Vancouver Statement on Antimicrobials in Consumer Products

A consensus of scientists and healthcare professionals on the hazards and lack of well substantiated benefit of many antimicrobial chemicals as used in consumer products

As scientists and healthcare professionals, we are concerned about the continued widespread use of many antimicrobial chemicals in consumer products where no evidence-based benefit has been demonstrated. Chemicals of concern include QACs (e.g., benzalkonium chloride, benzethonium chloride, and didecyldimethylammonium chloride), halogenated aromatics (i.e., chloroxylenol, triclosan, and triclocarban), bisbiguanides (i.e., chlorhexidine), and metal-based agents (i.e., silver) used in consumer antibacterial soaps, wipes, sprays, laundry sanitizers, antimicrobial-treated textiles, and other household and building products. We are concerned for the following reasons:

1. Antimicrobial chemicals are unnecessarily present in many consumer products. For example, there is no evidence that antibacterial hand soap containing QACs, chloroxylenol, or related biocides prevents infection or improves health outcomes compared to plain soap and water in household or community settings. There is similarly no evidence that laundry sanitizers, antimicrobial clothing, or antimicrobial durable goods provide health benefits to consumers.
2. When disinfection is warranted in consumer settings, effective and less persistent alternatives are available including alcohols, hydrogen peroxide, sodium hypochlorite (bleach), citric acid and other organic acids, or non-halogenated phenolics such as thymol.
3. QACs and related biocides promote the development of resistance in microbes through multiple mechanisms. Cross-resistance between these biocides and clinically important antibiotics has been demonstrated in laboratory and environmental settings. Widespread consumer use of antimicrobial products could be an important and avoidable contributor to environmental antimicrobial resistance. The World Health Organization states that antimicrobial resistance is one of the greatest global health threats.
4. Many antimicrobials are linked to dermal and respiratory disease in humans as well as reproductive, developmental, neurological, cardiovascular, and other harms in animal studies including at environmental concentrations.
5. Emerging evidence shows that repeated exposure to these chemicals can disrupt both skin and gut microbiomes. Skin microbiome disruption is associated with eczema, atopic dermatitis, and increased susceptibility to skin infections. Gut microbiome disruption is associated with altered immune development, metabolic disturbance, increased colonization by opportunistic pathogens, and neurological effects in human and animal studies.
6. Many of these chemicals accumulate in indoor dust and are detected in indoor air, particularly in settings where antimicrobial sprays and wipes are used regularly. Inhalation and dust ingestion represent significant exposure routes, especially for workers, infants, and young children. Dermal exposure from antimicrobial treated surfaces and textiles adds to this burden.
7. Several of these antimicrobials or their metabolites are widely detected in human blood, breast milk, urine, meconium, and stool. Exposure has increased substantially with pandemic-era product expansion.
8. Many of these consumer products are washed down the drain and enter wastewater treatment or septic systems. For many of these compounds, such as QACs, a sizable fraction accumulates in the sewage sludge produced by wastewater treatment plants which may then be land applied. The fraction emitted in liquid effluent can accumulate in the sediments and biota in receiving waters where they are toxic to aquatic microorganisms and can disrupt microbial community structure. High concentrations in influent can disrupt certain wastewater treatment processes.
9. The substitution of harmful antimicrobials with inadequately evaluated replacements is a recurring pattern. Triclosan and triclocarban were themselves introduced as substitutes for the neurotoxic hexachlorophene after it was restricted in the 1970s. Antimicrobial additives should not be incorporated into consumer products unless there is clear evidence of benefit to reduce infection transmission in real-world settings and adequate evidence of safety.

We therefore call on the international community to stop non-essential uses of these antimicrobial chemicals. We urge scientists, governments, unions, chemical and product manufacturers, purchasing organizations, retailers, and consumers to take the actions recommended below.

Recommendations

Regulators

• Prohibit QACs, chloroxylenol, chlorhexidine, metal agents, and related biocides in consumer hand and body soaps, wipes, surface sprays, laundry sanitizers, clothing, and other products marketed to the general public without evidence of benefit or where safer alternatives exist.
• Require demonstration of both safety (including evaluating the potential to contribute to antimicrobial resistance) and efficacy over existing safer alternatives before approving any new and when reevaluating currently approved antimicrobial active ingredient for consumer use.
• Prohibit antimicrobial claims and marketing for consumer products that lack credible, independent evidence of an infection-prevention benefit.
• Provide guidance for safer cleaning and prioritize restricting non-essential use of antimicrobial consumer products in schools and other settings serving children, given their higher exposures through hand-to-mouth contact, dust ingestion, and floor contact, and the vulnerability of their developing immune system and microbiome.

Chemical and Product Manufacturers

• Stop using antimicrobial ingredients in consumer products where no benefit has been demonstrated, and refrain from substituting one biocide for another. Where an antimicrobial ingredient has been restricted, the product should be reformulated without antimicrobial additives unless a clear and evidence-based need for antimicrobial functionality can be demonstrated.
• Disclose all antimicrobial ingredients that are intentionally used in products (such as soaps, detergents, etc.)

Institutions

• Schools, workplaces, gyms, and other non-healthcare institutions should avoid using antimicrobial consumer products for routine use. Cleaning protocols should call for plain soap and water or, where disinfection is needed, less persistent alternatives such as hydrogen peroxide, sodium hypochlorite, or alcohol-based products used by trained staff with proper protections.