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Am Fam Physician. 2004;70(9):1786-1788

Because of increased media attention to episodes of foodborne infections, concern about infectious disease has increased. Sales of antibacterial products recommended for personal hygiene and general home cleaning have increased without any clear evidence of their efficacy. The potential role of home hygiene practices in preventing infections is unknown. Studies have demonstrated that hygiene efforts in child care centers and schools can decrease infection transmission, but the value of a home-based hygienic program is less clear. Potentially, the long-term use of antibacterial products could lead to increased bacterial resistance. Larson and associates performed a double-blind clinical trial in which inner-city households used antibacterial preparations for handwashing and household cleaning, or products without antibacterial ingredients.

Researchers randomized 238 households with at least one preschool-aged child to one of two study groups; 224 households participated in the entire 48 weeks of the study. Households randomly assigned to the antibacterial group received appropriate products labeled with the term “antibacterial” or “disinfectant.” Households in the control group received products that looked similar but were not antibacterial. Both groups were given dishwashing detergents and bar soaps that were not antibacterial.

All households were followed with weekly telephone calls and monthly visits for product use and symptoms of infection. Almost one third of households had at least one member with symptoms of infectious disease monthly; the most common symptoms were respiratory. The symptoms by household-month did not differ between the two trial groups. Interestingly, persons with chronic disease or poor health in the antibacterial family groups were significantly more likely to have fever, runny nose, and cough than counterparts in the nonantibacterial group.

The authors conclude that although personal hygiene may be useful in decreasing the rates of infection transmission in specific households, including those with immunosuppressed members or persons with skin or gastrointestinal infections, the use of antibacterial soaps does not benefit the households of the general, healthy population. The potential value of antibacterial cleansers in household use should not be overestimated by zealous manufacturers.

In an editorial in the same issue, Weber and Hughes point out that infection control probably is better aimed at reducing community risk than at household transmission. Viral infection is unlikely to be diminished by the use of antibacterial preparations. Perhaps other maneuvers, such as covering the mouth during sneezes or coughs, will prove to be more effective in deterring household infection transmission.

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