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[Uzu Bash]

The FDA had been talking about this for awhile before they announced last year that they were investigating the effectiveness and risks of antibacterial soap. I can guess what they'll say about their effectiveness vs. any other soap. But coming to a conclusion about the potential danger of fostering resistant bacteria has been slow to progress.

Could someone more familiar with the medicine/chemistry explain the likelihood of risk that a topical antibacterial could pose? And what implications would this have for bacitracin?

[BigD145]

To put it simply, life will find a way. Find a way around what kills it if it can mutate and reproduce fast enough. The risk with antibacterial anything is that bacteria have a very fast reproductive cycle. Mutations pop up and any that are even remotely resistant to an antibacterial compound will succeed and reproduce where others fail. It won't be much longer before penicillin is ineffective against modern bacteria. It's all still biology. You kinda have to wait for it to happen with no firm hour of this day or that year to circle in red as THE day a particular antibiotic is no longer effective. You can only look at trends across all hospitals. Private citizens taking over the counter topicals and self medicating don't aggregate data anywhere.

Plain old soap and hot water with scrubbing for at least 20 seconds is your best bet. It's what everyone in the medical fields can agree upon. That and disposable barriers and autoclaves.

[Djohaal]

BigD summed it up. Antibacterial soap is a scam that feeds on people's neurosis of contamination.
Our skin is always teeming with microbes that don't kill us (and they even help protect us by competing with the nastier stuff), and we have a immune system to clean up the mess whenever the skin gets cut. Washing with a strong antibacterial won't make them go away since they hide in the deep pores in our skin and grow back from there in a matter of minutes to hours.
Widespread use of such antibacterial agents will eventually render bacteria resistant to them and when you actually do need antibacterial action such as in pre-operatory work up or washing a wound, these agents won't work.
Old soap and scrubbing with water with a touch of scrubbing alcohol or chlorexidine still remains the gold standard for reducing infections even inside hospitals and ICUs. Just soap and scrubbing is enough for most day-by-day needs. You don't need a bazooka to kill ants.

[TheBiggerFish]

PTW.

[Uzu Bash]

Plain old soap and hot water with scrubbing for at least 20 seconds is your best bet. It's what everyone in the medical fields can agree upon. That and disposable barriers and autoclaves.

It's never 20 seconds, not unless you have a water tap directly connected to a water heater. Realistically, doctors rarely have time to wait for water to heat up; that's why there are Purell dispensers in every room and hallway at the hospital I go to. And I similarly use anti-bacterial soap only when I need to disinfect my hands to handle something quickly.

After a surgery I asked my doctor about using Neosporin for more than a week, and he didn't seem to think it could be either beneficial or harmful. He told me if I was getting good results, which I was, then I should continue.

[Neonivek]

Yes but there is a HUGE difference between "Purell" and Antibacterial soap...

Purell is alcohol.

[BigD145]

The Purell is mostly for viruses.

The standard in any hospital, doctor office, nursing home, etc is 20-60 seconds of scrubbing. Some facilities have on demand heaters so yes it is directly connected. If a doctor can't take even a couple minutes to clean up then you've got yourself a bad doctor. A very bad doctor.

[ChairmanPoo]

The standard in hospitals nowadays is hydroalcoholic gel.

[wierd]

However, the gel is not a suitable replacement for hand washing. Normal guideline is that you can use the gel for 2 out of every 3 times you would need handwashing, but not more frequent than that.

Proper handwashing is still necessary.

Also, the gel is not effective at killing all harmful pathogens. For instance, C. Diff.  Alcohol does not touch it. You need to scrub and scrub and scrub, and if possible, use bleach or peroxide.

The major issue with antibacterial soaps is that the action of the agent continues after you wash it down the drain, prompting microbial evolution to resist these agents, or worse, their methods of attack. (eg, resistence to one agent, can confer resistence to a whole classification of agents.)

Little Timmy's helicopter mom feeling paranoid pangs of fear after seeing little timmy play in the dirt does not justify her contributing to a growing threat to major public health, by slathering the boy in antibiotics.

Really, antibacterial soaps should not exist. Really, they shouldnt.

[Uzu Bash]

You guys know that the line between 'not always' and 'never' isn't a fine one, right? I thought I made it clear that proper washing wasn't completely ruled out in favor of antibacterial soaps or alcohol gel, so the lectures regarding it wasn't necessary to answering the question actually posed in the OP. Which you've answered, but you could curb the pedantry a bit.

[wierd]

Most antibacterial soaps are sold to the general public. The general public does not practice medicine.

For the general public, there is no real need for antibacterial soaps-- the risk to public health it poses through rapid germ evolution GREATLY outstrips any public health benefit, because of the reasons already cited (such as rapid recolonization from environmental exposure, etc.)

Most sales of antibacterial soaps are from the general public, and most of those are from overprotective parents.

The criticism stands.  I would like to see antibacterial soap require a medical license to obtain. Antibiotic resistant germs are not a laughing matter, but the difference in effectiveness between proper handwashing and the use of antibacterial soaps, *IS*.  Proper hand washing will get you just as clean, regardless of the soap used.

[Neonivek]

There is no point in requiring a medical license.

Since anti-biotic soaps have no use.

If you desperately needed a germ free environment or body... you would use something else.

Heck washing your hands with Listerine is more effective.

[Bumber]

There is no point in requiring a medical license.

Since anti-biotic soaps have no use.

If you desperately needed a germ free environment or body... you would use something else.

Heck washing your hands with Listerine is more effective.

Oh, they have a use alright. They breed resistant bacteria so that in the future hospital patients can die of infected wounds.

[Shadowlord]

Call me when someone invents antibacterial soap based on phages.

[Djohaal]

The one use for antibacterial soap some of my surgeon professors cited was for the patient to use to wash his whole body in the shower immediately before a surgery. Anecdotal evidence suggests it improves the risk of incision infections on post-op, but I never bothered to search for a randomized controlled trial on the subject versus common soap. (I'm a psychiatry resident, surgery isn't exactly something I care deeply about)

If timmy's paranoid mom really wants their kid germ free she's better off dousing him in alcohol and flambing. We need the skin microbiota just as we need the gut microbiota.