Publications, Data, & Statistics

• Bowen A, Agboatwalla M, Luby S, Tobery T, Ayers T, Hoekstra RM. Improvements in child development following a cluster-randomized, controlled trial of intensive handwashing promotion—Karachi, Pakistan. Arch Pediatr Adol Med. 2012 166;(11):1037-1044.
• Palit A, Batabyal P, Kanungo S, Sur D. In-house contamination of potable water in urban slum of Kolkata, India: a possible transmission route of diarrhea. Water Sci Technol. 2012;66(2):299-303.
• Curtis V, Schmidt W, Luby S, Florez R, Touré O, Biran A. Hygiene: new hopes, new horizons. Lancet Infect Dis. 2011 Apr;11(4):312-21.
• Stewardson A, Allegranzi B, Sax H, Kilpatrick C, Pittet D. Back to the future: rising to the Semmelweis challenge in hand hygiene. Future Microbiol. 2011 Aug;6(8):855-76.
• Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, Mohareb E, El-Sayed N. Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis. 2011 Apr;17(4):619-25.
• Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis. Am J Public Health. 2008;98(8):1372-81.
• Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database Syst Rev. 2008;1:CD004265.
• Bowen A, Ma H, Ou J, Billhimer W, Long T, Zeng M, Wang E, Painter J, Mintz E, Luby S.  A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg. 2007;76(6):1166-1173, 2007.
• Huang DB, Zhou J. Effect of intensive handwashing in the prevention of diarrhoeal illness among patients with AIDS: a randomized controlled study.  J Med Microbiol. 2007;56(5):659-63.
• Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer W, Keswick B, Hoekstra RM. Combining drinking water treatment and hand washing for diarrhoea prevention, a cluster randomised controlled trial. Trop Med Int Health. 2006 Apr;11(4):479-89.
• Rabie T, Curtis V. Handwashing and risk of respiratory infections: a quantitative systematic review.  Trop Med Int Health. 2006 Mar;11(3):258-67.
• Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005;366:225-33.
• Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L, Colford JM Jr. Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. Lancet Infect Dis. 2005 Jan;5(1):42-52.
• Roberts L, Jorm L, Patel M, Smith W, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of diarrheal episodes in child care: a randomized, controlled trial. Pediatrics. 2000 Apr;105(4 Pt 1):743-6.
• Roberts L, Smith W, Jorm L, Patel M, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomized, controlled trial. Pediatrics. 2000 Apr;105(4 Pt 1):738-42.

• Carrico AR, Spoden M, Wallston KA, Vandenbergh MP. The Environmental cost of misinformation: why the recommendation to use elevated temperatures for handwashing is problematic. Int J Consum Stud. 2013 Jul 1;37(4):433-441.
• Burton M, Cobb E, Donachie P, Judah G, Curtis V, Schmidt WP. The effect of handwashing with water or soap on bacterial contamination of hands. Int J Environ Res Public Health. 2011 Jan;8(1):97-104.
• Luby SP, Halder AK, Huda T, Unicomb L, Johnston RB. The effect of handwashing at recommended times with water alone and with soap on child diarrhea in rural Bangladesh: an observational study. PLoS Med. 2011 Jun;8(6):e1001052.
• Todd ECD, Michaels BS, Holah J, Smith D, Grieg JD, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 10. Alcohol-based antiseptics for hand disinfection and a comparison of their effectiveness with soaps. J Food Prot. 2010 Nov;73(11):2128-40.
• Todd EC, Michaels BS, Smith D, Greig JD, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 9. Washing and drying of hands to reduce microbial contamination. J Food Prot. 2010 Oct;73(10):1937-55.
• Fuls JL, Rodgers ND, Fischler GE, Howard JM, Patel M, Weidner PL, Duran MH. Alternative hand contamination technique to compare the activities of antimicrobial and nonantimicrobial soaps under different test conditions. Appl Environ Microbiol. 2008 Jun;74(12):3739-44.
• Gordin FM, Schultz ME, Huber R, Zubairi S, Stock F, Kariyil J. A cluster of hemodialysis-related bacteremia linked to artificial fingernails. Infect Control Hosp Epidemiol. 2007 Jun;28(6):743-4.
• Luby SP, Agboatwalla M, Billhimer W, Hoekstra RM. Field trial of a low cost method to evaluate hand cleanliness. Trop Med Int Health. 2007 Jun;12(6):765-71
• Laestadius JG, Dimberg L. Hot water for handwashing–where is the proof? J Occup Environ Med. 2005 Apr;47(4):434-5.
• Hoque BA. Handwashing practices and challenges in Bangladesh. Int J Environ Health Res. 2003 Jun;13 Suppl 1:S81-7.
• Lin CM, Wu FM, Kim HK, Doyle MP, Michael BS, Williams LK. A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails. J Food Prot. 2003 Dec;66(12):2296-301.
• Michaels B, Gangar V, Schultz A, Arenas M, Curiale M, Ayers T, Paulson D. Water temperature as a factor in handwashing efficacy. Food Service Technology. 2002;2:139-49.
• McGinley KJ, Larson EL, Leyden JJ. Composition and density of microflora in the subungual space of the hand. J Clin Microbiol. 1988 May;26(5): 950–953.
  

Handwashing has been clearly shown to prevent a variety of diseases and is one of the most important ways to protect oneself and others from infections. To date, studies have shown that there is no added health benefit for consumers (this does not include professionals in the healthcare setting) using soaps containing antibacterial ingredients compared with using plain soap. CDC looks forward to any future data about the safety and effectiveness of antibacterial consumer products and will continue to adjust recommendations based on the best available science.

Efficacy of Antibacterial Soaps

• Boyce JM, Dupont HL, Massaro J, Sack D, Schaffner DW. An expert panel report of a proposed scientific model demonstrating the effectiveness of antibacterial handwash products. Am J Infect Control. 2012 Oct;40(8):742-9.
• Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot. 2011 Nov;74(11):1875-82.
• Aiello AE, Larson EL, Levy SB. Consumer antibacterial soaps: effective or just risky? Clin Infect Dis. 2007 Sep 1;45 Suppl 2:S137-47.
• Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: a randomised controlled trial. Lancet. 2005 Jul 16-22;366(9481):225-33.
• Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA. 2004 Jun 2;291(21):2547-54.
• Larson EL, Lin SX, Gomez-Pichardo C, Della-Latta P. Effect of antibacterial home cleaning and handwashing products on infectious disease symptoms: a randomized, double-blind trial. Ann Intern Med. 2004 Mar 2;140(5):321-9.

Environmental Fate & Potential Health Impact of Antibacterial Soap Additives

• Lankester J, Patel C, Cullen MR, Ley C, Parsonnet J. Urinary Triclosan is associated with elevated body mass index in NHANES. PLoS One. 2013 Nov 21;8(11):e80057.
• Butt CM, Stapleton HM. Inhibition of thyroid hormone sulfotransferase activity by brominated flame retardants and halogenated phenolics. Chem Res Toxicol. 2013 Nov 18;26(11):1692-702.
• Padhye LP, Yao H, Kung'u FT, Huang CH. Year-long evaluation on the occurrence and fate of pharmaceuticals, personal care products, and endocrine disrupting chemicals in an urban drinking water treatment plant. Water Res. 2013 Nov 7.
• Frederiksen H, Nielsen JK, Mørck TA, Hansen PW, Jensen JF, Nielsen O, Andersson AM, Knudsen LE. Urinary excretion of phthalate metabolites, phenols and parabens in rural and urban Danish mother-child pairs. Int J Hyg Environ Health. 2013 Nov;216(6):772-83.
• Lozano N, Rice CP, Ramirez M, Torrents A. Fate of Triclocarban, Triclosan and Methyltriclosan during wastewater and biosolids treatment processes. Water Res. 2013 Sep;47(13):4519-27.
• Meeker JD, Cantonwine DE, Rivera-González LO, Ferguson KK, Mukherjee B, Calafat AM, Ye X, Anzalota Del Toro LV, Crespo-Hernández N, Jiménez-Vélez B, Alshawabkeh AN, Cordero JF. Distribution, variability, and predictors of urinary concentrations of phenols and parabens among pregnant women in Puerto Rico. Environ Sci Technol. 2013 Apr 2;47(7):3439-47.

• Huang C, Ma W, Stack S. The hygienic efficacy of different hand-drying methods: a review of the evidence. Mayo Clin Proc. 2012 Aug;87(8):791-8.
• Jensen D, Schaffner D, Danyluk M, Harris L. Efficacy of handwashing duration and drying methods. Int Assn Food Prot. 2012 July.
• Gustafson DR, Vetter EA, Larson DR, Ilstrup DM, Maker MD, Thompson RL, Cockerill FR 3rd. Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial. Mayo Clin Proc. 2000 Jul;75(7):705-8.
• Patrick DR, Findon G, Miller TE. Residual moisture determines the level of touch-contact-associated bacterial transfer following hand washing. Epidemiol Infect. 1997 Dec;119(3):319-25.

• Blaney DD, Daly ER, Kirkland KB, Tongren JE, Kelso PT, Talbot EA. Use of alcohol-based hand sanitizers as a risk factor for norovirus outbreaks in long-term care facilities in northern New England: December 2006 to March 2007. Am J Infect Control. 2011 May;39(4):296-301.
• Pickering AJ, Davis J, Boehm AB. Efficacy of alcohol-based hand sanitizer on hands soiled with dirt and cooking oil. J Water Health. 2011 Sep;9(3):429-33.
• Pickering AJ, Boehm AB, Mwanjali M, Davis J. Efficacy of waterless hand hygiene compared with handwashing with soap: a field study in Dar es Salaam, Tanzania. Am J Trop Med Hyg. 2010 Feb;82(2):270-8.
• Stebbins S, Cummings DA, Stark JH, Vukotich C, Mitruka K, Thompson W, Rinaldo C, Roth L, Wagner M, Wisniewski SR, Dato V, Eng H, Burke DS. Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial. Pediatr Infect Dis J. 2011 Nov;30(11):921-6.
• Edmonds SL, Mann J, McCormack RR, Macinga DR, Fricker CM, Arbogast JW, Dolan MJ. SaniTwice: a novel approach to hand hygiene for reducing bacterial contamination on hands when soap and water are unavailable. J Food Prot. 2010 Dec;73(12):2296-300.
• Hübner NO, Hübner C, Wodny M, Kampf G, Kramer A. Effectiveness of alcohol-based hand disinfectants in a public administration: Impact on health and work performance related to acute respiratory symptoms and diarrhoea. BMC Infect Dis. 2010;10:250.
• Kampf G, Marschall S, Eggerstedt S, Ostermeyer C. Efficacy of ethanol-based hand foams using clinically relevant amounts: a cross-over controlled study among healthy volunteers. BMC Infect Dis. 2010 Mar 26;10:78.
• Todd EC, Michaels BS, Holah J, Smith D, Greig JD, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 10. Alcohol-based antiseptics for hand disinfection and a comparison of their effectiveness with soaps. J Food Prot. 2010 Nov;73(11):2128-40.
• Miller M, Borys D, Morgan D. Alcohol-based hand sanitizers and unintended pediatric exposures: a retrospective review. Clin Pediatr (Phila). 2009 May;48(4):429-31.
• Grayson ML, Melvani S, Druce J, Barr IG, Ballard SA, Johnson PD, Mastorakos T, Birch C. Efficacy of soap and water and alcohol-based hand-rub preparations against live H1N1 influenza virus on the hands of human volunteers. Clin Infect Dis. 2009 Feb 1;48(3):285-91.
• Oughton MT, Loo VG, Dendukuri N, Fenn S, Libman MD. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infect Control Hosp Epidemiol. 2009 Oct;30(10):939-44.
• Kramer A, Galabov AS, Sattar SA, Döhner L, Pivert A, Payan C, Wolff MH, Yilmaz A, Steinmann J. Virucidal activity of a new hand disinfectant with reduced ethanol content: comparison with other alcohol-based formulations. J Hosp Infect. 2006 Jan;62(1):98-106.
• Lee GM, Salomon JA, Friedman JF, Hibberd PL, Ross-Degnan D, Zasloff E, Bediako S, Goldmann DA. Illness transmission in the home: a possible role for alcohol-based hand gels. Pediatrics. 2005 Apr;115(4):852-60.
• Sandora TJ, Taveras EM, Shih MC, Resnick EA, Lee GM, Ross-Degnan D, Goldmann DA. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics. 2005 Sep;116(3):587-94.
• Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev. 2004 Oct;17(4):863-93.
• CDC. Antimicrobial spectrum and characteristics of hand-hygiene antiseptic agents. MMWR Morb Mortal Wkly Rep. 2002;51(RR16):45.
• Charbonneau DL, Ponte JM, Kochanowski BA. A method of assessing the efficacy of hand sanitizers: use of real soil encountered in the food service industry. J Food Prot. 2000 Apr;63(4):495-501.
• Barbee SL, Weber DJ, Sobsey MD, Rutala WA. Inactivation of Cryptosporidium parvum oocyst infectivity by disinfection and sterilization processes. Gastrointest Endosc. 1999 May;49(5):605-11.

• National Association of State Public Health Veterinarians, Inc., CDC. Compendium of measures to prevent disease associated with animals in public settings, 2011: National Association of State Public Health Veterinarians, Inc. [PDF - 28 pages] MMWR Recomm Rep. 2011;60(RR-04):1-24.