Antiseptic Stewardship for Antimicrobial Soaps

Antimicrobial soaps are usually based on chlorhexidine digluconate, povidone iodine, triclosan, benzalkonium chloride, DDAC, octenidine dihydrochloride, polyhexanide or sodium hypochlorite. Evidence of a health benefit is inconsistent. Routine antiseptic body washing of ICU patients appears to prevent catheter-associated bloodstream infections, and bundles including antiseptic body washes on MRSA carriers may reduce transmission or infection. Benzalkonium chloride, triclosan, chlorhexidine digluconate and DDAC can cause a large and stable MIC increase, mainly in Gram-negative bacteria. Cross-tolerance between benzalkonium chloride, triclosan and chlorhexidine digluconate is common. Horizontal gene transfer can be induced by chlorhexidine digluconate, polihexanide and triclosan in E. coli. Efflux pump genes may be upregulated in some species by benzalkonium chloride, chlorhexidine digluconate, triclosan and octenidine dihydrochloride. Some risks may be potentially serious for the development of antibiotic resistance. The least adaptive reaction is seen with povidone iodine, sodium hypochlorite and octenidine dihydrochloride. The use of antimicrobial soaps should be restricted to applications where there is an expected health benefit and should not be used for routine hand washing at home, for surgical scrubbing (preference for alcohol-based hand rubs without selection pressure) and for hygienic hand washing (preference for plain soap).