Weird Wastes: Antimicrobials in Household Cleaners

1. Weird Wastes: Antimicrobials in Household Cleaners Ann Blake, Ph.D. PSI/ Northwest NAHMMA June 3, 2009

2. Today’s Topics • Health and environmental impacts of common disinfectants • General concerns • Antibacterials/ antimicrobials: specific concerns • Triclosan, Triclocarban, quaternary ammonium compounds (“quats”) • Regulatory structures and their gaps • Poster children for the Precautionary Principle • “Is this product/ process necessary?” • Most effective leverage points to change a system • Chemicals policy reform….. • Educating consumers • Educating medical professionals • Enforce against CAFOs • Sustainable agriculture • Others?

3. Health Effects of Common Disinfectants: General • Skin, eye, respiratory irritation • Asthma & immune system hazards • Endocrine disruption/ reproductive hazards • Emerging subtle neural effects • Disruption of neuronal cell-signaling systems • Indoor air quality: • interactions with ambient air pollutants • Unknown: nano-silver

4. Health Effects: Childhood Poisonings • Cosmetics and personal care products accounted for over 13% of poisonings in children five years old or under, with household cleaners a close second at nearly 10% of poisonings in this same group. Antimicrobial compounds make up another 3% of childhood poisonings in young children. • Food poisoning and food products, by contrast, make up 1.4% of poisonings. • For all poisoning cases, regardless of age, analgesics exceed cosmetics, personal care products and household cleaners at 12%. Analgesics are the third most likely source of childhood poisonings[1]. • [1] 2006 Annual Report of the American Association of Poison Control Centers' National Poison Data System (NPDS) Alvin C. Bronstein; Daniel A. Spyker; Louis R. Cantilena Jr; Jody Green; Barry H. Rumack; Stuart E. Heard, p. 18 Tables 17A and 17B http://www.aapcc.org/archive/Annual%20Reports/06Report/2006%20Annual%20Report%20Final.pdf

5. Life Cycle of an Anti-Microbial

6. Antibacterials: TCS/ TCC • Triclosan (b. 1964): Ciba • Registered pesticide; 40 formulations approved for use by US EPA in 140 types of consumer products • Until the early 1970s, used primarily in hospital settings • Currently used in over 75% of liquid hand & dish soaps (at 0.5-3.0%) • Triclocarban (b. 1957): Lanxess • Used in over 30% of bar soaps

7. Regulatory Authority • US EPA • Federal Insecticide Fungicide and Rodenticide Act (FIFRA) • Must submit efficacy data for each microbe class; information on label • Safe Drinking Water Act • Need data on prevalence, persistence, potency to regulate under this authority • US FDA • Non-prescription drugs • Approved for OTC topical antimicrobial at 1.5% • New Drug Application (NDA) process: drugs • e.g. Colgate Total Toothpaste for gingivitis • Dental cement, sutures • Antibacterial vs. antimicrobial • Antibacterial: bacteria only • Antimicrobial: bacteria and viruses

8. Polybrominated Diphenyl Ether: PBDE Added to POPS lists May 2009 Tri-chlorinated diphenyl ether: Triclosan Meets EU REACH criteria for SVHC Déjà vu all over again…

9. Is it in you? • Widespread human exposure • 2003-2004 NHANES found TCS in the urine of 75% of Americans (Calafat, CDC 2007) • No differences due to race/ ethnicity or sex • Concentration peaks at age 20-29 and in households with income $20K and > $40K year • In girls aged 6 to 8, found in 61% of urine samples (Mt. Sinai, 2007) • In breast milk and urine, US and Sweden • Linked to use of personal care products • USGS: 1 ppm in most surface waters • Found in 58% of 85 streams studied • Wastewater treatment plants are the biggest sources of TCS, TCC (2002 USGS study)

10. Environmental Working Group www.ewg.org/reports/triclosan, July 2008

11. Antibacterials: Specific Concerns • Increased inclusion in consumer products, often unknown to the consumer • Over $1 billion/ year spent on consumer products containing antibacterials/ antimicrobials • Massive increase in wastewater and biosolids • 9 ppb in influent, 10x reduction in effluent, 5 orders of magnitude concentration in biosolids: 50- 68 ppm combined • TCS 20 ppm median, TCC 10 ppm median • 12 million tons/ year of biosolids generated, of which 50% are land-applied • Accumulating in biosolids applied to food crops • 10-25 ppm TCS/ TCC in biosolids land-applied to food crops • Persistence: under land-applied aerobic conditions, • TCS < I yr, TCC > 10 yrs • TCS contains dioxin contaminants, degrades into chloroform or dioxin upon exposure to UV

12. Environmental Impacts • Already a hazard for microbes, algae, crustacea, fish at existing environmental concentrations • Potential for thyroid hormone disruption • TCS disrupts TH-mediated development in tadpoles • At 10 micromolar concentration, impacts on liver enzyme (PXR) that breaks down TH • Bioconcentration in earthworms • 90 different “anthropogenic waste indicators” studied at Colorado State University, top three were • TCS @ 10 ppm • DEHP @ 20 ppm • 1,7 dimethylxanthine, a coffee metabolite • TCS had highest BCF at 10.8, and as high as 39.6 in an Oregon hayfield with repeated land applications of biosolids

13. Quaternary Ammonium Chlorides • Traditionally used in medical settings; increasingly added to consumer “disinfecting cleaners” • Known occupational asthmagens • Now found in every municipal water system at ppm concentrations • Emerging data show immune adjuvant effects (pig farmers using disinfectants) • Possible contributor to drastic rise in pediatric asthma • Nature, June 2008: Patricia Hunt, who highlighted hazard of BPA leaching from plastic….found the same thing for ammonium chloride disinfectants used on her mouse cages

14. Antibacterial resistance Antibiotics given to animals 'helping spread superbugs' Over-use of antibiotics on livestock is helping potentially lethal human infections become more resistant to drugs, an expert has warned. By Joanna Corrigan Last Updated: 7:20PM BST 10 Aug 2008 New strains of MRSA and E.coli have already developed in animals and are starting to transfer to humans, according to Richard Young, policy adviser to the Soil Association.

15. Antibacterial Soaps • Plain soap and water as effective in general use as antibacterial soaps • AMA 2002: “No data support the efficacy or necessity of antimicrobial agents in such products. …Considering available data and the critical nature of the antibiotic-resistance problem, it is prudent to avoid the use of antimicrobial agents in consumer products." • FDA 2005: "The data we saw said handwashing was pretty effective, plain handwashing, and there was no data that …was very convincing that antiseptic handwashing was substantially more effective." • FDA to study efficacy of use for food handlers, health care workers vs. general consumer public • Resistance to one antimicrobial often associated with cross-resistance to other compounds

16. What’s actually necessary? • WASH YOUR HANDS REGULARLY • CLEAN FIRST: physically removes most disease-causing organisms • http://www.cdc.gov/ncidod/op/_resources/OOP%20Brochure%2012.20.05.pdf • Safe food handling reduces biggest home-based illness sources • Per USDA: Clean, Separate, Cook, Chill • Microwave sponges • Disinfect if someone in your house is immune compromised (chemo, autoimmune, etc.) or currently sick • CDC http://www.cdc.gov/Features/FightGerms/

17. Possible Solutions • Chemical disinfection is unnecessary in most situations • Encourage the use of cleaners that do not contain anti-bacterials (both home and workplace) • Remove TCS,TCC, quats from consumer products • Keep effective for appropriate uses (medical, etc.) • 66% of pharmaceutical/ personal care product chemical loading in biosolids could be eliminated if we eliminate just these two compounds • Support sustainable agriculture • Reduces overall use of antibiotics and risk of antibiotic resistance • Keeps antibiotics effective for when we need them

18. Keep Cows (and Pigs and Chickens) Happy

19. Additional Resources • PORS presentations and upcoming EHP summary http://www.epa.gov/region09/waste/organics/symposium/index.html • Environmental Working Group http://www.ewg.org/reports/triclosan • Beyond Pesticides http://www.beyondpesticides.org/pesticides/factsheets/Triclosan%20cited.pdf http://www.beyondpesticides.org/infoservices/pesticidesandyou/Winter%2004-05/triclosan%20update.pdf • Antibiotic resistance: http://www.cdc.gov/ncidod/eid/vol7no3_supp/levy.htm • Manufacturers: Ciba: http://cibasc.com/index/ind-index/ind-per_car/ind-pc-ah/ind-pc-triclosan.htm

20. Environmental and Public Health Consulting 510-769-7008 annblake@comcast.net www.annblake.net