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Hygiene in the Industrial World:
An Unhealthy Obsession with Cleanliness?

(Released June 2011)

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  by Kathryn Mori & Carolyn Scearce  

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Antibiotics and Antiseptics

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The backdrop of history and comparisons between the developed and undeveloped portions of the globe establish a context in which to consider hygiene and related practices. Clearly, the drawbacks to living under conditions where water and food supplies are not protected from microbial and parasitic agents strongly outweigh the possible benefits of living in an environment untouched by human technology. It has even been suggested that the lower rates of allergies observed in third world countries may not be due to differences in environmental conditions, but to survivor’s bias. In other words, it is possible that only the healthiest members of society are surviving in these challenging conditions, and we see fewer incidences of allergies simply because those people who survive are healthier. Even if this is so, perhaps the industrialized world still has lessons to learn regarding balancing current hygiene practices and technology usage and maintaining a more natural, healthy lifestyle. One aspect of current health practices in industrialized countries that is drawing significant attention is the use and possible overuse of antibiotics and antiseptics (Weber and Rutala).

Antibacterial soap on a personís hand
Antibacterial soap on a person's hand.

The development of antibiotic therapies is frequently hailed as one of the primary health advances of the modern age. Consequently, the more recent development of antibiotic-resistant strains of microorganisms has caused considerable concern in the medical community and the population at large (Meropol et al.). Due to microorganisms’ rapid mutation rates and quick proliferation times, a small colony of antibiotic-resistant bacteria can quickly form large colonies if there is any selection pressure for the resistant trait. Currently, the development of resistant pathogens seems to be outpacing the discovery and production of new antibiotics. Also, the ability of unrelated bacteria to pass on genetic material to other bacterial species raises worries that pathogens that possess natural resistance to a wide variety of antibiotics may eventually acquire resistance to all currently available antibiotics.

Concerns about antibiotic resistance extend beyond the treatment of human diseases. Large quantities of antibiotics are used both in agriculture and veterinary practice for the treatment of livestock or other domesticated animals. It has been estimated that more than 80% of the antibiotic usage in the United States is being used for growth promotion and treatment of food animals such as chickens, pigs, and cattle (Gilchrist et al.). Most livestock are housed in overcrowded and unsanitary conditions, and under these circumstances the majority of these antibiotics are used prophylactically. That is, instead of treating infections as they arise, livestock are given antibiotics in animal feed to help ward off infections in the hope that the animals with grow more rapidly or in the case of dairy cattle, produce more milk. The use of antibiotics to promote the growth of livestock is currently drawing criticism both in terms of the concerns it raises for antibiotic-resistant bacteria, and in the pollution caused by releasing such large quantities of antibiotics into the environment.

In 1998, the European Union phased out the use of antibiotics used in human medicine for the treatment of animals. In 2006, they banned the use of antibiotics for growth promotion in animals (Gilchrist et al.). In the United States, there has been some reduction in the prophylactic use of antibiotics in the production of food products by individual suppliers and food chains. In 2010, the FDA issued a draft of guidelines that look to restrict the use of antibiotics by meat producers. Currently the guidelines are only voluntary, and there has been some very vocal disapproval of these new guidelines by the meat industry. Since the guidelines are new and voluntary in nature, it is unclear how much influence they will actually have on current agricultural practices. The FDA has previously attempted to pass enforceable regulations, but to date such attempts have been blocked by Congress (Gutierrez).

Concerns regarding the use of antibiotics for livestock production extend beyond the direct consumption of animal products. Large amounts of antibiotic-laden animal waste products are released into the environment. Even when these waste products are contained within specially designed lagoons, it is impossible to ensure complete isolation from nearby food and water sources. This poses a particularly significant problem if any resulting antibiotic resistant microorganisms make it into the human food or water supply (Smith et al.). Also of concern is the potential toxicity of antibiotics and their metabolites as they enter new ecosystems, exposing untargeted organisms (Halling-Sorensen).

Animation of Microbial Resistance
Animation of Microbial Resistance, Food and Drug Administration's Center for Veterinary Medicine, YouTube

Similar concerns also revolve around the use of antiseptics. In recent years, it has become common practice to include various antimicrobial agents such as triclosan in many household products such as hand soap, dish soap, and other detergents. In the early 1990s, only a few such household products were commercially available. However, by 2001 there were more than 700 on the market (Levy, 2001). This has caused researchers and medical professionals to speculate as to whether these products may also end up contributing to the development of resistant microbes. Also, there may be toxicological implications for release of such antimicrobials into the environment.

Currently, it is unclear if the household use of antibacterial agents for hand washing and home cleaning actually significantly reduce the spread of infectious diseases (Larson, et al., 2004). Most upper respiratory diseases are caused by viral rather than bacterial infections. In such cases, the use of antibacterials confers no benefit. Furthermore, common household cleaning practices frequently are not effective at eliminating microbes for long.

Removing microorganisms from our living spaces may not be as desirable an outcome as some people imagine. One hypothesis suggests that certain microorganisms that form strong commensal relationships with humans and are important to our health (Noverr and Huffinagle, 2005). These microorganisms colonize our skin, digestive tract, and other human systems and ultimately end up forming a barrier between us and more pathogenic microorganisms. When the appropriate microbial community is maintained, it is easier to remain healthy. However, if internal or environmental factors alter this community, we can be colonized by less benign microorganisms.

Depiction of the human body and bacteria that predominate
Depiction of the human body and bacteria that predominate.

People who adhere to such a theory suggest that it is not the elimination of microorganisms from our living environment that has lead to the increase in allergies and other inflammatory diseases (Noverr and Huffnagle, 2005). Instead, modern lifestyles have altered the nature of the bacterial community that we live in. The farther we remove ourselves from the sorts of bacterial communities that one might encounter in a rural or, more particularly, a farm environment, the more the bacterial community alters from that most conducive to warding off inappropriate immune responses. If this hypothesis is correct, the use of antibiotics and antiseptics may actually be exacerbating inflammatory conditions such as allergies.

Along a similar line of reasoning, it is argued that the use of antibiotics in early childhood may be a strong contributing factor to the development of allergies in later life (Salvi and Holgate, 2001). It is well known that using antibiotics dramatically alters the composition of intestinal flora, at least on a short term basis. Early childhood has been identified as a critical time for the development of a healthy immune system. In developed countries, very few children make it through their early childhood without being prescribed antibiotics. Additionally, as first world inhabitants have adopted diets with increasing quantities of highly processed food, the consumption of prebiotic and probiotic foods has declined.

Microorganisms are a ubiquitous element of the living environment, and only extremely strict protocols can maintain truly sterile conditions. Increasing public awareness of the existence of microscopic organisms seems to be something of a mixed blessing for modern society. Introduction of better medical hygiene and more careful means of the production and preparation of food have dramatically reduced the incidences of some types of diseases. On the other hand, terms such as bacteria and microorganism are often used synonymously with germs or diseases. This is not a very accurate portrayal of the microbial world. Only a very tiny minority of bacteria or even viruses are actually pathogenic to humans. In our preoccupation of maintaining a germ free environment, we may merely be creating new, less beneficial microbial associations. Next we will look at a country which exercises some of the most stringent hygienic practices in the world.

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