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Infection Control

CM/Spotlight: Infection control — Is this the right thing to do?

September 19, 2010
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Over a year ago, an article appeared in the October 30, 2007 New York Times under the heading, "Germ Fighters May Lead to Hardier Germs."

According to the article: "Today, hundreds of soaps, hand lotions, kitchen cleansers and even toothpastes and mouthwashes include antibacterial agents. One of the most popular is triclosan, which has been used not only in cleaners but also to coat toys, cutting boards, mouse pads, wallpaper and even dog bowls.

"But, Allison E. Aiello, an assistant professor of epidemiology at the University of Michigan School of Public Health, says the laboratory evidence against triclosan is compelling enough to raise questions about the products. More meaningful, she says, is that several studies show that antibacterial soaps sold to consumers are no better than plain soaps in terms of reducing illness or the count of bacteria left on hands."

"Given that there doesn''t seem to be a benefit, I think it warrants further evaluation," noted Dr. Aiello, whose review article on antibacterial soaps was recently published in the medical journal Clinical Infectious Diseases. "We should be questioning use of these products."

"Natural resistance happens on such a small scale that it is generally not a health worry. But when antibiotics are overused — either by individuals or when farmers add them to animal feed — the effect is amplified.

You''re going to have this exaggerated, snowballing effect of resistant bacteria multiplying all around you," added Marlene Zuk, a biology professor at the University of California, Riverside, whose book, Riddled with Life, discusses the proliferation of antibacterial cleaners and personal products.

"Here you have a substance that has been widely used in hospital settings and household settings," said Herbert P. Schweizer, associate director for research at the department of microbiology, immunology and pathology at Colorado State University, who conducted some of the lab studies showing triclosan resistance. "The exposure to this widely used antimicrobial caused emergence of multidrug resistance in laboratory strains."

"That studies of triclosan use haven''t shown a resistance problem in the community doesn''t mean it won''t happen," said Dr. Stuart B. Levy, a microbiology professor at Tufts who is president of the Alliance for Prudent Use of Antibiotics. "I''m the first to say we haven''t seen a difference yet in the home. We know from antibiotic data that if it happens in a lab it will eventually happen outside the lab."

Beyond science
This has more than academic interest, because custodians nationwide are being asked more frequently to perform extensive disinfection while they are cleaning.

Concern about CA-MRSA, community-associated Methicillin-resistant Staphylococcus aureus, is becoming paranoia and, along with flu season, is increasing the demand for more killing of the denizens of the microscopic world around us.

Should cleaners be more concerned with the destruction of microorganisms than with the removal of dust and grime?

Should custodians focus on becoming assassins of the unseen? Is this truly health-focused cleaning? Is it the right thing to do?

Healthy cleaning
The Times article points to several things we need to think about.

One is the ease with which we can be exposed to antimicrobial chemicals in the home and workplace. They are in everything from hand soaps to mouse pads.

But the cleaning industry''s concern is not just about the ubiquitous triclosan (Microban®) and the possibility that it can cause resistant bacteria to prosper.

Nor is it just about occasionally spraying an office telephone handset or a door knob with a disinfectant.

It is really about the far more extensive and serious problem being created by the thoughtless introduction of a multitude of man-made toxins into our daily environment as a necessary step toward "Healthy Cleaning."

Antimicrobials are toxic in one way or another to microorganisms. Toxic is defined as "having the effects of a poison."

A poison, in turn, is defined as "a substance that can destroy life or impair health by its chemical action inside the body."

So, are we to believe that adding an ever-increasing volume of poisons to our indoor environment is really a vital part of the new "green" movement meant to increase the quality and longevity of human life?

When the poison promoters tell us that effective surface cleaning must destroy all microscopic life we encounter in the process, are they showing sound judgment?

This is not the best approach because there is nothing logical or reasonable in those positions.

Clearing the air
Let''s consider three fallacies.

First, some have the mistaken notion that to protect our health we need to kill everything microscopic with which we may come into contact, even if, in attempting to do so, we weaken our immune systems, requiring us to be even more persistent in killing everything we come into contact with, further weakening our immune systems … and so on.

Protecting ourselves by building our immune systems and eliminating toxins is the safer way to go.

And, we don''t need to kill microbes to be protected, simply avoid or remove them.

Hand washing with soap and water is an extremely effective defense against the spread of norovirus, MRSA and a host of other harmful organisms that can cause no illness until ingested.

We don''t need to kill them all; we just need to keep them out of our bodies by good personal hygiene.

Second, we cannot exist without many beneficial microorganisms, such as those in the digestive tract.

When antibiotics, needed to fight a serious infection, indiscriminately kill all helpful intestinal bacteria along with the undesirable infectious agents, the result is not better health, but indigestion and unwellness until those beneficial organisms are reintroduced into the gut.

Three, thinking that humans can live in a germ-free environment ignores the fact that we are surrounded by the invisible world and so disinfected surfaces are quickly re-contaminated, making the decontamination effort one requiring constant repetition, hence costly.

In truth, the idea of destroying all microorganisms randomly is ludicrous in its sheer impossibly and nightmarish in its clear threat to the human immune system.

Clearly, it is not the right thing to do!

Studies have already been done that reveal the threats posed by "excessive hygiene."

The Times article mentions the University of Michigan School of Public Health and Colorado State University as two sources and there are many more.

Since its dangers are known, now is the time to oppose foolish "blanket microbe extermination" cleaning and start to assess the risks accurately.

Not all cleaning involves health risks.

Not all cleaning requires microbial reduction.

More importantly, hygienic cleaning, when called for, can be done without poisons.

We are now faced with what to do when pressured by the panicked promoters of pharmaceutical protection to add more microbe-killing to our busy work schedules.

It seems as if we are going to have to make this call using our own judgment. Are you prepared to do so?

There is one additional thing we should consider.

Too often, the cleaning industry is asked by the misinformed media and even some within its own ranks to take responsibility for the illnesses, impaired immunity and general malaise affecting so many in the indoor environments we clean for our livelihood.

Should we take the blame for this while ignoring the poor nutrition, unclean homes and health-destroying habits of these same people?

Before accepting this onus with resignation, we should ask ourselves again, "Is this the right thing to do?"

You may be surprised how little research it takes to come up with the right answer to that question.

Lynn E. Krafft, is an ICAN/ATEX associate editor and a cleaning service operator. Mr. Krafft is also a supporting member of ISSA and CIRI.

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