solution

Why are bar soaps still in popular demand? What is so special about antimicrobial hand soap? And why disease outbreaks are still occurring even when hand sanitizer dispensers are widely available? Are non-alcohol hand sanitizers really safer than alcohol ones?

This is the post to read to get some answers

General information about soap
One notable difference between soaps is their pH. A pH is a measure of the acidity and alkalinity (base) of a solution. Traditionally, soaps have had a pH between 9 and 10, compared to a pH of 7, which is considered to be neutral. Our skin is fairly acidic, which helps it ward off the advances of harmful bacteria and fungi (naturally). The optimal pH of human skin is 5,5 (you can measure it with a piece of litmus paper). Without getting too much into the science side of soap making, the pH becomes an issue for people with sensitive skin, and you do not need to have a skin condition to have a sensitive skin. The higher the alkaline or base, the more irritating. Some natural soap are more acidic, as they use botanical ingredients and are usually much less irritating to the skin.

Another important information to take in consideration when choosing a soap is the list of ingredients used to manufacture it. Under the false pretext of trade secret – the idea that someone else might try to replicate someone else’s product – many manufacturers disclosed only a short list of ingredients. What I know is that it is relatively easy to reverse-engineer a detergent or soap composition. What makes a product a bit difficult to “replicate” is the amount of each ingredient in the final formulation as well as its industrial process. So if they do not want you to know … better not trusting them. It becomes an issue with fragrance and the luring “unscented” attribute – usually a chemical used to mask some ingredients “natural” odor. Some people should be aware that many soaps contain animal fat (more here at the green guide).

As far as type of hand soap, the one, in my opinion, that offers the best combination of convenience and germ prevention is foam hand soap. There are three main advantages to foam soap over bar and gel soaps: 1) It works marvels with kids, 2) it is easier to evenly spread on your hand and 3) you use less water as wetting your hands becomes unnecessary (unless very dirty). Most gel soaps (with a pump) are fine too, but they require you to wet your hands and – as I can attest with my kids – it might slip through a child’s hands. As for bar soaps, I find them inconvenient and definitely not a kid’s favorite. However, they are definitely more cost efficient and more environmentally-friendly (less packaging). Last but not least, there much more botanical soaps available in bars than in gel or foam.

The antimicrobial solution

It is important to put antimicrobial hand soap and sanitizers in perspective with their introduction: They have first been (successfully) introduced in the healthcare and food industries, gaining almost immediate momentum as both industries needed solutions to lower the risks of cross-contamination. Although no products have been efficient at eliminating the risk itself they probably have, in some circumstances, prevented a disease outbreak. But they have also lured users into a false state of security that was a factor in other infectious outbreaks. Since the 1980s and their introduction into the consumer space and other institutional markets (schools and cruise ships were in high demand) they are found literally in so many personal care products that I am almost certain you use or at least store one somewhere (even if you think you don’t). Are they that effective and useful?

Let’s start with antimicrobial hand soaps.

Most contain the infamous Triclosan, which is present in at least 70% of all liquid soap and 30% of all bar soap (probably more since the last market data I could collect dates back 2002) such as Dial, Fa and Softsoap. Studies suggest that soaps containing Triclosan (and triclocarban) do not perform better than regular soap in terms of illness and log-reduction outcome, which is not surprising. Are they more efficient if you wash your hands faster than recommended (especially the 20 seconds rubbing)? I do not know of any study highlighting any benefits in this regard. But this is a non-issue: what is the difference between spending 1 minute and spending 50 seconds washing your hands if you can eliminate from your life a chemical compound that adds a toxic burden to the environmental and our health? I want to believe that the FDA, hospitals and food facilities have found a benefit to using hand soaps containing Triclosan: is there any residual activity (when a product forms a shield against pathogens for a limited time)? Illness outcome studies suggest they do not, since we need to rinse our hands, it seems quite logical. Do they eliminate pathogens that could have survived in the sink? Perhaps, but this is not very compelling, is it? Another benefit of mixing antimicrobial ingredients in soap will be in bar soaps as some germs could survive on them – but that is not very compelling either. How about other antimicrobial hand soaps (AHS)? PCMX (para-chlorometaxylenol) is used in hospitals. It has not been packaged for the consumer market, may be because its natural chemical smell (strong phenol odor) is difficult to mask and the quantity needed to make it efficient against pathogens might be too high to make it price competitive.

A new comer is bringing AHS into a new dimension. A formulation of pure-essential oils, Ingenium by CleanWell (see disclaimer below) eliminates the health and environmental hazards other AHP pose. It truly should be considered as a natural soap with an extra benefit.

My recommendation on this: unless you feel better having antimicrobial soap, you don’t need antimicrobial hand soap. But if you do, get a natural, toxic free and environmentally friendly one.

Hand sanitizers.

Hand sanitizers (HS) have become very popular in recent years but have also carried their share of controversy. Every major personal care product company has launched one. About 20% of the US population uses hand sanitizers, and the market is growing rapidly. Health professionals recommend the use of HS when water and a sink are not available. When used as such, they offer a much higher health benefit than antimicrobial hand-soaps. Imagine all the places that do not provide an easy access to a sink – parks, shopping stores – or places that do but to which we have developed a strong feeling of disgust – airplanes, train stations. Unfortunately, many people seem to have an aversion for the sink and think they have found in HS the perfect alternative to avoid the wetting-scrubbing-rinsing-drying routine. Fair enough, it is more convenient but Dr. Steve Williams feels that false sense of security is responsible for disease outbreaks. The reality is liquid HS will not remove enough dirt and germs from soiled hands to stop cross-contamination from happening. Only wipes can eventually do the trick, although, once again, if your hands are very dirty, it might do half the job.

Choosing your hand sanitizer: beware of the active ingredient
Are all HS equal? No, and if you have experienced the three different types available in stores, you probably have your opinion on the matter. Gojo created this product category in 1997 with Purell, an alcohol-based hand sanitizer (ABHS). It is still the market share leader, by far, but its position is now being challenged by non-alcohol hand sanitizers (NAHS). In addition to its “natural” drawbacks – smelly, drying, stinging, irritating – ABHS are now perceived to have a health risk especially in light of child-related alcohol poisoning when swallowed. I have shared hand sanitizers experience with well over 500 K to 5 graders and the vast majority of them does not like ABHS. It poses also a safety risk due to its high flammability reaction (it seems there is a contest going on on youtube). These negative attributes have created a void that many manufacturers are aggressively trying to fill with non-alcohol hand sanitizers (NAHS).

You’ll find an increasing number of NAHS containing BAC positioned as “waterless hand wash”, “safe for kids” and packaged with inactive ingredients as soothing as chamomile, as pleasant as lavender and as nutrient for the skin as aloe. BAC stands for Benzalkonium Chloride, a synthetic biocide belonging to a large group of biocides known as “Quats” (for quaternary ammonium). Quats have been used in many applications ranging from disinfectants and skin antiseptic to cosmetics. Quats are praised for their efficacy against a wide spectrum of bacteria, viruses and fungi. In the world of biocides, many scientists and medical doctors consider BAC the safest of the meanest. However as with all synthetic biocides there are issues we should be aware of when using these products. BAC is damaging to the aquatic environment, and since it is the most used biocide nearly 70% of all disinfectants and sanitizers) it is no wonder it has been found in our streams and lakes. But the weakest point of Benzalkonium Chloride is … it looses of its efficacy when in contact with organic matter (read dirt, mud, grease, oil and even cotton!).

Dr. Stephen G. Baum says “Amazingly, despite more than 4 decades of nosocomial infections caused by use of contaminated quaternary ammonium compounds, these agents are still popular as surface disinfectants” (Journal Watch Infectious Diseases May 23, 2003). As surprising is the direction given to janitors “must not be applied to areas that have not been fully rinsed”. In short, better be cleaned before it disinfects/ sanitizes. Dr. Larry Weiss, notes in a thorough assessment of this biocide that quats have also been associated with significant health risk including dermatitis and asthma and is often identified as an allergy trigger. So you’ll ask: what the h…? Simple: it sells and no governmental or state agency requires testing antimicrobials in real life situation.
A word about Procter and Gamble’s Vicks hand sanitizer containing Triclosan, which has prompted the FDA to issue a warning to P&G (FDA does not want Triclosan to stay on your skin). Mr. Lafley, what were you thinking? Is this your way of embracing the green mainstream? P&G is fighting for its product to remain on the market. 6 months after … Vicks “early defense” is still distributed as it was …

Talking about green … yes, they do have a natural hand sanitizer as well. No, not P&G, that would be too good. And time for me to issue my disclaimer (if you have read the “And a little about me” page, you know already): I have been very fortunate to have worked on Ingenium, an antimicrobial formulation made of essential oils, and with the people who created it since 2004 and more recently I have participated in the launch of the CleanWell brand. I do not currently work with CleanWell as I have chosen to be more involved in spreading the green. The story of this encounter, I might tell it one day. But it is how this product performs and its absolute clean sheet in regards to safety, health and the environment that puts it simply way above any synthetic antimicrobial product. It is effective against bacteria, viruses and fungi. It uses only botanical ingredients – the active ingredient is thyme oil. And best of all, its lemony scent (real, no synthetic here either) makes it a kids’ favorite. The only possible issue would be a skin reaction to citrus as some people – fortunately a few – have developed allergies to it. A big effort has been put on convenience (0.5oz and 1oz spray) and pleasantness (it leaves your hand really soft). The wipes are compostable (better than biodegradable). And that is all I’ll say about it.

My exceptions

Now there are circumstances – even when soap and water are available – that make it difficult to perform or implement: public restrooms (including the list provided above). The most obvious reason for not washing your hands in a public restrooms is they repulse you. The least obvious one is if you are – like I – trying to avoid putting triclosan based antimicrobial hand soap on your skin, you might want to avoid using soap dispensed in public restrooms, as there is a very high probability (80%) they do contain triclosan. Instead, I’ll “water wash” my hands and then will rub them with a natural hand sanitizers – wipe or spray (yes, CleanWell). People with skin condition might want to follow the same routine as most “public” soaps have a high pH that might damage sensitive skin. The most effective alternative is to have a liquid hand sanitizer and a microfiber cloth handy.

Microfiber cloth Vs. Paper Towel Vs. Cotton cloth.

Let me start with the easiest: cotton cloth. They are quite absorbent and as you wipe your hands after having washed them they will also retain water and everything that has not been washed away. What is the problem you’d ask me if you wash your hand properly? Really none, as long as you use that piece of cotton exclusively to that effect. But if it is used for another purpose, say a quick wiping of the kitchen counter and it will be a perfect home for germs that will be happy to get back to your hands every time you use the cloth. I am aware of some companies that are working on a cotton microfiber material to which – probably to avoid harboring germs – is added a silver based antimicrobial coating. Silver … that is another one that leaves me puzzling when I do the math … do we need silver in our water streams? I mean we have lead, we have zinc, we have copper, we have mercury … soon fishes will be more valuable for their content in metals than for their protein. Others are adding Microban. Another trick to put Triclosan on your body …

Paper towel are the safest but not the most economical and a very much nature intensive product unless you use 100% post consumer recycled paper. See, a company like Kimberly-Clark uses 1.1 million cubic meters of trees from Canada’s boreal forests to produce over 500,000 tons of pulp to manufacture paper towels, napkins, toilet paper, facial tissue for home use in North America. Only 19% of its needs come from recycled source. Paper and recycling deserve a post on their own, but since I am touching on the topic, look for 100% post consumer recycled pulp, although it does not match completely virgin pulp’s softness, it makes a huge positive impact on the environment.

Here comes the microfiber cloth. What so great about it? Although they are made from petroleum sources (polyester or PET and polyamide) , they are easily recyclable (comparable to a plastic bottle). They are reusable. they can retain 6 six times their weight in water. They are rather inexpensive. There is ample evidence that these engineered fibers out-clean paper towels both in terms of removing dirt and microscopic contamination including germs. Once trapped in the microfibers, germs will eventually die. If you’d like to learn more about microfibers, here are 10 reasons to use them from sustainable hospitals.

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