We all need good hand hygiene, but antibacterial soap is a waste of time


Alice Howarthhttps://dralice.blog/
Dr Alice Howarth is a research academic working in pharmacology and therapeutics at the University of Liverpool. She is vice president of the Merseyside Skeptics Society, has written for The Guardian, Breast Cancer Now and is co-host of the skeptical podcast Skeptics with a K. In August 2020 Alice took on the role of deputy editor for The Skeptic.

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Pre-Covid-times, we’d had the same hand-soap in the kitchen for months. It’s not like you go through hand-soap that often, you only use a pump or two at a time and since my partner and I both work, we would do most of our handwashing either at work or in the bathroom, rather than in the kitchen. So, we’d had the same kitchen hand-soap for ages.

But then Covid happened, and we were suddenly home a lot more and washing our hands a lot more frequently throughout the day. We started to get through that bottle of hand-soap much more quickly. When we ran out, my partner picked up a new bottle – I assumed I had no real preference on hand-soap, as long as it gets my hands clean – but, apparently, I was wrong. My partner picked the antibacterial hand-soap. It turns out I have unnecessarily strong feelings on antibacterial hand-soap.

I’ve always thought antibacterial hand-soap was a waste. The important part of cleaning your hands, isn’t what you use to clean them – any old soap will do – but actually that you properly use friction on the skin to manually disrupt any grime and bugs on the surface. That’s why, all the way back in March when the recommendation was to carry on as usual, but wash our hands more frequently, we started to see those instruction posters explaining how exactly to wash our hands.

Handwashing specifically as a way to minimise disease transmission has been around for a long time – in the 1840s Ignaz Semmelweis introduced a practice of physician handwashing between the morgue and delivery rooms and cut the mortality rate during labour dramatically providing evidence of some sort of transmission of disease long before we really understood germ theory. In those days physicians used chlorinated lime to clean their hands and of course, now, hand hygiene is an essential part of health care. But we also know it reduces transmission of diseases in a community setting as well as in health care and there are now guidelines from the World Health Organisation, the Centre for Disease Control and Prevention, and the NHS on how and when to wash your hands.

While the act of scrubbing is important when washing your hands – we do know that soap is also helpful. Soap contains surfactants that help to lift the oils from your skin and remove dirt and grime but it also acts as a lubricant to make scrubbing more comfortable. Scrubbing your hands with plain water is enough to help reduce transmission of some illnesses, even if adding soap makes it even better. Once you’ve washed your hands thoroughly for the duration of Happy Birthday sung twice over, then it’s also important that you thoroughly rinse your hands – the soap that lifted the oils, grime and germs from your skin needs removing so those germs don’t settle back down. It’s also important that you dry your hands well because germs pass more easily to and from wet surfaces. There’s no real evidence that paper towels are better than hand dryers, the important thing is to completely dry your hands before you touch anything again.

With all the guidance on how important it is to wash your hands, especially during the Covid pandemic, it’s really easy to assume that if using soap and water is good, then using extra special soap is even better. Shops sell antibacterial soaps, and while most people recognise that Sars-Cov-2 is a virus that won’t be affected by antibacterial agents, it’s easy to assume that it can’t hurt to get an “extra thorough” soap. And antibacterial soap isn’t usually more expensive than regular soap – so this isn’t a case of people wasting their money.

But that doesn’t mean using antibacterial soap is actually better.

A person with black skin and black nail varnish washes their hands in a sink.

Antibacterial soaps contain extra chemicals that are thought to actively kill bacteria. Many contain a chemical called triclosan, which was developed in the 1960s and used in hospital soaps, before it went on sale for use to consumers in the 1990s. In 2017 the FDA concluded that manufacturers of triclosan containing soaps hadn’t done enough to prove that their products were more effective than regular soap.

On top of this, there are rising concerns that repeated exposure to antimicrobial agents could be causing an increase in antimicrobial resistance which is contributing to a rise in “superbugs” that are difficult to treat. There isn’t enough evidence to suggest that antibacterial soaps are contributing to this – but there is evidence that they might.

There are some health concerns associated with Triclosan; mostly this boils down to an increased risk of contact dermatitis, or skin irritation, but some other concerns have been reported and again, manufacturers haven’t done enough to show that these soaps are safe for long term, repeated use. So, the FDA decided to prevent the marketing of soaps containing triclosan and some other antibacterial chemicals and have clarified that using regular soap is more than enough to clean your hands, reduce disease transmission and help reduce antimicrobial resistance. 

With all this said, I think it’s probably reasonable to say that using antibacterial soap is mostly harmless for most people and it’s not like the stuff is extortionately expensive, but it might irritate your skin, could cause problems if you’re using a lot of it regularly for a long period of time and it’s not any better than regular soap.

I’ll keep using the bottle of antibacterial soap we have until it’s gone, but I will continue to roll my eyes when people insist on buying it – and at least now I have an article to point them to when I tell them it’s a waste.

As a final point, I realised I’d written this entire article without actually checking the ingredient antibacterial soap that we have in the kitchen. So, as a diligent skeptic, I checked it to see which antibacterial agent was in this antibacterial soap that I own. It turns out that the “active” ingredient is… tea tree.

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