[Epidemic C difficile-associated diarrhea is a reality. Fewer prescriptions and more soap].
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Anti-Bacterial Agents↗
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Clean up your records with SOAP. S (subjective findings), O (objective findings), A (assessment), P (plan).
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Continuity of Patient Care↗
SOAP'98. Society for Obstetric Anesthesia and Perinatology, 30th annual meeting. Vancouver, British Columbia, Canada. April 29-May 2, 1998. Abstracts.
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Anesthesia↗
Has mildness replaced cleanliness next to godliness?
Over the past 30 years we have witnessed a change in our approach to soaps. The turning point was, in fact, the publication of an article by Frosch and Kligman in 1979, in which they described a new method for assessing the irritancy of soaps. They maintained that the chief weakness of the usage tests in the past was that the reactions under normal usage conditions were weak and did not discriminate adequately between different soaps. They proposed a test, called the soap chamber test, which was conducted under extreme conditions, on people known to have a sensitive skin, thereby resulting in strong reactions that emphasized the slight differences between the various soaps. Frosch and Kligman's work opened up a whole new era in the field of assessment of soap quality. Following their initial studies, many other studies were conducted, including the exaggerated use tests, often in conjunction with instrumental methods of evaluation, such as measurement of transepidermal water loss, electrical conductance, skin color and blood flow, and other tests designed to evaluate the irritation potential of various soaps. All those tests had a common purpose: to achieve extreme conditions which would provide greater sensitivity and discriminating power and would accentuate and emphasize the differences between soaps as much as possible: the greater the discrimination and the differences between the products, the more efficient and useful the test. The introduction and publication of tests such as those completely changed out approach to soaps. The sought-after qualities in a soap became safety, mildness, gentleness, less irritation, less drying--in particular, gentleness and mildness were emphasized.(ABSTRACT TRUNCATED AT 250 WORDS)
Dermatitis, Irritant↗
Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial.
CONTEXT: Washing hands with soap prevents diarrhea, but children at the highest risk of death from diarrhea are younger than 1 year, too young to wash their own hands. Previous studies lacked sufficient power to assess the impact of household handwashing on diarrhea in infants. OBJECTIVE: To evaluate the effect of promoting household handwashing with soap among children at the highest risk of death from diarrhea. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized controlled trial of 36 low-income neighborhoods in urban squatter settlements in Karachi, Pakistan. Field workers visited participating households at least weekly from April 15, 2002, to April 5, 2003. Eligible households located in the study area had at least 2 children younger than 15 years, at least 1 of whom was younger than 5 years. INTERVENTIONS: Weekly visits in 25 neighborhoods to promote handwashing with soap after defecation and before preparing food, eating, and feeding a child. Within intervention neighborhoods, 300 households (1523 children) received a regular supply of antibacterial soap and 300 households (1640 children) received plain soap. Eleven neighborhoods (306 households and 1528 children) comprised the control group. MAIN OUTCOME MEASURE: Incidence density of diarrhea among children, defined as the number of diarrheal episodes per 100 person-weeks of observation. RESULTS: Children younger than 15 years living in households that received handwashing promotion and plain soap had a 53% lower incidence of diarrhea (95% confidence interval [CI], -65% to -41%) compared with children living in control neighborhoods. Infants living in households that received handwashing promotion and plain soap had 39% fewer days with diarrhea (95% CI, -61% to -16%) vs infants living in control neighborhoods. Severely malnourished children (weight for age z score, <-3.0) younger than 5 years living in households that received handwashing promotion and plain soap had 42% fewer days with diarrhea (95% CI, -69% to -16%) vs severely malnourished children in the control group. Similar reductions in diarrhea were observed among children living in households receiving antibacterial soap. CONCLUSION: In a setting in which diarrhea is a leading cause of child death, improvement in handwashing in the household reduced the incidence of diarrhea among children at high risk of death from diarrhea.
Adolescent↗
Effect of handwashing on child health: a randomised controlled trial.
BACKGROUND: More than 3.5 million children aged less than 5 years die from diarrhoea and acute lower respiratory-tract infection every year. We undertook a randomised controlled trial to assess the effect of handwashing promotion with soap on the incidence of acute respiratory infection, impetigo, and diarrhoea. METHODS: In adjoining squatter settlements in Karachi, Pakistan, we randomly assigned 25 neighbourhoods to handwashing promotion; 11 neighbourhoods (306 households) were randomised as controls. In neighbourhoods with handwashing promotion, 300 households each were assigned to antibacterial soap containing 1.2% triclocarban and to plain soap. Fieldworkers visited households weekly for 1 year to encourage handwashing by residents in soap households and to record symptoms in all households. Primary study outcomes were diarrhoea, impetigo, and acute respiratory-tract infections (ie, the number of new episodes of illness per person-weeks at risk). Pneumonia was defined according to the WHO clinical case definition. Analysis was by intention to treat. FINDINGS: Children younger than 5 years in households that received plain soap and handwashing promotion had a 50% lower incidence of pneumonia than controls (95% CI (-65% to -34%). Also compared with controls, children younger than 15 years in households with plain soap had a 53% lower incidence of diarrhoea (-65% to -41%) and a 34% lower incidence of impetigo (-52% to -16%). Incidence of disease did not differ significantly between households given plain soap compared with those given antibacterial soap. INTERPRETATION: Handwashing with soap prevents the two clinical syndromes that cause the largest number of childhood deaths globally-namely, diarrhoea and acute lower respiratory infections. Handwashing with daily bathing also prevents impetigo.
Acute Disease↗
A close look at alcohol gel as an antimicrobial sanitizing agent.
BACKGROUND: Hand transmission of microbes by health care workers is a primary cause of nosocomial infections in both long-term and acute care facilities. Compliance with effective handwashing and hand sanitization regimens can break this cycle. METHODS: We investigated the antimicrobial efficacy and irritation potential of 5 handwash product regimens: a nonantimicrobial lotion soap, an antimicrobial lotion soap, an alcohol gel sanitizer, a nonantimicrobial lotion soap with an alcohol gel sanitizer, and an antimicrobial lotion soap with an alcohol gel sanitizer. The regimens were evaluated by using a Healthcare Personnel Handwash procedure, and irritation was assessed by using expert hand evaluation after 25 consecutive washes. RESULTS: The Healthcare Personnel Handwash data showed that the mean log reductions from baseline were greatest for the lotion soaps with alcohol gel sanitizer, less for the alcohol and the antimicrobial soap alone, and least for the bland soap. All of the product regimens showed a low potential for skin irritation. CONCLUSION: In terms of both microorganism reduction and skin irritation, the most effective product regimens were the use of alcohol gel sanitizer in combination with either an antimicrobial or a plain lotion soap.
Adult↗
The relationship between stool hardness and stool composition in breast- and formula-fed infants.
"Constipation" and "hard stools" are associated with formula feeding of both term and preterm infants and, in the latter, can lead to life-threatening complications. This study tested the hypothesis that stool hardness is related to excretion of fatty acid (FA) soaps in term infants, and in the extreme to milk bolus obstruction in premature infants. Stools (n = 44) were collected from 20 formula-fed and 10 breast-fed infants aged 6 weeks and were classified using visual charts for stool hardness on a 5-point scale (1, watery; 5, hard). Stools were analysed for nitrogen, minerals, and lipid, the latter divided between the soap and nonsoap fractions. We explored the relationship between stool hardness or solids content and stool constituents, relative to both wet and dry weight. Calcium and FA soaps were the dominant factors significantly related to stool solids and hardness score across the breast- and formula-fed groups. An 8% increase in stool dry weight FA soap content corresponded to a 1-point change in stool hardness score. Stools from formula-fed infants had a higher solids content and were classified as significantly harder than those from breast-fed infants (hardness scores, 4.0 +/- 0.5 versus 2.6 +/- 0.7, mean +/- SD) and on both a wet- and dry-weight basis contained severalfold higher levels of minerals and lipid and considerably less carbohydrate. Differences in lipids between formula- and breast-fed infants' stools were due almost entirely to FAs (mainly C16:0 and C18:0) excreted as soaps (27.7 +/- 7.5% compared to 3.1 +/- 4.1% of dry weight), suggesting the groups differed markedly in their handling of saturated FAs. An inspissated stool sample from a premature infant requiring surgical disempaction of an obstructed small intestine was found to be enriched in FA and calcium relative to the preterm formula. FA soaps, predominantly saturated, accounted for one third of the stool dry weight. These data support the hypothesis that calcium FA soaps are positively related to stool hardness; we speculate that this may, at least in part, explain the greater stool hardness in formula- versus breast-fed infants and milk bolus obstruction in preterm infants. This conclusion is consistent with the physical properties of calcium FA soaps.
Breast Feeding↗
[The effectiveness of various disinfection methods on the surface of gloved hands].
The gloved hands were contaminated by using E.coli and Pseudomonas aeruginosa Brain Heart Infusion broth cultures and the efficacy of tap water, unmedicated bar soap, benzalkonium chloride 1% (Zefiran), Na-hypochloride 1% and 5%, alcohol 70%, hexachlorophene 3%, hexachlorophene 3% liquid soap (Solu-heks), chlorhexidine 1.5% liquid soap (Savlon), chlorhexidine 4% liquid soap (Hibiscrub), povidone-iodine 10% solution (Betadine and polyod), povidone-iodine 7.5% liquid soap (Betadine and Polyod) were compared onto the gloved hands. Disinfectants were applied for 30, 45 and 60 seconds. It was found that washing time of 30 seconds with chlorhexidine 4% (Hibiscrub) liquid soap or povidone-iodine 7.5% liquid soap (Betadine and Polyod) was required to eradicate all the organisms inoculated from both glove surfaces. Povidone-iodine and chlorhexidine were more effective washing agents than the other disinfectants. In underdeveloped or developing countries and areas where gloves can not easily supplied, it has been suggested that gloved hands could be washed between patient treatments and gloves re-used in dentistry, gynecology and like the other areas of medicine. Chlorhexidine 4% and povidone-iodine 7.5% liquid soaps are recommended as a hand-washing agents in these areas.
Chlorhexidine↗
Skin tolerance and effectiveness of two hand decontamination procedures in everyday hospital use.
BACKGROUND: Hand decontamination is crucial to control nosocomial infections. The utility of hand decontamination is related not only to its antimicrobial effectiveness, but also to its acceptability by hospital staff. OBJECTIVES: We aimed to assess skin tolerance and antimicrobial effects of two widely accepted hand hygiene measures under in-use conditions. METHODS: Fifty-two nurses were randomly assigned for an 8-day period to either an alcohol-based disinfectant or a hand wash with a non-antiseptic soap. At baseline and at the end of the test period, microbiological hand samples were obtained both before and after a hand hygiene procedure, and skin tolerance was assessed using clinical scores and measurement of transepidermal water loss. RESULTS: Self-assessment of skin condition and grade of skin damage worsened significantly more in the group using soap than in the group using alcoholic disinfectant (P = 0.004 and P = 0.01, respectively). The alcohol-based rinse was significantly more effective than liquid soap in removing transient contaminant micro-organisms (P = 0.016). Twenty of 50 hand washes with non-antiseptic soap apparently resulted in bacterial contamination of the hands. At the end of the study, the total bacterial count increased with the increasing number of hand washes in the soap group (P = 0.003), and with the degree of skin damage (P = 0.005) in the antiseptic group. CONCLUSIONS: In everyday hospital practice, alcohol-based disinfectant is more effective and better tolerated than non-antiseptic soap; soap is at risk of spreading contamination; and skin comfort strongly influences the number and the quality of hand hygiene procedures.
Alcohols↗
Behavioral responses and mortality in German cockroaches (Blattodea: Blattellidae) after exposure to dishwashing liquid.
Behavioral responses and mortality of the German cockroach, Blattella germanica (L.), after exposure to solutions of common household dishwashing liquid diluted in tap water without other known insecticidal active ingredients are described. Soap solutions of 0.05, 0.1, 0.25, 0.5, 1.0, 2.0, 3.0, 4.0, and 5.0% were tested on first and second instars, fifth and sixth instars, and adults. Cockroaches were treated individually or in groups. Behavioral observations after treatment included an immediate knockdown period, an awakening and a struggle period, an unresponsive period, and either death or recovery between 30 min and 18 h after treatment. Probit analysis gave an excellent fit of unresponsive rates 18 h after treatment with the various soap concentrations, and LD50 and LD99 values were calculated to be 0.4 and 3.0% soap, respectively. Adult females were the most difficult to kill, but at soap concentrations of 1% or higher, 95% or greater unresponsiveness and death occurred. Soap concentrations of 3% or greater resulted in 100% unresponsiveness after 3 min, and eventually resulted in 100% mortality within 72 h for all adults and nymphs treated. Observations on the mode and site of action for soap are consistent with the blockage of spiracles and/or tracheae that results in asphyxiation and death. Future investigations into the efficacy of soaps against other arthropod groups are warranted and may be beneficial in certain situations.
Animals↗
Separation and assay of lysins and lysin-inhibitor complexes in blood and tissues.
1. A process of extraction and assay, which combines the features of several existing methods, is described for the lytic materials which can be obtained from blood, plasma, serum, and tissues. At least two alcohol-soluble substances, one ether-soluble ("soap-like") and the other insoluble in ether in the cold ("lysolecithin-like"), can be obtained from preincubated blood, plasma, or serum. The hemolytic activity (or concentration) of the soap-like lysin obtained from blood is greater than that of the lysolecithin-like substance, but for plasma and serum the reverse is true, i.e. the red cells are involved in the production of the soap-like lysin, and probably supply some of it when acted upon by enzymes contained in plasma and serum. Preincubation of the blood or plasma increases the yield of lysin two- or threefold, and small quantities of both soap-like and lysolecithin-like lysins can be obtained from unpreincubated blood or plasma. 2. The soap-like lysins obtained from preincubated mouse liver are some 5 to 15 times as active as, or occur in some 5 to 15 times the concentration of, those obtained from blood or plasma. The lysolecithin-like lysins of preincubated liver are about twice as active as, or occur in about twice as great concentration of, those obtained from blood. Because of the shape of the time-dilution curve for these lysins, the relations between their activities, or concentrations, are often quite different from those which one would anticipate if one were to consider only the times required for the production of hemolysis. 3. Paper chromatography can be used to separate the soap-like and the lysolecithin-like lysins obtainable from small quantities of preincubated mouse liver homogenates or preincubated mouse blood. The presence of lysins is detected by their effect on the red cells of a suspension as it wets the paper. Various technical procedures for separating lytic components and for demonstrating that they move on the paper along with protein components are described. 4. Paper strip electrophoresis can be used to show that the supernatant fluid of a preincubated mouse liver homogenate contains at least two protein components and at least two lytic components, not very closely associated in their electrophoretic behavior. 5. Observations on the physical nature of the alcohol- and ether-soluble lysin point to its having a soap-like character. Its activity, as well as that of the lysolecithin-like lysin, is inhibited by cholesterol, by lecithin, and by various fractions of serum. Some of these effects have been studied quantitatively. The most inhibitory of the protein fractions are those which contain lipoproteins; i.e., II + III and IV + V.
Cell Death↗
Analysis of calcium-lipid complexes in faeces.
Calcium is purported to prevent colorectal cancer by forming insoluble complexes with bile acids and long-chain fatty acids in the large bowel. Therefore, a method for analysing calcium-lipid complexes in faeces has been developed to investigate this. The calcium soaps of a long-chain fatty acid (calcium palmitate) and bile acids (calcium deoxycholate, chenodeoxycholate, cholate and lithocholate) were obtained by organic synthesis. Studies with the authentic soaps reveal that they exist in an empirical ratio of calcium-to-lipid of 1:2. On addition to lipid-free faeces, approximately 30% of calcium palmitate could be recovered and quantified in the authentic state by extraction with 72% ethanol and overnight precipitation at 0 degree C. In contrast, the calcium soaps of the bile acids could not be recovered in the authentic state but were quantified entirely as the free acids. The method was applied to the analyses of calcium-lipid complexes in the faeces of adenoma patients partaking in a placebo-controlled calcium-intervention study. The results show that human faeces contain appreciable amounts of calcium long-chain fatty acid soaps predominantly in the form of calcium palmitate and stearate. The faecal concentration of long-chain fatty acid soaps was increased significantly (P = 0.005) during calcium intervention but this did not have a statistically significant effect on the excretion of free long-chain fatty acids (P = 0.4). Calcium long-chain fatty acid soap formation was found by multiple regression to be equally dependent on stool long-chain fatty acid and calcium concentration. Calcium soaps of the bile acids were not detected by this method.(ABSTRACT TRUNCATED AT 250 WORDS)
Adenocarcinoma↗
The efficacy of low-pressure lavage with different irrigating solutions to remove adherent bacteria from bone.
BACKGROUND: Recent studies have suggested that high-pressure irrigation may have adverse effects on bone. However, the use of low-pressure irrigation may not remove all adherent bacteria from bone. The type of irrigating solution may be an important factor in the removal of adherent bacteria with pulsatile lavage. In this study, we compared the effects of various irrigating solutions on the number and function of osteoblasts and osteoclasts and we examined the effectiveness of these solutions in removing adherent bacteria from bone. METHODS: To examine the effect of irrigating solutions on the number and activity of osteoblasts, we isolated calvarial cells from newborn C57BI/6 mice and exposed the cells to equivalent concentrations of ethanol, povidoneiodine, liquid soap, antimicrobial wash (50 U/L of bacitracin), or chlorhexidine gluconate, for two, ten, or twenty minutes. The cells were then cultured in the presence of bone-nodule-enhancing medium (beta-glycerophosphate and ascorbic acid) for twenty-one days. The medium was changed every three or four days. Mineralized nodules were stained with alizarin red S, and osteoblasts were stained with a histochemical stain for alkaline phosphatase. Osteoclasts were identified with tartrate-resistant acid-phosphatase staining. In a second experiment, canine cortical tibiae were contaminated with Staphylococcus aureus for six hours and subjected to different irrigating solutions with or without low-pressure lavage. Bacterial colony-forming units were quantitated under each set of conditions. RESULTS: Each solution resulted in a time-dependent decrease in the number of calvarial osteoblasts and osteoclasts compared with that in the controls. The 1% soap solution resulted in greater preservation of both alkaline-phosphatase activity and bone-nodule formation than did the other solutions. Moreover, the soap solution preserved the number of osteoclasts to the greatest extent. The povidone-iodine and chlorhexidine-gluconate solutions resulted in the largest decline in bone-nodule formation, alkaline-phosphatase activity, and number of osteoclasts. Low-pressure pulsatile lavage with the soap solution removed the most bacteria from the contaminated tibia when compared with either the soap solution alone or low-pressure irrigation with saline solution. CONCLUSIONS: Our findings suggest that certain solutions may be more effective in removing bacteria from bone than mechanical irrigation with saline solution alone. Among the various solutions examined, the soap solution preserved the number and activity of osteoblasts the most. Low-pressure lavage with the soap solution resulted in the greatest removal of adherent bacteria from bone.
Animals↗
Deposition of 3,4,4'-trichlorocarbanilide on human skin.
For rinse-off products such as soaps, quantitating the deposition of ingredients left behind on the skin following rinsing may be important particularly if the ingredient is biologically active, e.g. germicides, perfumes. The residue comprises the major portion of material which is available for percutaneous penetration. A method is described for quantitating the deposition of the soap germicide, 3,4,4'-trichlorocarbanilide (TCC) as the result of direct application of bar soap on human skin. A soap pellet containing 1.5% [14C]TCC was gently rubbed on a small area of the volar forearm for 30 s. 90 s after soap application the site was thoroughly rinsed with water. After rinsing, 1.4% of the applied [14C]TCC, or 0.33 micrograms/cm2, remained on the treated site as determined by cellophane tape stripping followed by scintillation counting. The amount of TCC deposited from a simulated wash with a bar soap onto human skin is compared to the amount deposited onto the skin of other species.
Animals↗
A novel approach using an attenuated recombinant vaccinia virus to test the antipoxviral effects of handsoaps.
Evidence indicates an increase in nosocomial and household infections due to viruses (Jeffries, D.J., 1995. Viral hazards to and from health care workers. J. Hosp. Infect. 30, 140-155). An antiviral assay was developed for evaluating efficiency of handsoaps at inactivating cell-free and cell-associated virus. A recombinant vaccinia virus, lacking a virulence factor (Isaacs, S.N., Kotwal, G.J., Moss, B., 1992. Vaccinia virus complement-control protein prevents antibody-dependent complement-enhanced neutralization of infectivity and contributes to virulence. Proc. Natl. Acad. Sci. USA 89, 628-632), whose construction was described earlier (Kotwal, G.J., Isaacs, S.N., McKenzie, R., Frank, M.M., Moss, B., 1990. Inhibition of the complement cascade by the major secretory protein of vaccinia virus. Science 250, 827-830), was used as the representative poxvirus. Two antibacterial handsoaps, one surgical handsoap, one moisturizing handsoap, and a sanitizing agent were tested. An aliquot of the virus was mixed and incubated with soap, then titrated onto BSC-1 cells for incubation at 37 degrees C for 48 h. The soaps' effect on cell-associated virus was tested similarly. The antibacterial soaps inactivated all cell-free virus in 1 min. The surgical soap was effective with a 5-min incubation. None of the soaps eliminated all of the cell-associated virus in 1 min. This safe and reproducible assay seems efficient to establish the comparative efficacy of household and surgical soaps.
Anti-Infective Agents↗
Preparation of soybean oil-based greases: effect of composition and structure on physical properties.
Vegetable oils have significant potential as a base fluid and a substitute for mineral oil in grease formulation. Preparation of soybean oil-based lithium greases using a variety of fatty acids in the soap structure is discussed in this paper. Soy greases with lithium-fatty acid soap having C12-C18 chain lengths and different metal to fatty acid ratios were synthesized. Grease hardness was determined using a standard test method, and their oxidative stabilities were measured using pressurized differential scanning calorimetry. Results indicate that lithium soap composition, fatty acid types, and base oil content significantly affect grease hardness and oxidative stability. Lithium soaps prepared with short-chain fatty acids resulted in softer grease. Oxidative stability and other performance properties will deteriorate if oil is released from the grease matrix due to overloading of soap with base oil. Performance characteristics are largely dependent on the hardness and oxidative stability of grease used as industrial and automotive lubricant. Therefore, this paper discusses the preparation methods, optimization of soap components, and antioxidant additive for making soy-based grease.
Chemical Phenomena↗
A comparison of hand washing techniques to remove Escherichia coli and caliciviruses under natural or artificial fingernails.
Compared with other parts of the hand, the area beneath fingernails harbors the most microorganisms and is most difficult to clean. Artificial fingernails, which are usually long and polished, reportedly harbor higher microbial populations than natural nails. Hence, the efficacy of different hand washing methods for removing microbes from natural and artificial fingernails was evaluated. Strains of nonpathogenic Escherichia coli JM109 and feline calicivirus (FCV) strain F9 were used as bacterial and viral indicators, respectively. Volunteers with artificial or natural nails were artificially contaminated with ground beef containing E. coli JM109 or artificial feces containing FCV. Volunteers washed their hands with tap water, regular liquid soap, antibacterial liquid soap, alcohol-based hand sanitizer gel, regular liquid soap followed by alcohol gel, or regular liquid soap plus a nailbrush. The greatest reduction of inoculated microbial populations was obtained by washing with liquid soap plus a nailbrush, and the least reduction was obtained by rubbing hands with alcohol gel. Lower but not significantly different (P > 0.05) reductions of E. coli and FCV counts were obtained from beneath artificial than from natural fingernails. However, significantly (P < or = 0.05) higher E. coli and FCV counts were recovered from hands with artificial nails than from natural nails before and after hand washing. In addition, microbial cell numbers were correlated with fingernail length, with greater numbers beneath fingernails with longer nails. These results indicate that best practices for fingernail sanitation of food handlers are to maintain short fingernails and scrub fingernails with soap and a nailbrush when washing hands.
Alcohols↗