The use of soap and detergents in skin diseases; an evaluation of a new soapless soap.
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A comparison has been made of the in-use bacterial load of two bar soaps with and without antibacterials and two liquid soaps in five different locations over a 1-week period. Of the 25 samples taken from each soap, 92 to 96% of samples from bar soaps were culture positive as compared to 8% of those from liquid soaps. Bacterial populations ranged from 0 to 3.8 log CFU per sample for bar soaps and from 0 to 2.0 log CFU per sample for liquid soaps. The mean bacterial populations per sample were 1.96 and 2.47 log CFU for the two bar soaps, and 0.08 and 0.12 log CFU for the two liquid soaps. The difference in bacterial population between bar soaps and liquid soaps was statistically significant (P = 0.005). Staphylococcus aureus was isolated on three occasions from bar soaps but not from liquid soaps. S. aureus was isolated twice from the exterior of the plastic dispensers of liquid soap but not from the soap itself. Gram-negative bacteria were cultured only from soaps containing antibacterials. Bacterial populations on bar soaps were not high compared with bacterial populations on hands, and the flora was continually changing without evidence of a carrier state.
BACKGROUND: The difference between use of a scrub brush versus soap alone in reducing hand bacterial counts has never been established by a prospective, comparative study. METHODS: Fifteen volunteers were taught the 5-minute surgical scrub. Baseline specimens were obtained by the glove fluid sampling procedure. Subjects were randomized to (1) scrub with an inert scrub brush and 4% chlorhexidine soap with isopropyl alcohol or (2) wash with 4% chlorhexidine soap with isopropyl alcohol alone. Specimens were obtained immediately after the scrub was completed and 45 minutes later. The experiment was repeated by use of a cross-over design after a 1-week washout period. The data were analyzed by three methods that took into account the broad range of baseline hand counts (5 x 10(1) to 11.2 x 10(4): method 1, the discordance between presence/absence of hand bacterial counts within individuals at 45 minutes for soap versus soap and brush; method 2, the absolute reduction of bacteria (baseline vs 45 min.) for soap versus soap and brush; and method 3, the proportional change in bacterial counts at 45 minutes from baseline for soap versus soap and brush. RESULTS: Although there was no statistically significant difference for any method, the point estimates for the odds ratio (OR) showed that up to twice the number of subjects had a greater reduction in bacterial counts when they washed with soap than when they scrubbed with a brush, as evidenced by the following data: method 1, OR 2.3 (95% confidence interval [CI] 0.53, 13.99) for soap alone; method 2, OR 1.0 (CI 0.23, 4.35); and method 3, OR 2.0 (CI 0.54, 9.10) for soap alone. CONCLUSIONS: The effect of use of soap alone in reducing hand bacterial counts at 45 minutes was similar to use of soap and brush. Soap can be used alone and the surgical infection rate prospectively monitored.
Two trials were conducted to determine the effects of calcium soaps of long-chain fatty acids (calcium soap) on feedlot performance, diet digestibility, carcass characteristics and ruminal metabolism of steers fed diets (85% concentrate:15% corn silage) containing 0, 2, 4 or 6% calcium soap. In Trial 1, increasing calcium soap decreased (P less than .05) DM, CP and gross energy intake but increased total fatty acid intake. Feed to gain ratio tended to improve with increased calcium soap; gross energy conversion was not affected (P greater than .05) by diet. Average daily gain and hot carcass weight decreased (P less than .05) with addition of calcium soap; other carcass characteristics were not affected (P greater than .05). Apparent digestibilities of DM, N, energy and ash were not affected (P greater than .05) by calcium soap. Neutral detergent fiber digestibility increased linearly (P less than .08) with increasing calcium soap, whereas digestibility of total fatty acids was affected quadratically (P less than .05); fatty acid digestibility was similar among 0, 2 and 4% calcium soap diets but decreased for the 6% calcium soap diet. In Trial 2, increased calcium soap did not affect (P greater than .05) ruminal VFA concentrations, pH or in sacco NDF disappearance of orchardgrass following 12, 24 and 48 h of incubation. Calcium soap increased (P less than .07) ruminal concentrations of calcium soap fatty acids at 1, 2, 4 and 8 h postfeeding. Calcium soap did not improve performance of feedlot cattle fed high-concentrate diets. Further, calcium soap did not affect ruminal fermentation and did not dissociate significantly even when ruminal pH was below 6 for extended periods of time.
A study about the acceptability, protective efficacy, effectiveness, and cost of a repellent soap containing 20% diethyltoluamide and 0.5% permethrin was carried out on the Pacific coast of Ecuador and Peru, where malaria is endemic and the transmission is seasonal. The malaria vectors were Anopheles albimanus, An. punctimacula, and An. pseudopunctipennis in Ecuador and An. albimanus in Peru. Comparing the hourly mosquito bites on human subjects with and without the protection of the repellent soap, it showed that inactive, protected subjects were bitten 94.2% less than unprotected controls 2 hr after application of the soap. This protective efficacy was reduced to 81% after 6 hr. In persons physically active for 3 hr after application, the efficacy of the soap was 67% in the fourth hour after application and 52% in the sixth hour after application. Sweating decreased the protective efficacy of the soap even more. In a community-based malaria control program, the soap was introduced by community health promoters. Acceptance was good when it was given free of charge but reduced dramatically when it was sold. People used the soap mainly because of the nuisance of mosquitoes. The application was generally done correctly. However, no significant impact on the incidence of malaria episodes could be shown when comparing intervention communities with control communities, either in Ecuador, where the proportion of Plasmodium falciparum cases was high, or in Peru, where P. vivax was the only species of Plasmodium seen. This can probably be explained by the limited use of soap and the shift of mosquito bites from users to nonusers of the repellent soap. The cost of a soap program would be $4.60 (USA) per person per year, which seems to be quite high in terms of cost of soap and its distribution related to people's low cash income. The implications of the introduction of repellent soap into a control program are discussed.
BACKGROUND: In January 1993, Nyamithuthu Camp in Malawi housed 64000 Mozambican refugees. Communicable diseases, primarily diarrhoea, pneumonia, malaria and measles, contribute to substantially higher mortality rates in refugee populations compared to similar non-displaced populations. METHOD: A systematic sample of 402 households in one portion of the camp were surveyed for diarrhoeal risk factors, and then interviewed twice weekly for 4 months regarding new diarrhoea episodes and the presence of soap in the household. Two-hundred grams of soap per person was distributed monthly. RESULTS: Households had soap on average only 38% of the interview days. Soap was used primarily for bathing and washing clothes (86%). Although 81% of mothers reported washing their children's hands, only 28% of those mothers used soap for that purpose. The presence of soap in a household showed a significant protective effect: there were 27% less episodes of diarrhoea in households when soap was present compared to when no soap was present (RR = 0.73, 95% CI: 0.54 < RR < 0.98). Potential confounding factors were assessed and did not appear to be responsible for the association between the presence of soap and reductions in diarrhoea incidence. CONCLUSION: In summary, our findings suggest that the provision of regular and adequate soap rations, even in the absence of a behaviour modification or education programme, can play an important role in reducing diarrhoea in refugee populations. If subsequent study confirms the soap as a cheap and effective measure to reduce diarrhoea, its provision in adequate amounts should be a high priority in refugee settings.
The significance of calcium soap formation in the inhibition of calcium absorption has been studied in rats. 47Ca labelled soaps of fatty acids were introduced into the duodenum and the absorption of calcium measured after four hours in a whole body counter. The absorption of calcium was inversely correlated with the chain length of the fatty acid varying from 1% for Ca-stearate to 60% for Ca-hexanoate. Increasing the degree of unsaturation of the fatty acid was accompanied by increased calcium absorption. The availability of calcium for absorption from the soaps was correlated with their solubility in 1% aqueous Na-tauroglycocholate. The percentages of calcium as soap in the small intestine and the faeces after intragastric administration of calcium and fats were similar, which suggests that the faecal content of calcium soaps is an index of intestinal soap formation. Soap formation was negligible when CaCl2 was given with tristearate, triolaeate, or tridecanoate and no depression of calcium absorption was observed. Calcium absorption was markedly impaired by the addition of phosphates at a Ca/P ratio of 1:1 irrespective of the presence of neutral fats. Stearic acid resulted in significant soap formation and reduced calcium absorption. The degree of Ca-soap formation and the inhibition of calcium absorption were well correlated. The results suggest that, although calcium soap formation may markedly depress calcium absorption in the rat, no significant soap formation takes place when fats are given in the form of triglycerides.
Skin tears are common among residents of long-term care facilities. This study evaluated the effectiveness of emollient antibacterial soap compared to non-emollient antibacterial soap in improving skin quality and reducing skin tears among residents of a long-term care facility. Skin tears were monitored over 4 months: non-emollient soap in the first and third months, and emollient soap in the second and fourth months were used. Rate of skin tears per resident per month were calculated. Incident reports were monitored the first month to establish skin tear rates using non-emollient soap. Skin tears decreased with the use of emollient soap (37% and 33% decrease in months two and four, respectively) and increased with the reintroduction of non-emollient soap (43% increase in month three). Overall incidence of skin tears with the use of emollient soap was 34.8 percent lower than that of the non-emollient soap. Analysis of variance did not show statistical significance [F(1,84) = 3.108, p = .0821], but clinical significance was demonstrated by the reduced number of skin tears with the use of emollient soap. While the etiology of skin tears seems to be a problem of aging, the decrease in skin tears in this study supports the continued use of emollient soap.
Two aspects of handwashing in hospital were considered. A study was carried out to examine the contamination of bar soap and containers, and the use of antiseptic soaps in reducing the resident flora of the skin. Swabs were collected from soap dishes on six wards and from a bacteriology laboratory on four consecutive days. The unmedicated bar soap was replaced by bar soap containing 2.5% povidone-iodine, and further swabs were collected over a period of seven days. Ninety-two isolates from 48 samples were obtained when unmedicated bar soap was used, and nine isolates from 42 samples when povidone-iodine (Betadine) soap was substituted. The number of organisms recovered when povidone-iodine soap was used was much reduced, and Pseudomonas spp were recovered in low numbers on only one occasion. Six laboratory workers took part in a study to compare bar soap with other agents-povidone-iodine soap, povidone-iodine surgical scrub, povidone-iodine alcoholic solution, chlorhexidine surgical scrub, and alcoholic chlorhexidine. Samples were collected after standard washes and after surgical gloves had been worn for 90 minutes. The effect of multiple washes was assessed by samples collected after six washes with the agent under study (three per day) followed by 90 minutes wearing surgical gloves. The average percentage reduction in normal flora obtained indicated that alcoholic chlorhexidine was superior to the other agents.
In a previous study, we speculated that some of the high mercury levels observed in head hair from a total of 14 subjects who resided around Lake Victoria, Tanzania, might be attributable to the habitual use of toilet soap containing considerable amounts of mercury (Harada et al. Sci Total Environ 1999;227:249-256). In August 1998, the current study was conducted to investigate if such mercury-containing soap was also available in the surroundings of Lake Victoria, Kenya, and if so, its toxic effects. A total of nine goldminers, 44 fishermen and their families, and 12 residents of Kisumu City, Kenya, volunteered for the study. Fourteen types of toilet soap were collected in Kisumu. Total mercury content was very significantly higher than in European-made soap (0.47-1.7%, as mercury iodide) compared with Kenya-made soap (0.41 x 10(-4)-6.2 x 10(-4)%). Indeed, all the subjects with a high hair mercury level (> 36.1 ppm) had made habitual use of European-made soap, accompanied by various symptoms, such as tremor, lassitude, vertigo, neurosthenia, and black and white blots, suggesting inorganic-mercury poisoning. On the other hand, any subject who had used soap other than the European-made soap, did not exceed a mercury level of 10 ppm in hair that is well within normal limits (Harada et al. Sci Total Environ 1999:227:249-256). The findings obtained suggest that the mercury-containing soap must be barred from circulation without delay, and that the residents' health in addition to the environmental pollution in Lake Victoria (Kenya as well as Tanzania) should be kept under close observation.
The effects of a commercial trichlorocarbanilide-containing deodorant soap and a commercial plain soap upon the cutaneous flora of individuals were compared. Using a cross-over design, 21 volunteers (10 women and 11 men) washed their forearms at least once a day with one soap for 3 weeks and then switched soaps for another 4 weeks use. By analysis of variance no significant difference in total colony counts was noted among individuals in their use of the two soaps. With the exception of individual variation, neither sequence of use, sex, nor any combination was influential. However, in 20 of 21 subjects an alteration in the composition of skin flora was observed. The deodorant soap, which in six cases increased total flora, tended to reduce or eliminate diphtheroids in 12 to 17 carriers (71%). Fewer kinds of bacteria were also noted. More Staphylococcus epidermidis was seen with the plain soap, but washing with the deodorant soap seemed to favour Acinetobacter calcoaceticus and Micrococcus luteus. The impact of this alteration and the use of total counts to measure effectiveness of deodorant soaps were brought into question.
Five different types of liquid soap were studied in hospital wards, each during two months' use. Altogether 1306 finger print samples were taken from the hands of the staff by sampling twice a week and the acceptability of the soaps was measured by a questionnaire. During the use of different soaps only slight differences were found in the numbers of total bacteria or in the occurrence of Staph. aureus and gram-negative bacilli on the hands. During the use of the emulsion-type product studied, several persons who had dermatological problems had lower mean bacterial counts of the fingers than during the use of the other soaps. This soap was also favourably accepted by the staff. After over one year's use of pine oil soap and alcohol, the staff of the hospital was satisfied with the method. However, several persons with skin problems admitted to not using soap or alcohol. The considerable differences found in the acceptability of soaps imply that for use in hospital the choice of a soap acceptable to the nursing staff is important in promoting proper hand hygiene.
The purposes of this study were to assess the effect of two quantities (1 mL or 3 mL) of four different handwashing products on reductions in log colony-forming units (CFU) from the hands and to determine the amount of liquid soap used for handwashing by personnel in one hospital. First, 40 subjects were assigned by block randomization to one of four handwashing products (4% chlorhexidine gluconate in a detergent base, two alcohol hand rinses, and a liquid, nonantimicrobial soap) to be used in either 1 mL or 3 mL amounts per wash. Each subject washed his or her hands 15 times per day for five days. After one and five days of handwashing there were significant reductions over baseline in log CFU between handwashing products (P less than 0.001). Additionally, subjects using 3 mL of antiseptic soap had significantly greater reductions in log CFU than those using 1 mL (P less than 0.001). Among subjects using control liquid soap there was no such dose response. Second, a survey of 47 members of a hospital nursing staff from nine specialty areas and ten individuals in the general population was conducted to measure amounts of two liquid soaps used for handwashing. Amount of soap ranged from 0.4 to 9 mL per handwash. Personnel working in clinical areas where patients were at high risk for nosocomial infection used significantly more soap than did others (P less than 0.05). We conclude that quantity of soap used for handwashing is one variable influencing the microbial counts on hands, and that the quantity of soap used by health care personnel varies considerably.