Bulk Soap Contamination Study Summary

Background

Microbiological contamination of soap has been shown to result in infections and nosocomial outbreaks.^1-4 Several studies conducted during the last 25 years have demonstrated that soaps can become contaminated with microorganisms. This contamination can occur after the product reaches the user (extrinsic contamination).^2;3;6 This includes both germicidal (antimicrobial) and bland hand washing products. Bacterial contamination has been observed in nonmedicated³ and antimicrobial products including those whose active ingredients were PCMX², Benzalkonium chloride^6;7, Triclosan¹, and CHG.^4-6;8-11 All types of soap regardless of the active ingredient or preservative system used are susceptible to contamination when exposed to adverse circumstances. Soap dispensers with sealed refills were developed in response to this contamination challenge. By contrast, open refillable soap dispensers continue to present significant risk of contamination during use. As a result of this evidence, the CDC recommends against using soap dispensers that allow for users to add soap to a partially empty dispenser since it can lead to bacterial contamination.¹²

A recent study conducted at the University of Arizona by a prominent microbiologist, Dr. Charles P. Gerba, revealed that liquid hand soap collected from open refillable (commonly known as bulk) dispensing systems are a public health risk. He found unsafe levels of bacterial contamination in open refillable dispensing systems, while no bacterial contamination was found in soap from sealed (a.k.a. bagged or cartridge) style dispensers. Dr. Gerba intends to submit his research findings for publication.

Study Overview

Objective
The objective of the study was to determine whether soap from open refillable dispensers in public restrooms contain significant levels of bacterial contamination, and to identify contaminating organisms. Samples of liquid soap were collected from open refillable dispensers and showers from across the country and their bacterial content analyzed.

Results
Unsafe levels of bacterial contamination were found in 25% of the samples from open refillable dispensers. The average contamination level was over 1,000,000 bacteria per mL of soap. This level of contamination is 1000 times greater than recommended by cosmetic industry standards.¹³ Coliforms, which are organisms associated with fecal contamination and which are known to cause illness, were present in 16% of the samples. Klebsiella was the most frequently isolated bacteria, followed by Enterobacter and Serratia. In contrast, no bacterial contamination was found in soap dispensed from sealed systems.

Conclusion
Since these samples represent a diverse cross section of geographical locales and individual sites, it is concluded that soap from open refillable dispensers commonly found in the US are routinely contaminated with bacteria. The type and level of bacteria found in these systems represent a potential health risk to users. All unsealed, open, bulk dispensers should be eliminated and users should switch to the safer alternative, sealed soap dispensing systems, to avoid unnecessary public health risk.

1. McNaughton M, Mazinke N, Thomas E. Newborn conjunctivitis associated with triclosan 0.5% antiseptic intrinsically contaminated with Serratia marcescens. Can J Infect Control 1995; 10(1):7-8.
2. Archibald LK, Corl A, Shah B et al. Serratia marcescens outbreak associated with extrinsic contamination of 1% chlorxylenol soap. Infect Control Hosp Epidemiol 1997; 18(10):704-709.
3. Sartor C, Jacomo V, Duvivier C, Tissot-Dupont H, Sambuc R, Drancourt M. Nosocomial Serratia marcescens infections associated with extrinsic contamination of a liquid nonmedicated soap. Infect Control Hosp Epidemiol 2000;21(3):196-199.
4. Vigeant P, Loo VG, Bertrand C et al. An outbreak of Serratia marcescens infections related to contaminated chlorhexidine. Infect Control Hosp Epidemiol 1998; 19(10):791-794.
5. Brooks SE, Walczak MA, Malcolm S, Hameed R. Intrinsic Klebsiella pneumoniae contamination of liquid germicidal hand soap containing chlorhexidine. Infect Control Hosp Epidemiol 2004;25(10):883-885.
6. Oie S, Kamiya A. Microbial contamination of antiseptics and disinfectants. Am J Infect Control 1996; 24(5):389-395.
7. Oie S, Kamiya A. Microbial contamination of benzalkonium chloride products. Am J Health Syst Pharm 1998; 55(23):2534, 2537.
8. McAllister TA, Lucas CE, Mocan H et al. Serratia marcescens outbreak in a pediatric oncology unit traced to contaminated chlorhexidine. Scott Med J 1989; 34(5):525-528.
9. Sobel JD, Hashman N, reinherz G, Merzbach D. Noscomial Pseudomonas cepacia infection associated with chlorhexidine contamination. Am J Med 1982; 73(2):183-186.
10. Kahan A, Philippon A, Paul G et al. Nosocomial infections by chlorhexidine solution contaminated with Pseudomonas picketti (Biovar VA-I). J Infect 1983; 7(3):256-263.
11. Brooks SE, Walczak MA, Hameed R, Coonan P. Chlorhexidine resistance in antibiotic-resistant bacteria isolated from the surfaces of dispensers of soap containing chlorhexidine. Infect Control Hosp Epidemiol 2002;23(11):692-695.
12. Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Society for Healthcare Epidemiology of America/Association for Professionals in Infection Control/Infectious Diseases Society of America. MMWR Recomm Rep 2002; 51(RR-16:1-45, quiz.
13. Technical Guidelines. Microbial Limits for Cosmetics and Toiletries. 2001. The Cosmetic, Toiletry, and Fragrance Association.

Bulk Soap Study Summary

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