Purell Pandemic: The Creation of Super Germs?

With today’s generation of germaphobes and antiseptics such as Purell at the convenience of the general public, is the overuse of such antiseptics setting the stage for super germs? Super germs are germs that are resistant to most antibiotics. Antibiotics work by targeting specific mechanisms within bacterial cells, inhibiting biosynthetic processes such as protein production. While most antibiotics function similarly, the specific mechanisms that they target within bacterial cells vary. In short, antibiotics destroy bacteria from the inside out. Antiseptics work in the opposite way in that they destroy bacteria from the outside.[i]

A.D. Russell (1999)[ii] compares antibiotics to antiseptics noting that it is much more common for bacterial cells to have natural defenses against specific antibiotics. However, because antiseptics do not target the internal mechanisms of the bacteria, resistance to antiseptics is sparse. Antiseptics are biocidal (life destroying) agents and tend to have numerous target sites. Many bacteria defend themselves from antibiotics through efflux, where specific membrane proteins are designated to pump molecules, including antibiotics, out of the cell. Some bacteria have the ability to use the same mechanisms with antiseptics.

Russell notes that “increased resistance of bacteria to antiseptics and disinfectants is not a clinical problem at present.”[iii] There has, however, been a correlation to low level of resistance to antiseptics, specifically E.coli resistance to triclosan, and increased antibiotic resistance. This effect has also been observed with pine oil. These studies used very low concentration of pine oil and triclosan. Purell is a low level antiseptic.

A more recent study, Alps, S. et., al 2007, notes that bacteria do show capability of building resistance to antiseptics through efflux and also through the acquisition of plasmids (circles of DNA encoding for a resistance to the antiseptics), some bacteria can also build a biofilm, a protection shield. Bacteria and microbiological organisms are capable of building and spreading resistance to antiseptics.[iv] An additional problem with antiseptics is that they do not differentiate the cells that they target; in order to be safe enough to be used on human skin, antiseptics such as hand sanitizers, have to be greatly diluted.  In fact, it has been proven that it is more effective to wash ones hands with soap and water than to use hand sanitizers.[v] This recent research brings to question whether antiseptics such as hand sanitizers are worth the risk.

While the long term effects of hand sanitizers and low level antiseptics are not clear, would today’s society change its their day to day actions to prevent the creation of a super germ? George Lowenstein and Jennifer S. Lerner (2003)[vi] discuss the cognitive process of decision making in their book, The Role of Affect in Decision Making. They note how immediate emotions or desires can sway one’s perception of probabilities, putting a greater importance on immediate gains. The immediate effect, ward off that common cold, flu or virus, outweighs the long term risk of creating a super germ. Perhaps this long term risk of a super germ will not be prevalent in society’s decision making until it becomes a factor of immediate effect. If the risk of a super germ will not impact decision making, reverting to old ways is a better alternative: stick to the soap, a more effective microbial eliminator.

[i] A.D. Russell, M. T. Suler and J. Y. Malliard, “Do antiseptics and disinfectants select for antibiotic resistance?” (J. Med Microbiology, 1999) 48: 613-15.

[ii] A.D. Russell, 613-15.

[iii] A.D. Russell, 614.

[iv] Alp S. “Bacterial resistance to antiseptics and disinfectants” (Mikrobiyol Bul, 2007): 41(1):155-61.

[v] Anoosh Moadab, Kathryne F. Rupley, Peter Wadhams, “Effectiveness of a non-rinse, alcohol-Free antiseptic hand wash” (J Am Podiatr Med Assoc, 2001) 91:288-93.

[vi] G.F. Lowentstein, J.S. Lerner, in press, 2003 “The role of affect in decision making” (R. J.).