With all the concern over Ebola virus, there has been heightened awareness of risks that can be faced by health care workers who are just doing their best to care for patients. In the case of that deadly virus, the need is paramount not only to wear gloves, but also to fully suit-up in protective gear (the shortage of such supplies has proved to be a killer). But for more run of the mill protection, simple adequate hand washing is a key practice in protecting both the patient and caregiver.  Only now it seems, hand washing itself can carry its own exposure risks.

What was once just soap and water is nowadays soap infused with special chemicals purported to kill pathogens. Chief among those chemicals is a synthetic molecule called “tricolsan.” Triclosan is not a substance that most people have ever heard of, including people who work in health care. Maybe it’s time we all learned more.

Triclosan has characteristics that make it something the Natural Resources Defense Council, for one, is worrying about. Triclosan is a manmade material that does not occur on its own in nature, but it has a chemical structure that can be mistaken for a biological messenger, in particular a chemical that might otherwise serve as a hormone. When a foreign substance acts as a hormone imposter (the more genteel scientific label is “hormone disruptor”), it can block normal routes of communication. This, in turn, can throw off the delicate natural hormonal balance required for a wide array of normal functions. For triclosan, in addition to being a potential hormone disruptor, it carries the double whammy of being persistent in the environment. Coming in as a trifecta of troubles, triclosan use also is very widespread. Even as you read this, triclosan-containing materials are being washed down drains all around the country – traveling out to taint our water resources and the wider environment.          

I consider myself one of those consumers who knew very little about triclosan and other antibacterial additives, even though I use hospital-dispensed soaps many times per day when I am carrying out clinical duties. When one of the medical residents training in our occupational and environmental medicine residency approached me to ask my help in studying triclosan, it peaked my interest. That research study went on to be completed and ultimately published this month. What it showed, comparing one hospital with tricloasan-containing soaps and another that was farsighted enough to have eliminated the product, was that a substantive concentration of the chemical was detectable in the urine of the doctors and nurses who participated in the study. This in itself does not show harm – only its potential. But it is a first step in adequately assessing risk.

One of the complicating factors in our study was that we had to take into account a second major potential source of exposure to triclosan, whether or not a hospital uses soaps with the product. It turns out that triclosan-containing toothpaste also can account for nearly as much exposure as multiple hand washings.

The major toothpaste brand on the market containing with triclosan is Colgate Total®. That brand is currently in damage control mode because of this. It is a story being followed closely by Bloomberg News. Bloomberg had featured a news story about the Food and Drug Administration’s flawed safety review of tirclosan nearly two decades ago. In the wake of that story, it seems that negative consumer attitudes about the Colgate product are tracking through its falling “buzz score.”

Maybe just as big a question may be, who is following the FDA’s buzz score?  

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