Co-Written by Dr. Parul Malik, Prabhu Dutta Shaw and Dr. Arathi P Rao
Sanitizing agents or biocides play an essential role in cleaning and disinfecting and are widely used for environmental and personal disinfection in both- the healthcare and the non-healthcare settings. They are also extensively used to disinfect the areas associated with food production and livestock, such as equipment, transport vehicles, farm buildings, etc. This usage extends to them being used directly on animals, for instance, during footbaths or udder cleansing. Therefore, it would not be an exaggeration to say that such sanitizing agents or biocides are a critical component of the food production chain. Since the last few decades, people are using alcohol-based sanitizers as disinfectants for better hand hygiene to control pathogenic diseases worldwide.
The advent of the COVID-19 pandemic, lead to a significant surge in demand for alcohol-based hand sanitizers, antimicrobial soaps, and also of products, less known before in the markets, like ‘vegetable sanitizers’ etc. This has happened because of the promotion of maintaining and developing best hygiene practices to tackle the pandemic. While protecting against the coronavirus on one hand, these agents are silently contributing to hastening the development of antimicrobial resistance (AMR). This could put a greater strain on our already over burdened healthcare systems and the menace caused by this could even stay long after the pandemic may get over.
Antimicrobials are important to fight against infections and infectious agents, but some organisms may change or mutate on exposure to an antimicrobial agent, and be able to withstand the medicines targeted at them. The excessive and uncontrolled usage of antimicrobials could increase the number of the resistant strains and otherwise easily treatable infections, may become life-threatening. Theoretically, AMR is less likely to occur because of exposure to biocides due to distinct modes of actions and applications. Yet, let us suppose that there is any potential occurrence of biocidal agent usage to co-select for antimicrobial resistance. In that case, it could be either through cross-resistance (which occurs if two chemicals have a shared mechanism of action), or due to coresistance (when the genes that confer reduced susceptibility to a biocidal agent get selected along with antimicrobial-resistant genes). Therefore, there is a possibility that a low level of exposure to biocidal agents over a long period of time can lead to selection for drug-resistant strains and increase the risk of cross-resistance to antibiotics, especially for those that treat gram-negative bacteria.
In isolation, this over use of sanitizing agents may not have been a problem of sorts. But, the rapidly emerging resistant bacteria reflecting the worldwide overuse of antibiotics and other antimicrobials, have been threatening healthcare since a long time. It has become a global crisis with antibiotic-resistant infections significantly increasing the health and economic burden on the healthcare systems. Excessive use of alcohol-based sanitizer over an extended period increases skin permeability and deprives oil and water of skin and causes roughness and irritation of the skin. Dry and damaged skin is a breeding ground for pathogens with an enhanced risk for the virus to enter into the skin. Earlier research reports have suggested that overuse of sanitizers may enhance the risk of viral outbreaks in some cases. Frequent exposure of antibiotics, disinfectant, or other genotoxic chemicals to pathogens may make them get mutated through a natural process, making them resistant and helping them survive from frequent hand sanitization. Thus, the antimicrobial resistance developed due to the overuse of alcohol-based sanitizers can increase the burden on the healthcare professionals who are already struggling.
AMR has been a cause of concern way before the COVID-19 struck. While, in the present scenario, the use of ‘sanitizers’ seems to be inevitable, methods or solutions need to be devised to tackle the anticipated peril of AMR. Biocidal or sanitizing agents manufacturers should consider evaluating the potential of any novel biocidal products that can lead to co-selection of resistance genes to clinically relevant antibiotics. Any novel biocidal active substances must be authorized by taking a risk-based scientific approach regarding the substance’s potential to prevent antimicrobial resistance. When using biocides or sanitizing agents, maximum caution must be exercised for personal and environmental disinfection. The biocidal agents without or with a low selection pressure for antibiotic resistance should be prioritized. Research needs to be carried out to determine the short- and long-term effect of the wide use of sanitizing agents for personal and environmental disinfection, including cross-resistance to antimicrobials; and to develop potential substitutions for sustainable personal and ecological disinfection.
Dr. Parul Malik is a medical doctor with a Master of Public Health (Global Health) degree from Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.
Prabhu Dutta Shaw has a bachelor’s degree in Cardiac Technology from CMC, Vellore, following which he completed his MBA in Hospital and Healthcare Management from Amity University Online. He is currently a postgraduate student, pursuing Master of Public Health (Epidemiology) at Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.
Dr. Arathi P Rao is the Coordinator of MPH Programme and the Head of Manipal Health Literacy Unit at the Prasanna School of Public Health, Manipal Academy of Higher Education (MAHE), Manipal, India.