Does Antimicrobial Soap Promote Drug Resistance in Children

¶ … Antibacterial Soap by Children Promote Antimicrobial Drug Resistance? Patient Problem: Today, young people are encouraged to wash their hands several times a day in order to stay healthy (Clean hands save lives, 2015). This guidance is based on research that confirms that regular handwashing is the most cost-effective approach to keeping young people healthy (Clean hands save lives, 2015). For instance, the U.S.

Centers for Disease Control (CDC) emphasizes that, "Regular handwashing, particularly before and after certain activities, is one of the best ways to remove germs, avoid getting sick, and prevent the spread of germs to others. It's quick, it's simple, and it can keep us all from getting sick" (Clean hands save lives, 2015, para. 1). The potential exists, though, that using antibacterial soap versus regular soap and water causes antimicrobial drug resistance in children.

These concerns are similar to concerns that the over-prescription of powerful antibiotics for routine healthcare problems that could be treated otherwise diminishes the effectiveness of antibiotics in future situations where their application may be essential. The research to date indicates that using regular soap and water is more effective than antibacterial soap. In fact, the CDC recommends the use of antibacterial soap only in those cases where there is no soap and water available (When & how to wash your hands, 2015).

In this regard, the CDC advises that even using whatever water is available with soap is preferable to the use of antibacterial soap: "Many diseases and conditions are spread by not washing hands with soap and clean, running water. If clean, running water is not accessible, as is common in many parts of the world, use soap and available water. If soap and water are unavailable, use an alcohol-based hand sanitizer that contains at least 60% alcohol to clean hands" (When & how to wash your hands, 2015, para. 2).

Antibacterial soap has not been proven to kill more germs but has been shown by the CDC and Food and Drug Administration (FDA) research to be potentially harmful to so-called "good germs." In this regard, the CDC points out that, "Alcohol-based hand sanitizers can quickly reduce the number of germs on hands in some situations, but sanitizers do not eliminate all types of germs" (When & how to wash your hands, 2015, para. 2).

Likewise, the FDA reports that "there currently is no evidence that over-the-counter (OTC) antibacterial soap products are any more effective at preventing illness than washing with plain soap and water" (Rogers, 2015, para. 2). More importantly, the long-term use of antibacterial soaps could have some unintended consequences that clearly outweigh any benefits that may accrue to their use (Rogers, 2015). As Rogers emphasizes, "There are indications that certain ingredients in these soaps may contribute to bacterial resistance to antibiotics, and may have unanticipated hormonal effects" (2015, para. 2).

Furthermore, antibacterial soaps also contain certain chemical ingredients (i.e., triclocarbon and triclosan) that may pose a risk to young people in view of a dearth of timely and relevant studies concerning their efficacy versus their corresponding risks (Rogers, 2015). Because schools are "breeding grounds for germs" (Strong, 2010, p. 40), it is vitally important for school districts to implement evidence-based policies concerning best hand-washing practices for their students as discussed further below.

Intervention: Based on the research to date, this intervention will implement regular soap-and- water hand-washing practices for one middle school while antibacterial soap only is provided in a second, similarly sized and demographically comparable middle school in a U.S. public school district. This intervention is based on guidance from the CDC, FDA and a growing number of scientific researchers as well as educators based on their empirical observations. For instance, one educator emphasizes that, "There are smart ways to prevent the spread of germs.

The number one defense against catching colds is to wash hands with soap and warm water several times a day" (Strong, 2010, p. 40). Comparisons: Ideally, an intervention of this type would involve large numbers of participants over a lengthy period of time (e.g., >5 years) to evaluate any potential effects in antimicrobial drug resistance, but longitudinal studies involving human subjects in general and young people in particular are extremely difficult and expensive to conduct (Forrester & Borthwick-Hunter, 2015).

Therefore, the efficacy of the proposed handwashing intervention will be evaluated by comparing the number of student absences due to illness in both schools after each semester for a full school year to determine if the use of soap and water was more effective in keeping students healthy compared to the use of antibacterial soap and water handwashing techniques.

Outcomes: While there exists a potential for a number of confounders such as an influenza outbreak at one of the middle schools to skew the findings from this intervention, it is expected that based on the research to date, the middle school that used soap and water-only handwashing practices would experience fewer student absences due to illness compared to the middle.