Hexachlorophene

During the past two decades, a variety of new home products containing antibacterial substances have been introduced to the consumer market. These products may have certain maleficent effects on the normal bacterial flora of households, and bacterial resistance is now a phenomenon observed not only in hospitals and health care facilities, but also in private residences.

Resistance to an antibiotic is the insusceptibility of a bacterium to a test material (antibiotic, antiseptic, and preservative).1 Resistance can be an inherent properly of a microorganism or an acquired property. The inherent property is due to several mechanisms. The first involves a lack of structure within the bacterial organism that the antibiotic normally inhibits (Gram positive bacteria will resist antibiotics susceptible for Gram negative bacteria). The organism may also be impermeable to the antibiotic, the bacteria may change the antibiotic to an inactive form, or the organism may modify the target of the antibiotic.2

The other way in which a bacterium becomes resistant is through acquired mechanisms. The organism initiates these mechanisms when antibiotics and antimicrobial products are abused. Acquired resistance occurs by the process of mutation or genetic exchange.2 This transaction is directly related to controllable behaviors including: long and repeated courses of antibiotic therapies; excessive use of broad-spectrum antibiotics; failure to finish an antibiotic prescription; availability of antibiotics obtained without a prescription in some countries; and the use of home antimicrobial products in the immediate familial environment.

* Educate Patients

It is important for nurse practitioners (NPs) to inform and educate patients regarding antibiotic home products.

Tuffnell et al3 did a study in a hospital setting that clearly demonstrated the use of topical antimicrobial soap led to the eradication of a methicillin resistant staphylococcus aureus (MRSA) outbreak. The use of triclosan has replaced a 3% hexachlorophene product for whole body bathing, and is substantiated to be more effective in that environment. Extensive research has been done in hospital settings, but rarely in a home environment.4-6

The reality of antimicrobial resistance is cause for serious concern. It should be explained to patients that most bacteria are harmless and in many cases, are actually beneficial.

Normal household flora can be disrupted with constant use of these nondiscriminating products. The "hygiene hypothesis" suggests that allergies (including asthma) may develop because the childhood immune system fails to mature properly due to lack of contact with immune-stimulating bacteria in particular, endotoxins. Exposure to microbes can occur in the absence of infection.7 Exposure to endotoxins may have a crucial role in the development of tolerance to ubiquitous allergens found in natural environments.7

NPs should suggest the use of plain soap for any kind of cleaning and running water for rinsing. Hands should be washed after using the toilet, changing a diaper, emptying a diaper pail, cleaning the toilet, or after handling raw meat or poultry. The same should be done to the board or surface on which the raw meat or poultry had contact. In addition, hand washing is also recommended before the preparation of food, before eating food, treating or dressing a wound, inserting or removing contact lenses, after nose blowing, coughing, or sneezing, handling garbage, or caring for someone who is sick.

REFERENCES

1. Jones R D: Bacterial resistance and topical antimicrobial wash products. Am J Infect Control 1999; 27: 351-363.

2. Levy SB: The challenge of antibiotic resistance. Sci Am 1998; 46-53.

3. Tuffnell D J, Croton R S, Hemingway D M, et al.: Methicillin resistant Staphylococcus aureus; the role of antisepsis in the control of an outbreak. J Hosp Infect 1987; 10: 255-9.

4. Harbarth S, Dharan S, Liassine N, et al: Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage or methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 1999; 43: 1412-16.

5. Zafar A B, Butler R C, Reese D J, et al: Use of 0.3% triclosan (Bacti-Stat) to eradicate an out break of methicillin-resistant Staphylococcus aureus in a neonatal nursery. Am J Infect Control 1995; 23: 200-8.

6. Brady L M, Thomson M, Palmer M A, et al: Successful control of endemic MRSA in a cardiothoracic surgical unit. Med J Aust 1990; 152: 240-5.

7. Bach J F: The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 2002; 347:911-20.

Claude Locas RN, MSN, CRRN, APRN

ABOUT THE AUTHOR

Claude Locas is affiliated with the Hospital for Special Care, New Britain, Conn.

Copyright Springhouse Corporation Sep 2003
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