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While antimicrobial drug-containing products are superior to plain soaps for reducing both transient pathogens and colonizing flora, widespread use of these agents has raised concerns about the emergence of bacterial strains resistant to antiseptic ingredients such as triclosan (32,33). Such resistance has been noted in England and Japan (34), and molecular mechanisms for the development of resistance have been proposed (32,35). Although in some settings exposure to antiseptics has occurred for years without the appearance of resistance, a recent study described mutants of Escherichia coli selected for resistance to one disinfectant that were also multiply-antibiotic resistant (35).
Some evidence indicates that long-term use of topical antimicrobial agents may alter skin flora (36,37). The question remains whether antimicrobial soaps provide sufficient benefit in reducing transmission of infection without added risk or cost.
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Soaps and detergents have been described as the most damaging of all substances routinely applied to skin (43). Anionic and cationic detergents are more harmful than nonionic detergents (54), and increased concentrations of surfactant result in more rapid, severe damage
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Damaged skin more often harbors increased numbers of pathogens. Moreover, washing damaged skin is less effective at reducing numbers of bacteria than washing normal skin, and numbers of organisms shed from damaged skin are often higher than from healthy skin