A risk assessment framework for the evaluation of skin infections and the potential impact of antibacterial soap washing

Abstract

Antibacterial soaps may have an important role in the control of skin infection. However, quantitative estimation of their benefit is difficult because of the problems associated with conducting epidemiologic studies. An alternative benefit estimation approach, quantitative microbial risk assessment, has application to this problem. This article sets forth the quantitative microbial risk assessment method and applies it specifically to the estimation of the reduction in risk of dermal infection from Staphylococcus aureus resulting from use of antibacterial soaps. A dose-response model was formulated by using available information on growth kinetics of the organism on the skin and dose data based on the inoculation of the forearm skin in volunteers. A predictive relationship for microbial growth on the skin was developed. These data were limited, and clearly more studies are needed on inoculation at more than one site and growth leading to infection on the skin with and without the use of germicidal soaps. However, by using relationships based on extant data sets, it was estimated that the use of germicidal soap could result in a substantial reduction in the risk of infection by S aureus . The estimated risk reduction was in general concordance with published results from epidemiologic studies conducted on military cadets. The methodology of quantitative microbial risk assessment has thus been shown to be applicable to this problem and may have broader applicability in other personal hygiene contexts. (AJIC Am J Infect Control 1999;27:S26-S33)