Antimicrobial Stuff Jim Hutchinson Vancouver Island Health Authority
Transcript of Antimicrobial Stuff Jim Hutchinson Vancouver Island Health Authority
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Antimicrobial StuffAntimicrobial Stuff
Jim HutchinsonJim HutchinsonVancouver Island Health AuthorityVancouver Island Health Authority
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DisclosureDisclosure
• Virox sponsored this symposium including my expenses
• I have no relationship whatsoever with any companies or products mentionedany companies or products mentioned
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My new jobMy new job
• Medical Director of the Vancouver Island Health Authority’s Antimicrobial Stewardship Program
• 50% FTE• 50% FTE
• Organized under Quality, Research and Safety (QRS) along with Infection Prevention
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What is the issue?What is the issue?
• Antimicrobial substances are being put in and on everyday consumer items at a very large and increasing scale
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What is the issue?What is the issue?
• The effects (short and long term) are poorly understood
• The antimicrobial activity of these substances may be contributing to the substances may be contributing to the expanding problem of antimicrobial resistance
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A paradoxA paradox
• Antimicrobial resistance fuels the market for antimicrobial products
• Antimicrobial products may fuel the problem of antimicrobial resistanceproblem of antimicrobial resistance
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An observationAn observation
• Most antimicrobials in substances don’t protect anyone from any disease
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An observationAn observation
• Most antimicrobials in substances don’t protect anyone from any disease
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Another paradoxAnother paradox
• Antimicrobial resistance is identified as a world public health crisis
• There is little regulation of antimicrobials in stuffin stuff
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Another paradoxAnother paradox
• Antimicrobial resistance is identified as a world public health crisis
• There is little regulation of antimicrobials in stuffantimicrobials in stuff
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Another paradoxAnother paradox
• Antimicrobial resistance is identified as a world public health crisis
• There is little regulation of antimicrobials in stuffantimicrobials in stuff
• At least not from the antimicrobial resistance generation perspective
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BiocidesBiocides
• Pesticides used to prevent harmful animals, plants or microorganisms from causing detrimental effects on humans, products, animals or the environmentproducts, animals or the environment
• Most substances are not only antimicrobial
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BiocidesBiocides
• Pesticides used to prevent harmful animals, plants or microorganisms from causing detrimental effects on humans, products, animals or the environmentproducts, animals or the environment
• Most substances are not only antimicrobial
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What is in all the stuff?What is in all the stuff?
• Silver
• Copper and zinc
• Triclosan
• Many other things that it is hard to find • Many other things that it is hard to find information on
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What is in all the stuff?What is in all the stuff?
• Silver
• Copper and zinc
• Triclosan
• Many other things that it is hard to find • Many other things that it is hard to find information on
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SilverSilver
• Sanitized®
• Polygiene®
• Agiene®
• SteriTouch®• SteriTouch®
• X-Static®
• Silpure®
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Silpure® Silpure®
• Thomson Research Associates, Toronto, Canada
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Silpure® Silpure®
A simple to use process that attaches silver to textile fibers, giving long- term protection against the development of odor-causing bacteria. Tests carried out in TRA laboratories established that even on difficult fabrics such as 100% polyester, even on difficult fabrics such as 100% polyester, Silpure provides effective bacteria control through extensive washing cycles
http://www.silpure.com/man-about-silpure.php
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The The TriclosanTriclosan storystory
• 5-Chloro-2- (2,4-dichlorophenoxy) phenol
• An easy to produce chemical with antibacterial propertiesantibacterial properties
• Has been used for more than 20 years as the antiseptic in antiseptic soaps
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Easy to put into stuffEasy to put into stuff
• Mixes into the matrix of many kinds of materials
• Plastics
• Ceramics• Ceramics
• Textiles
• Acrylics
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Big brandsBig brands
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What stuff has biocides?What stuff has biocides?
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Cleaning productsCleaning products
• soaps
• hand-washes
• dish-washing products
• laundry detergents and softeners• laundry detergents and softeners
• deodorants and antiperspirants
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Personal carePersonal care
• toothpaste
• mouth washes
• cosmetics and shaving creams
• acne treatment products• acne treatment products
• hair conditioners
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TextilesTextiles
• sportswear
• underwear
• shoe soles
• hats• hats
• gloves
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TextilesTextiles
• socks
• mattresses
• mattress covers
• pillows• pillows
• bedding
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TextilesTextiles
• towels
• rugs
• furniture
• curtains• curtains
• fabric wall coverings
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Building productsBuilding products
• floor and wall coatings (polyurethane, ceramic tiles, PVC, quartz etc.)
• insulation material for plumbing
• various knobs and handles• various knobs and handles
• hot tubs
• lawn furniture
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Kitchen ware Kitchen ware
• cutting boards
• food boxes
• knives
• salad bowls• salad bowls
• plates
• sinks
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Kitchen wareKitchen ware
• dish brushes
• plastic bags
• refrigerators
• freezers• freezers
• dishwashers
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Bathroom accessories Bathroom accessories
• shower hoses
• tiles
• bathtubs
• toothbrushes• toothbrushes
• shower curtains
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Bathroom accessoriesBathroom accessories
• bath mats
• toilet paper
• toilet lids
• cat litter• cat litter
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Cleaning supplies Cleaning supplies
• scouring mops
• cleaning cloths
• sponges
• washing balls• washing balls
• vacuum cleaners
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Office supplies Office supplies
• pencils
• keyboards
• computer mice
• calculators• calculators
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Office suppliesOffice supplies
• stamps
• headsets
• iPod and mobile phone accessories
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Child care articles Child care articles
• teddy bears
• baby bottles
• nursing pads
• changing stations• changing stations
• diapers
• children's scissors.
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The The TriclosanTriclosan storystory
• Public pressure pushed regulators in many countries
• Environmental lobbies
• Medical Groups• Medical Groups
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The The TriclosanTriclosan storystory
• Dr. Stuart Levy of the Alliance for Prudent Use of Antibiotics (APUA)
• Described specific mechanism of action similar to an anti-TB drugsimilar to an anti-TB drug
• Resistance generation is easy in the laboratory
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TriclosanTriclosan in peoplein people
• CDC National Health and Nutrition Examination Survey (NHANES) 2003-2004
• 75% had measurable levels• 75% had measurable levels
• Mean 13µg/L
• 95 percentile 461 µg/L
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EU Review 2002EU Review 2002
“there is no convincing evidence that triclosan poses a risk to humans or to the environment by inducing or transmitting antibacterial resistance under current antibacterial resistance under current conditions of use.”
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Hence, overall, the new studies available since the EU review
provide no evidence that triclosan poses a risk to humans or to
the environment by inducing or transmitting antibacterial
resistance under current conditions of use. Though the
recent limited number of studies do not resolve specific
Australian Review 2009Australian Review 2009
recent limited number of studies do not resolve specific
technical/use issues identified by the SSC (see EC Health &
Consumer Protection Directorate-General, 2002a), and
therefore the relationship between the use of biocides and the
development of clinically relevant antimicrobial resistance
should be kept under regular review.
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Hence, overall, the new studies available since the EU review
provide no evidence that triclosan poses a risk to humans or to
the environment by inducing or transmitting antibacterial
resistance under current conditions of use. Though the
recent limited number of studies do not resolve specific
Australian Review 2009Australian Review 2009
recent limited number of studies do not resolve specific
technical/use issues identified by the SSC (see EC Health &
Consumer Protection Directorate-General, 2002a), and
therefore the relationship between the use of biocides and the
development of clinically relevant antimicrobial resistance
should be kept under regular review.
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What is Canada doing?What is Canada doing?
• Very recent report
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What is Canada doing?What is Canada doing?
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Three regulatory actsThree regulatory acts
• Canadian Environmental Protection Act 1999 (CEPA 1999)
• Pest Control Products Act (PCPA)
• Food and Drugs Act• Food and Drugs Act
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Government positionGovernment position
“The Government of Canada is proposing that triclosan is safe for human health within identified maximum limits, but can be harmful to the environment.”be harmful to the environment.”
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Pest Control Products ActPest Control Products Act
• Therefore, PMRA proposes to conclude that the use of pest control products containing triclosandoes not pose an unacceptable risk to the environment. No further risk mitigation measures will be required at this time, as the current registrant of triclosan has chosen not to maintain registrant of triclosan has chosen not to maintain its Canadian registration. Should a registrant seek to re-enter the Canadian market, further data may be required to supplement the current risk assessment.
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Pest Control Products ActPest Control Products Act
• “No further risk mitigation measures will be required at this time, as the current registrant of triclosan has chosen not to maintain its Canadian registration.”maintain its Canadian registration.”
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TriclosanTriclosan Products Registered under the Products Registered under the Pest Control Products ActPest Control Products Act
Manufacturer Product
Thomson Research Associates Ultra-Fresh 300DD Non-ionic Liquid
Sanitized Inc. Sanitized Brand Bacteriostat S-2 Liquid
Sanitized Inc. Sanitized Brand Bacteriostat T 96-21 LiquidSanitized Inc. Sanitized Brand Bacteriostat T 96-21 Liquid
Sanitized Inc. Sanitized Brand Bacteriostat SN Liquid
Thomson Research Associates Ultra-fresh NM Germistat Concentrate
Ciba-Geigy Irgasan DP-300R Technical Powder
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What now?What now?
• Precautionary principle
• Antimicrobial resistance is real and is serious
• Health Care Workers must be advocates• Health Care Workers must be advocates
• Lets reserve the antimicrobials for the people with infections
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The role of governmentThe role of government
• This is very obviously (to me) a function of government
• We must lobby for continued and enhanced legislation, regulation and enhanced legislation, regulation and monitoring
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