We all use antimicrobial soaps. They are ubiquitous in every hospital, clinic and care home, and across the waste industries though in this latter sector getting workers to wash their hands properly and at a suitable frequency remains a challenge.

Antimicrobial soaps rid our hands of the nasty bugs that may cause infections, in ourselves or others. They protect.

Or do they?

If you test the standard formulations of antimicrobial soap against a cheap and cheerful non-antimicrobial equivalent the number and types of bugs remaining on skin is the same whichever product is used. Indeed, if you use just plain water – and this is NOT a recommendation – then the reduction in bugs on hands can be just as good.

This forms the basis of a series of experiments I use in teaching nurses, to highlight the importance of good handwashing technique. It I this which removes the bugs, with soaps providing useful lubrication and detergent activity that additionally removes oils and greases. Of course, soap makes a difference, especially on heavily soiled hands, but it is technique alone, of rubbing one hand vigorously against the other aided by the lubricating action of soap, that removes bacteria.

If soap doesn’t make a big difference, what about the antimicrobial soap products? Well, you’ve guessed it: there is no detectable difference in routine testing. If you place some antimicrobial soap into a test tube it does indeed kill some bacteria, though the efficacy is slight and on hands completely undetectable.

So, why do we use them? Is it a desire to do better for ourselves and others; a social responsibility to ensure no infections transmitted on our hands, to the detriment of ourselves or others? Or perhaps it is a result of good marketing? I favour the latter.

What we can be sure about is that millions of tonnes of antimicrobial soap go down the drain each year. As studies show, the impact of antibiotics and disinfectants in drains and sewers is profound, effectively “breeding” resistance in bacteria that come back to bite us as nasty bugs causing hospital infections.

We cannot abandon antibiotics but we must be aware of and manage environmental discharges, perhaps with local treatment of hospital wastewater. That can only be a partial solution, as the majority of patients taking antibiotics at any time are not in hospital, but peeing antibiotics into the drains from the home, their workplace, even the pub!

And what about disinfectants? Perhaps more targeted use might reduce the overall environmental burden, perhaps ultimately with some thought to disposal as chemical waste rather than pouring used disinfectants to drain. And all these antimicrobial products that we are encouraged to use in the home – should we rethink this, substituting old fashioned elbow grease and perhaps the newer microfiber technologies for excessive disinfectant use?

Even antimicrobial soaps and antiseptic hand wash products must come under the microscope. Practice Greenhealth is proposing just that, asking the entirely pertinent question concerning the effect of the vast quantities of these products which go to drain each day. Should we reduce their use? Should we substitute non-antimicrobial (plain soap) alternatives? Clearly, its a cautious yes to both, but first we should remind those who rely upon antimicrobial soaps, albeit unnecessarily, to wash and dry their hands properly, and at the right time and place. Improvement in glove use and glove management (hygiene) must run in parallel. As noted many times previously on the Clinical Waste Discussion Forum and included in Blenkharn Environmental training packages, in the waste sector this requires great effort as standards are at present particularly poor, but any improvement is hand hygiene is to be welcomed.