Do antibacterial soaps pose risks to humans and the environment?

Each time Patience Njue goes shopping, she cannot forget to buy a month’s supply of antibacterial liquid soap. “It kills the germs on my hands and protects me from diseases,” she says.

Ms Njue is among thousands of middle class Kenyans who prefer these antiseptic soaps to others which they consider as just plain.

While it is true that antibacterial soaps can reduce the amount of bacteria population, there is no conclusive evidence to show that they are more effective at reducing infections compared to normal soaps.

Controversy has surrounded efficacy of these products with numerous studies pointing to some chemical components in antibacterial soaps —triclosan and triclocarban— as potential human health and environmental hazards.

In December 2013, the Food and Drug Administration (FDA) in the US issued a directive requiring soap manufacturers to provide more evidence demonstrating the safety and effectiveness of antibacterial soaps over normal non-antibacterial soap.

The deadline for submission of findings is on December 2014 and will inform FDA’s decision on whether to ban or permit use of these chemicals in soap making.

FDA’s directive targets manufacturers of consumer antibacterial soaps and body washes that are used with water.

It does not apply to hand sanitisers, hand wipes or antibacterial soaps that are used in health care settings such as hospitals.

Chemicals

“Kenyans should also be concerned as many people at home and institutions regularly use these antibacterial soaps and could thus be exposing themselves to toxic chemicals that may eventually harm them,” said Dr Issak Elmi, a chemical expert and chief research officer at the National Environmental Management Authority (Nema).

He notes that triclosan and triclocarban disrupt hormones critical for proper functioning of the brain and reproductive system.

Animal studies have linked triclosan with lower levels of thyroid and testosterone hormones which could result in altered behaviour, learning disabilities or infertility.

Triclocarban has been shown to artificially enhance the effects of sex hormones like oestrogen and testosterone which could promote the growth of breast and prostate cancer.

The two are common among Kenyan women and men respectively. Cancer is the third leading cause of death in the country, causing seven per cent of total national deaths every year.

It is estimated that the annual incidence of cancer is 28,000 cases while its annual mortality is about 22,000.

“An overdrive of these hormones could also breed social deviants such as rapists who are destructive to the society,” warns Dr Elmi.

He further states that frequent exposure to these chemicals may be linked to many cases of skin allergies, irritation and eczematous rash.

“My hands always itch every time I use certain antibacterial soaps. So maybe they are the problem,” says Christine Atieno who started using antibacterial liquid soaps late last year.

Laboratory studies suggest that triclosan and triclocarban could be making bacteria known to cause serious human infections resistant to antibiotic drugs intended to kill them and cure patients of ailments like pneumonia which is a leading cause of child mortality in Kenya.

“The more we expose bacteria to these chemical agents used to kill them—every now and then as we wash our hands—the more they begin mutating and eventually develop resistance to them,” scientists warn.

Antibiotic resistance is currently one of the world’s most pressing health problems.

It makes common ailments, once easily treatable very difficult and expensive to manage as patients require multiple doses of previous drugs or even stronger ones. Furthermore, infections caused by drug resistant bacteria often fail to respond to standard treatment resulting in prolonged illness and greater risk of death.

Resistance

Therefore fears abound that without putting measures to address the drivers of resistance, the world could witness a return of the historical era when antibiotics were non-existent and illnesses put lives in dangers.

Infectious diseases risk becoming untreatable and uncontrollable, which would compromise progress made towards reaching the millennium development goals in Kenya.

“Without effective drugs for care and prevention of infections, the success of treatments such as organ transplants, cancer, chemotherapy and major surgeries would be compromised,” the World Health Organisation (WHO) states.

A study done in rats showed that antibacterial soaps shortened lifespan of female off springs from mothers exposed to triclosan while nursing their little ones.

Health experts thus worry that mothers with higher levels of triclosan in blood and breast milk— as shown by a previous US survey— could be endangering lives of their children.

In addition, Dr Elmi notes that as these chemicals get washed down the drain, they may end up in water bodies.

This pollution may impede health and proper development of marine species that are important for Kenya’s food security and tourism industry through activities like snorkelling.

Triclosan can combine with chlorine water to form chloroform which is listed as a probable cause of cancer in humans.

So far, no major conclusive studies have been done on the effects of these chemicals specifically to human health. Most studies looking at their impact have been conducted through laboratory experiments and in animals like rats.

“While data showing effects on animals don’t always predict the same in humans, these studies are of concern and warrant further investigation to better understand how triclosan and triclocarban might affect humans,” notes FDA.

The Kenya Bureau of Standard (Kebs) permits the use of triclosan and triclocarban in the manufacture of antibacterial soaps so long as the chemicals do not exceed one per cent by mass either singly or in combination when tested.

“The concentrations used here are safe and so far we haven’t heard of any health complaints from Kenyans using antibacterial soaps with these chemicals,” says Albert Nyagechi, Kebs assistant manager in charge of chemical standards.

He states: “But if we get solid evidence that they are indeed harmful to human beings, then we will consider revising our standards to prohibit use of both chemicals.”

Mr Nyagechi notes that through inspection and market surveillance, Kebs performs random tests to ascertain whether manufacturers of antibacterial soaps continue adhering to stipulated guidelines even after they get approval.

Awareness

Based on Kebs guidelines, manufacturers are required to label their antibacterial soaps by providing a list of ingredients comprised in them.

“So consumers can read and decide whether to buy or not to buy products containing triclosan or triclocarban,” says Dr Elmi.

According to Dr Elmi, even low concentrations are not safe as a chemical such as triclocarban is not easily broken down by the body and can therefore accumulate over the years until it reaches toxic levels.

“We therefore need to weigh the benefits against potential risks before deciding to opt for antibacterial soaps instead of just washing hands with plain soaps,” Dr Elmi says.

A comprehensive analysis done by the University of Michigan’s School of Public Health found that washing hands with most over-the-counter antibacterial soaps was no more effective in preventing illness than plain soap.

Similarly, a study conducted in Karachi, Pakistan found that washing hands with soap reduced diarrhoea cases by about 50 per cent in children irrespective of whether the soap used was plain or had antibacterial agents.

Dr Elmi notes that local assessments should be done to determine the effects of triclosan and triclocarban among Kenyans.

He calls for increased awareness on the effects of the chemicals. “We also need to enhance research and development initiatives and come up with alternative chemicals for manufacturing antibacterial soaps that are effective but also safe. People could also opt for natural alternatives that are much better as they are easily broken down in the body.”

Doctors note that even with potential risks associated with antibacterial soaps, people should not shun the practise of hand washing as it is one of the most important steps they can take to avoid getting sick and spreading germs to others.

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