Excessive use can be to your detriment

By Marietjie Swanepoel

Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria, viruses, fungi and parasites mutate in ways that render the medications used to cure the infections they cause, ineffective. When the microorganisms become resistant to most antimicrobials they are often referred to as “superbugs”. Inappropriate use and overuse of antibiotics are the primary driver of antibiotic resistant microorganisms.

In order to understand the correlation between AMR and the indiscriminate use of disinfectants and sanitisers during the coronavirus pandemic it is important to offer an insight of the origins of AMR. And to explore how the fight against COVID-19 will impact on the further development of AMR.

Origin of “superbugs”. It all started when British scientist Alexander Fleming discovered penicillin in the 1920s which led to the start of the antibiotic era. By the 1940s pharmaceutical companies started production of penicillin for commercial purposes and it became widely accessible to the general public. However, the excitement about antibiotics was mitigated by a phenomenon called antibiotic resistance when healthcare professionals realised that in some cases penicillin was not effective against certain strains of Staphylococcus Aureus (bacteria that causes skin infections). Thus the first generation of “superbugs” was born.

Antimicrobial products to the rescue... Driven by the fear of “superbugs”, products flooded the market and consumers were bombarded with toothpaste, soaps, washing powder, dishwashing detergents and hand lotions: all containing antibacterial agents. People wanted to eliminate these “superbugs” from their surroundings at all cost. The US Centres For Disease Control (CDC) issued a warning that no additional health benefits has been proved when using anti-bacterial products. In fact, the CDC urged the general public to use these products responsibly, as overuse can alter a persons’ natural microflora and it could even negatively influence immune systems.

With the above in mind, there is general concern that the overuse and inappropriate use of disinfectants and sanitisers during the coronavirus pandemic could lead to an increase in the number of anti-microbial resistant species we encounter. There are further concerns that the high release of biocides and antibiotics used during the pandemic could have a negative impact on the environment. This includes an impact on wastewater, surface waters, soils and sediments. A practical example is the fact that China reportedly dispensed at least 2000 tons of disinfectants throughout the city of Wuhan from the outbreak of the pandemic until March 2020. Can the impact of this drastic action be imagined?

Misinformation and a lack of understanding of virus vulnerability to cleaning processes spiked peoples fear for the unseen. Disinfectant tunnels, fogging and substandard disinfectants and sanitisers flooded the market. The CDC once again had to issue urgent warnings to protect vulnerable individuals and reiterated the fact that spraying individuals with disinfectants in tunnels, cabinets or chambers is not recommended under any circumstances.

During April 2021 the CDC recommended that people rather use soap and water for environmental surface cleaning as it will reduce the bioburden on surfaces and decrease the risk of infection. The CDC only recommended disinfection of surfaces if someone tested positive for COVID-19 in a facility, or in high-risk areas.

Visiting a shopping centre and receiving too little of the unlabelled sanitiser product at the entrance brought me to the final question:

What is the impact of all these unlabelled, unregistered, sub-standard, non-regulated, easily dispensed products we are currently (over)using to (over)disinfect and (over)sanitise in the long term?

In misusing sanitisers and disinfectants during the COVID-19 pandemic, we are most likely helping the evolution of strains of microorganisms that are not only drug resistant but also disinfectant resistant. The misuse and incorrect use of disinfectants raises the question of whether this resistance will translate to antibiotic resistance.

Common ingredients in many cleaning supplies and hand sanitisers include toxins such as hydrogen peroxide, benzalkonium chloride and triclosan that are toxic and the use of some of these compounds have already been linked to an increase in anti-microbial resistance. As a hygiene auditor, I walk around sites and I am often shocked to notice ignorance when it comes to the use (abuse) of (unregistered and substandard) disinfectants. It is an alarming reality that if a microorganism develops insusceptibility or resistance to a certain disinfectant, it may also be unresponsive to antibiotics.

New research published by Science Translational Medicine warns that several strains of bacteria already started adjusting to alcohol-based hand sanitisers and are becoming “tolerant”. When hand sanitisers don’t contain the recommended 70 percent alcohol as recommended by the WHO, strains of bacteria can survive.

As cleaning experts, we should educate ourselves and our customers on the correct usage of disinfectants and sanitisers. We must evaluate the risk areas of the environments and areas to be cleaned as there are no additional benefits in the use of disinfectants in normal office environments. Disinfecting offices and schools that were closed during lockdown results in the exploitation of people’s trust and is an irresponsible action. We should rather consider disinfection of touch points during the pandemic.

In South Africa, disinfectants and detergent-disinfectants must comply with the standards as set out by the National Regulator for Compulsory Specifications Act (NRCS) and should be registered with the NRCS. SABS approval of hand sanitisers is not compulsory but recommended. The standard applicable for hand sanitisers in commercial use is: SANS 490:2020 and deals with “alcohol-based hand sanitisers and hand rubs” and the amended version of SANS 289 deals with the labelling and general requirements of the product. This assures consumers that a product has been verified against a high-quality standard.

How much of a good thing is good? The general recommendation is to go back to the basics. Washing of hands with soap and water as per WHO recommendation rather than reaching for the sanitiser is advised. When using a registered sanitising product, it is imperative to cover all areas of your hands (just as you will do with soap and water). Apply the product to the palm of one hand and rub it all over the surfaces of your hands until your hands are dry. Sanitisers should not be wiped off before it has dried. According to the CDC, sanitisers take about 30 seconds to kill germs. Use a NRCS-registered disinfectant only when needed and rather revert to good cleaning principles. The methodology of cleaning is far more important rather than trying to create a “germ-free” environment. The use of sanitisers and disinfectants should be with the same caution as the use of prescription medication.

When looking back, we see how fear for the unknown can result in panic and misuse of products which has an effect on human and environmental health. Tapping into past wisdom and recent scientific information it is advisable to stick to the basics: be informed of the situation and products, use products responsibly and according to product guidelines. Spread information, not panic.

Marietjie Swanepoel has over 25 years’ experience in the cleaning industry, specialising in environmental cleaning in commercial and healthcare facilities throughout South Africa. She can be reached at: marietjie@msconzult.com