Effect of Antibacterial Home Cleaning and Handwashing Products on Infectious Disease Symptoms

From Columbia University and Columbia University Medical Center, New York, New York.

Requests for Single Reprints: Elaine Larson, PhD, Columbia University School of Nursing, 630 West 168th Street, New York, NY 10032; e-mail, ude.aibmuloC@32LLE.

Current author addresses and author contributions are available at www.annals.org.

Current Author Addresses: Drs. Larson and Lin: Columbia University School of Nursing, 630 West 168th Street, New York, NY 10032.

Dr. Gomez-Pichardo: Center for Liver Disease and Transplantation, 622 West 168 Street PH14, P&S 9-501, New York, NY 10032.

Dr. Della-Latta: Clinical Microbiology Laboratory, Children’s Hospital of New York, 3S Room 325, 622 West 168th Street, New York, NY 10032.

Author Contributions: Conception and design: E.L. Larson.

Analysis and interpretation of the data: E.L. Larson, S.X. Lin.

Drafting of the article: E.L. Larson, S.X. Lin, P. Della-Latta.

Critical revision of the article for important intellectual content: E.L. Larson, S.X. Lin, P. Della-Latta.

Final approval of the article: E.L. Larson, S.X. Lin, C. Gomez-Pichardo, P. Della-Latta.

Provision of study materials or patients: P. Della-Latta.

Statistical expertise: S.X. Lin.

Obtaining of funding: E.L. Larson.

Administrative, technical, or logistic support: P. Della-Latta.

Collection and assembly of data: E.L. Larson, S.X. Lin, C. Gomez-Pichardo.

Abstract

Background

Despite the widespread household use of cleaning and personal hygiene products containing antibacterial ingredients, their effects on the incidence of infectious disease symptoms have not been studied.

Objective

To evaluate the effect of antibacterial cleaning and handwashing products for consumers on the occurrence of infectious disease symptoms in households.

Design

Randomized, double-blind clinical trial.

Setting

Northern Manhattan inner-city neighborhood, New York.

Participants

238 primarily Hispanic households (1178 persons) that included at least one preschool-age child.

Interventions

Households were randomly assigned to use either antibacterial or nonantibacterial products for general cleaning, laundry, and handwashing. All products were commercially available, but the packaging was blinded and the products were provided free to participants.

Measurements

Hygiene practices and infectious disease symptoms were monitored by weekly telephone calls, monthly home visits, and quarterly interviews for 48 weeks.

Results

Symptoms were primarily respiratory: During 26.2% (717 of 2736) of household-months, 23.3% (640 of 2737) of household-months, and 10.2% (278 of 2737) of household-months, one or more members of the household had a runny nose, cough, or sore throat, respectively. Fever was present during 11% (301 of 2737) of household-months, vomiting was present in 2.2% (61 of 2737), diarrhea was present in 2.5% (69 of 2737), and boils or conjunctivitis were present in 0.77% (21 of 2737). Differences between intervention and control groups were not significant for any symptoms (all unadjusted and adjusted relative risks included 1.0) or for numbers of symptoms (overall incidence density ratio, 0.96 [95% CI, 0.82 to 1.12]).

Conclusions

The tested antibacterial products did not reduce the risk for symptoms of viral infectious diseases in households that included essentially healthy persons. This does not preclude the potential contribution of these products to reducing symptoms of bacterial diseases in the home.

Abstract

Changing demographic and social patterns, such as more working parents, increased numbers of meals eaten in restaurants, and more child-care outside of the home, are causing concomitant changes in patterns of infectious diseases (1). For example, recent foodborne outbreaks have resulted from widespread distribution of contaminated foods, such as meat or ice cream. Media attention to such outbreaks and the resultant public concern about disease transmission may be one reason for the burgeoning of various products that are labeled “antibacterial” and that are readily available for personal hygiene and general cleaning.

These demographic and social shifts raise the question of the relative importance of home hygienic practices in the prevention of infectious diseases. The home environment has been implicated as one important source of spread of infectious diseases (2-4), and hygienic interventions have resulted in reduced incidence, particularly in less-developed countries (5). In the United States, several studies have demonstrated the effectiveness of hygienic interventions in reducing transmission of infections in child-care centers and schools (6-9). However, despite the fact that 75% of liquid and 29% of bar soaps available in the U.S. consumer market contain antibacterial ingredients (10), their benefits in terms of reducing the incidence of infectious diseases in households have not been demonstrated. In addition, concerns have been raised about the potential for long-term use of such products to increase resistance to antiseptics or cross-resistance with antibiotics (11, 12). Therefore, we sought to evaluate the effect of antibacterial cleaning and handwashing products on the occurrence of infectious disease symptoms in households.

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