title: Is reduced susceptibility to disinfectants and antiseptics a risk in healthcare settings? A point/counterpoint review.
abstract: BACKGROUND
  Given the breadth and depth of antiseptic use, it is surprising how few large-scale studies have been undertaken into the consequences of their use, particularly in clinical practice. Depending on your point of view, this may either reflect an assurance that reduced susceptibility to antiseptics, and notably whether this confers cross-resistance to systemically administered antimicrobial agents, is not an issue of concern, or relative ignorance about the potential threat.
  
  
  OBJECTIVE
  This point/counterpoint review offers a differentiated perspective and possible answers to the question, 'Should we be worried about reduced susceptibility to disinfectants and antiseptics in healthcare settings?'.
  
  
  METHODS
  This topic was the subject of a debate by MHW (point) and SH (counterpoint) during the SHEA Spring Conference 2013: Advancing healthcare epidemiology and the role of the environment, held in Atlanta, GA, USA on 4(th) May 2013. This review is a general representation of the main themes presented during the debate, rather than a systematic review of the literature.
  
  
  RESULTS
  There are examples of reduced susceptibility to antiseptics in clinical practice; however, to date, there is no strong evidence that reduced susceptibility to antiseptics is a major clinical problem. Given the growing number of potential indications for use of biocidal active ingredients, the potential for emergence of reduced susceptibility remains a concern.
  
  
  CONCLUSIONS
  Changes in the clinical use of antiseptics should be matched with surveillance studies to understand whether there are unintended microbiological or clinical consequences, including the selection of bacterial strains that can survive exposure to antiseptics.
authors.affiliation: Geneva University Hospitals and Medical School, Geneva, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Harbarth
authors.affiliation: Hospital Buloh, Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Tuan Soh
authors.affiliation: Leeds Teaching Hospitals and University of Leeds, Leeds, UK.
authors.forename: C
authors.initials: C
authors.lastname: Horner
authors.affiliation: Leeds Teaching Hospitals and University of Leeds, Leeds, UK. Electronic address: mark.wilcox@leedsth.nhs.uk.
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004202:Disinfectants / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D006268:Health Facilities; D006801:Humans; D018570:Risk Assessment; D014481:United States
chemical_list: D000891:Anti-Infective Agents, Local; D004202:Disinfectants
keywords: Antimicrobial resistance; Antiseptic; Disinfectant; Epidemiology; Multi-drug-resistant bacteria; Reduced susceptibility