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PubMed1978

Shedding of bacteria and skin squames after handwashing.

Particles released into the air by wringing the hands together were collected in a slit sampler before and after washing with bar soap, with three surgical scrubs, and after rubbing them with a spirit-based lotion. The particles were identified, their number estimated, those that bore bacteria counted, and the bacteria themselves classified. It was found that there was a significant increase, averaging 17-fold, in the number of particles carrying viable bacteria released after washing with soap. The increase in bacterial dissemination was suppressed if a surgical scrub was used in place of soap, or when the lotion was used without washing. The number of skin squames released increased by 18-fold or more after washing with soap or a surgical scrub, but not after using the lotion. This suggests that a surgical scrub should be used more widely in clinical practice, and that a spirit-based hand lotion might with advantage become a partial substitute for handwashing, particularly in areas where handwashing is frequent and iatrogenic coagulase-negative staphylococcal infection common.

Chlorhexidine↗
PubMed2003

Talking dirty: how to save a million lives.

Infectious diseases are still the number one threat to public health in developing countries. Diarrhoeal diseases alone are responsible for the deaths of at least 2 million children yearly - hygiene is paramount to resolving this problem. The function of hygienic behaviour is to prevent the transmission of the agents of infection. The most effective way of stopping infection is to stop faecal material getting into the child's environment by safe disposal of faeces and washing hands with soap once faecal material has contaminated them in the home. A review of the literature on handwashing puts it top in a list of possible interventions to prevent diarrhoea. Handwashing with soap has been calculated to save a million lives. However, few people do wash their hands with soap at these critical times. Obtaining a massive increase in handwashing worldwide requires a sea-change in thinking. Initial results from a new programme led by the World Bank, with many partner organisations, suggest that health is low on people's list of motives, rather, hands are washed to remove dirt, to rinse food off after eating, to make hands look and smell good, and as an act of motherly caring. Professional consumer and market research agencies are being used to work with the soap industry to design professional communications programmes to reach whole populations in Ghana and India. Tools and techniques for marketing handwashing and for measuring the actual impact on behaviour will be applied in new public-private handwashing programmes, which are to start up soon in Nepal, China, Peru and Senegal.

Adult↗
PubMed1988

Evaluation of the new type of military bullet and rifling.

The 5.56-mm caliber SS 109 projectile was fired from 7.7'' and 12'' twist rifles, respectively, into soap blocks and porcine thighs at 50-metre range using a standardized experimental setup. For comparison, the effects of the 5.56-mm M 193 bullet fired from the 7.7'' twist barrel and M-16 assault rifle were tested. The volume of residual cavity in soap, the shape and sizes of live tissue wounds, and the mass of surgically debrided devitalized tissue were measured. The effects of the two projectiles at 7.7'' twist were found similar in soap; the SS 109 produced more tissue damage than the M 193 missile. Using the 12" twist rifle, a significant increase in wounding capacity of SS 109 projectile was found. In conclusion, nonsignificant differences in local effects between the two projectiles using the 7.7'' twist rifles were found, and markedly increased effects of the SS 109--12'' system were ascribed to decreased essential stability and its earlier tumbling in penetrating a target. The soap as a live tissue simulant has proven its reliability in testing small-caliber arms.

Animals↗
PubMed1997

Disaggregation of corneocytes from surfactant-treated sheets of stratum corneum in hyperkeratosis on psoriasis, ichthyosis vulgaris and atopic dermatitis.

To elucidate the pathogenesis of impaired barrier function and the influence of surfactant on the stratum corneum in hyperkeratosis, we investigated morphological alterations of the corneocytes with soap solution. Groups of five patients each with psoriasis vulgaris (PV), ichthyosis vulgaris (IV), atopic dermatitis (AD), and normal controls were examined. Four samples of the horny layer were obtained from the same site by cyanoacrylate adhesive biopsy. The first sample was used for the superficial layer, and the fourth, for the basal horny layers. Each sample was agitated in 1% stirred soap solution at 60 degrees C. The number and size of isolated corneocytes and the morphologic changes were investigated. The release of corneocytes was greater and the swelling and morphological changes of corneocytes exposed to soap solutions were less in PV and AD than in IV or in healthy subjects. In IV, the release was markedly less than in controls. The release and swelling were greater in the superficial than in the basal horny layers. It was concluded that the cohesiveness of corneocytes was probably less in PV and AD and greater in IV than in normals. It was also suggested that the cohesion of corneocytes from the superficial horny layer was less than that from the deep layer. The permeability of the cornified envelope in PV and AD patients was less than in IV or healthy subjects. It was confirmed that highly potent soaps induce loss of many corneocytes and reduce the barrier function of the stratum corneum.

Adolescent↗
PubMed1996

The influence of hard water (calcium) and surfactants on irritant contact dermatitis.

Although the induction of irritant contact dermatitis has been extensively studied for surfactants, the role of the environmental factor water hardness (i.e., calcium content) on the induction process has not received attention. Our objective was to investigate differences in surfactant-induced irritant skin reactions from cumulative exposure to 3 different personal cleansing agents and determine whether the irritation potential can be affected by the hardness of the water. 2 commonly used exaggerated washing procedures were variously employed to evaluate representative sodium soap, triethanolamine-soap, or synthetic detergent cleansers under conditions where the water hardness varied from 0-grain to 11-grain (gr). Subjects were clinically evaluated for skin dryness, skin redness, and instrumentally for hydration. Soap binding to skin was quantified using Fourier transform infrared reflectance spectroscopy. Using the more mild wash procedure, skin sites treated under conditions of hard, 11 gr water were significantly drier, had more erythema, and were less hydrated than corresponding sites treated with deionized 0 gr water. All 3 surfactant cleanser behaved similarly. We also found the hardness of the rinse water to be the more significant factor versus that of the wash water. Effect of water hardness on soap binding to skin revealed a similar outcome. Under a more exaggerated wash condition the relationship between water hardness and irritation broke down.

Adolescent↗
PubMed1980

Survey of 99mTc contamination of laboratory personnel: hand decontamination.

Decontamination after exposure to various 99mTc radiopharmaceuticals was tested with serial hand washings both with and without soap. All radiopharmaceuticals were removed more effectively with soap and the degree of decontamination related closely to the number of washings. The affinity of the radiopharmaceuticals for the skin varied, depending upon the labeled material, and only macroaggregated albumin was effectively removed to less than 1% of its original activity with soap. Activity transfer to the opposite hand could be substantial with macroaggregated albumin and sulfur colloid if soap is not used.

Decontamination↗
PubMed1984

Toxicity of handcleaners.

The irritancy of commercially available liquid handcleaners was determined by means of soap chamber test (with Big Finn Chambers). This in vivo method appeared to registrate the irritant effects of the cleaners very well. Several alkaline soaps were tested in addition to surfactants and soaps with a neutral or low pH. Alkaline soaps were not extra irritating than other handcleaners. The cleaner with the highest irritancy score had a low pH. It was concluded that the pH was not a useful parameter to predict the irritancy of handcleaners.

Detergents↗
PubMed1993

Production and reproduction responses by dairy cows fed varying undegradable protein coated with rumen bypass fat.

Calcium soaps of fatty acids were used to coat proteins, thus reducing rumen degradability. This material was used to determine the effects of either increasing undegradable intake protein with constant CP or varying degradable protein with constant undegradable protein intake. Increased undegradable intake protein and Ca soaps fed for 120 DIM enhanced milk fat and FCM production during 140 and 305 DIM. Reproductive performance also was improved. Feed efficiency and partial efficiency of milk production were enhanced. Varying degradable protein intake at constant undegradable protein intake using proteins coated with Ca soap resulted in decreased production when degradable protein intake was .4 kg/d lower than NRC recommendations, but no differences were significant when intakes were close to or .5 kg/d above NRC recommendations. Use of Ca soaps to coat proteins appears to be useful to optimize protein supply to dairy cows while increasing ration energy density.

Animal Feed↗
PubMedDate not supplied

[Comparison of antibacterial effects of different antiseptics after hand washing].

The aim of this study was to compare 4% chlorhexidine gluconate, 7.5% povidone iodine and liquid soap, which are used as hand washing solutions for the immediate, cumulative and residual effects in bacterial growth. For this purpose, 18 volunteers washed their hands with 7.5% povidone iodine, 4% chlorhexidine gluconate and liquid soap by applying standard hygienic hand washing technique. In order to find out the bacterial amount in the hands of study group, glove liquid test was used. For the evaluation of immediate effects, samples were collected just after the washing procedure, for the residual effects samples were collected from gloved hands after 3 hours, and for the cumulative effects, samples were collected after 5 days with daily hand washings. It is found that the immediate effects of 4% chlorhexidine gluconate was superior than others, and 7.5% povidone iodine was superior to liquid soap. There was no difference between 4% chlorhexidine gluconate and 7.5% povidone iodine for residual effects. The cumulative effects were observed for 4% chlorhexidine gluconate and 7.5% povidone iodine, while there was no cumulative effect for liquid soap. According to these results, it can be suggested that 4% chlorhexidine gluconate can be used as a reliable antiseptic agent in the hospitals, especially for laboratories, intensive care units and operating rooms, owing to its favourable immediate, residual and cumulative effects.

Anti-Infective Agents, Local↗
PubMed2004

Delayed effectiveness of home-based interventions in reducing childhood diarrhea, Karachi, Pakistan.

We introduced home drinking water disinfection and handwashing with soap in Karachi squatter settlements to evaluate their effect on diarrhea. In April 2000, 150 households received soap, 76 received dilute bleach and a water storage vessel, and 76 were enrolled as controls. In 2000, among households wealthy enough to own a refrigerator, children in households that received bleach and a vessel had a 73% lower incidence of diarrhea than controls; those that received soap had a 56% lower incidence. There was no reduction in diarrhea in intervention households without a refrigerator. In 2001, households that received bleach and a vessel had a 71% lower incidence of diarrhea and children in households that received soap had a 35% lower incidence than controls. In 2001, the interventions were equally effective in households that had a refrigerator and those that did not. Both of these home-based interventions were ultimately effective in preventing diarrhea, but only households of slightly higher socioeconomic status changed their behavior quickly enough to benefit during the first summer.

Adolescent↗
PubMed1995

Research methodology for developing efficient handwashing options: an example from Bangladesh.

Handwashing has been universally promoted for health interventions, but it is essential that the factors related to behaviour are understood in order to develop appropriate handwashing messages. We found the study of behaviour complex and had to combine several methods: in-depth interviewing, questionnaire; observational and bacteriological. Here we present our experiences in developing efficient handwashing options for rural Bangladesh. The components of handwashing practices after defecation of 90 rural women were studied (phase 1). During phase 1 an in-depth interview was used to design the observational and questionnaire surveys. Behaviour was observed using a semi-structured record form and the effectiveness of the acts was measured by means of bacteriological tests. A questionnaire survey was undertaken on socioeconomic and water sanitation-related variables since they influence behaviour. Then, to develop efficient handwashing options, an experimental phase (phase 2) tested the bacteriological efficacy of the components found appropriate in phase 1. The effectiveness of the handwashing practices is believed to be poor since the bacteriological counts were found to be high (faecal coliform count of the left hand 1995, and of the right hand 1318 colony forming units/hand). The practice comprised several components: use of an agent, handedness, frequency of rubbing, source and volume of rinsing water, and drying of the hands. Seventy-five per cent of the women reported that they could not afford soap. The experimental trials showed that soap, ash and soil give similar results under similar conditions of handwashing (faecal coliform counts of left hands: 195 (soap), 98 (ash), 129 (soil) and of right: 112 (soap), 54 (ash) and 89 (soil) cfu/hand). The use of multi-method techniques in the study helped to understand and develop efficient handwashing options.

Bangladesh↗
PubMed1988

Prevention of intraoperative wound contamination with chlorhexidine shower and scrub.

In a prospective, controlled, clinical trial, we found that preoperative showering and scrubbing with 4% chlorhexidine gluconate was more effective than povidone-iodine or triclocarban medicated soap in reducing skin colonization at the site of surgical incision. Mean log colony counts of the incision site were one half to one log lower for patients who showered with chlorhexidine compared to those who showered with the other regimens. No growth was observed on 43% of the post shower skin cultures from patients in the chlorhexidine group compared with 16% of the cultures from patients who had povidone-iodine showers and 5% of those from patients who used medicated soap and water. The frequency of positive intraoperative wound cultures was 4% with chlorhexidine, 9% with povidone-iodine and 14% with medicated soap and water. This study demonstrates that chlorhexidine gluconate is a more effective skin disinfectant than either povidone-iodine or triclocarban soap and water and that its use is associated with lower rates of intraoperative wound contamination.

Baths↗
PubMed1996

Douching and sexually transmitted diseases in pregnant women in Surabaya, Indonesia.

OBJECTIVE: Our purpose was to investigate the association between douching (douching agents and timing) and sexually transmitted disease. STUDY DESIGN: A cross-sectional survey of sexually transmitted diseases and habits of vaginal douching was performed on 599 pregnant women who visited a prenatal clinic in Surabaya, Indonesia. RESULTS: Of the 599 pregnant women, 115 (19.2%) had at least one sexually transmitted disease (gonorrhea, chlamydia, syphilis, trichomoniasis, or herpes simplex virus-2). Most women had douched with water (19%) or water and soap (63%) at least once in the preceding month. Approximately 10% of the women had douched in the preceding month with a commercial agent (2%) or betel leaf (8%). Douching with water alone after sex was not associated with sexually transmitted disease. Douching with water and soap or with a betel leaf or commercial agent after sex was associated with sexually transmitted disease; adjusted odds ratios were 2.6 (95% confidence interval 1.0 to 7.1) and 2.7 (95% confidence interval 0.5 to 14.5), respectively. The association was enhanced if the women douched before sex or both before and after sex; adjusted odds ratio were 2.7 (95% confidence interval 1.0 to 7.3) for douching with water and soap and 5.2 (95% confidence interval 1.6 to 16.7) for douching with betel leaf or a commercial agent. Compared with women who never douched, women who always douched with betel leaf or a commercial agent had a substantially increased risk for sexually transmitted disease (adjusted odds ratio 9.4, 95% confidence interval 1.8 to 50.3). CONCLUSIONS: We found a significant association between sexually transmitted disease and douching habits (douching with betel leaf, commercial agents, or water and soap). However, further prospective investigations are needed to evaluate the temporal relationship between douching and sexually transmitted disease.

Areca↗
PubMed1999

Patient education model for increasing handwashing compliance.

BACKGROUND: A review of the literature on handwashing has documented the absence of research on the education of the patient as an intervention model for changing staff behavior regarding handwashing compliance. The primary objective of this project was to conduct a prospective control study of the effect of patient handwashing education on staff compliance with handwashing. METHOD: A prospective, controlled, 6-week intervention/control study was performed in 4 community hospitals in South Jersey. Each hospital served as its own control. Patients were educated within 24 hours of admission about the importance of asking their health care workers to wash their hands. Soap usage and handwashing was calculated by bed-days. Patient follow-up was conducted through telephone interviews 2 weeks after discharge. RESULTS: The patient handwashing education model increased soap usage by health care workers an average of 34% (P =.021); this increase was consistent across hospitals regardless of the initial soap usage rates. Of the patients interviewed, 81% read the materials provided, 57% asked health care workers whether they had washed their hands, and 81% of this 57% said they received positive responses. CONCLUSIONS: For the first time, our findings document that education of patients regarding their role in monitoring handwashing compliance among health care workers can increase soap usage and handwashing and provide sustainable reinforcement of handwashing principles for health care workers.

Cost-Benefit Analysis↗
PubMed2003

Hygiene in the home: relating bugs and behaviour.

Much infectious intestinal disease (IID) arises in the home environment. If programmes to prevent infection are to be effective it is essential to both identify the particular practices that risk disease transmission, and to understand the reasons for these practices. An in-depth, multidisciplinary study of carer and child hygiene in the domestic environment in the Wirral, UK, employed structured observation, surface swabbing for polio vaccine virus and enteric marker organisms, semi-structured interviews, projective interviews and focus group discussions. Observations revealed that child carers washed hands with soap after changing a dirty nappy on 42% of occasions, and that one in five toilet users did not wash hands with soap afterwards. Microbiological samples were taken from household surfaces at sites thought likely to be involved in the transfer of faecal material. 15% of bathroom samples showed contamination with polio vaccine virus. Nappy changing took place mainly in living rooms. Contact with living room surfaces and objects during nappy changing was frequent and evidence of faecal contamination was found in 12% of living room samples. Evidence of faecal contamination was also found in kitchens, again on surfaces thought likely to be involved in the transmission of faeces (taps and soap dispensers). Key factors motivating hygiene were the desire to give a good impression to others, protection of the child and aesthetics. In this setting, the particular risk practices to be addressed included washing hands with soap after stool and nappy contact and preventing the transfer of pathogenic organisms to the kitchen. The occasion of the birth of a child may be a privileged moment for the promotion of safer home hygiene practices. Using polio vaccine virus as an indicator of faecal contamination produces results that could be used in large-scale studies of household disease transmission. A better understanding of the household transmission of the agents of IID using multidisciplinary methods is needed if effective hygiene promotion programmes are to be designed.

Adult↗
PubMed1975

Comparison of two methods for assessing the removal of total organisms and pathogens from the skin.

A standard hand-wash sampling technique was compared with a simple finger-streak sampling method in assessing the relative effectiveness of a number of alternative preparations used for disinfecting the surgeon's hands (alcoholic 0.5% chlorhexidine, alcoholic 0.1% tetrabrom-o-methyl phenol, a 4% chlorhexidine detergent solution, aqueous 0.5% chlorhexidine, 2% 'Irgasan' detergent solution and, as control, bar soap). There was a fairly good correlation between the results of assessment by the two methods after a single disinfection and after six disinfections, three on one day and three on the next. Significant differences were shown in 21 comparisons between treatments when the hand-wash sampling test was used, and 16 of these comparisons also showed a significant difference by the finger-streak test. Staphylococcus aureus was found in hand samplings from 5 out of 8 nurses in the Burns Unit of Birmingham Accident Hospital by the hand-wash sampling method and from 2 of the same 8 nurses by the finger-streak method; the numbers were small, and no Staph. aureus were isolated from the same hands after 1 min. wash in 70% ethyl alcohol. Similar sampling on 29 nurses in other wards showed Staph. aureus on 3 nurses (one in large numbers) by the hand-wash technique and on 1 nurse by the finger-streak test; in only 1 nurse whose hands showed Staph. aureus before disinfection was the organism found, by hand-wash sampling, after disinfection. Parallel sampling of nurses' hands after washing with soap and water and after disinfection with 95% ethanol showed larger numbers of Staph. aureus in a hospital for skin diseases than in a general hospital, and a lower incidence and somewhat lower density of Staph. aureus after ethanol treatment than after washing with soap and water; Gram-negative bacilli, on the other hand, were commoner on hands in the general than in the skin hospital, and present in much smaller numbers after disinfection with ethanol than after washing with soap and water. Antibiotic sensitivity tests showed the frequent recurrence on the hands of some nurses of multi-resistant Staph. aureus with resistance patterns similar to those found in infective lesions in some of the patients; different sensitivity patterns were usually found in staphylococci isolated from the nose. Even in wards where many patients were infected, carriage by nurses' hands of a particular strain of Staph. aureus did not seem to last for more than a few days.

Anti-Bacterial Agents↗
PubMed2004

Imaging secondary ion mass spectrometry of a paint cross section taken from an early Netherlandish painting by Rogier van der Weyden.

Static secondary ion mass spectrometry (SIMS) is introduced as an analytical technique for the examination of paint cross sections to obtain simultaneous information about the nature and distribution of pigments and the binding medium from a single sample. A sample taken from the virgin's blue robe in the panel painting The Descent from the Cross (Museo del Prado, Madrid) of the Early Netherlandish painter Rogier van der Weyden (1399/1400-1464) was selected for investigation. Data were compared with reference compounds and reference lead white linseed oil paint and egg tempera paint. The static SIMS technique gave position-sensitive mass spectra that were used to image the elemental distribution of pigments and the molecular signature of components of the oleaginous binding medium. SIMS ion images of sodium and aluminum superimposed with the blue pigment ultramarine and those of copper, lead, and calcium with the position of the mineral pigments of azurite, lead white, and chalk, respectively. Preserved monocarboxylic acids of palmitic and stearic acids present as fatty acids and fatty acid lead soaps pointed to the use of linseed oil as a binding medium. Images from the oleaginous binding medium fatty acids show a correlation with the three main paint layers. The observed palmitic/stearic acid ratios for the two ultramarine layers and azurite layers are 1.3, 1.4, and 1.8, respectively. Fatty acids and fatty acid soaps show highest ion yields near lead white, a mineral pigment that serves as a natural chemical drier and is proposed to act as a template for the initial grafting of the polyunsaturated triglycerides of the linseed oil. Almost no fatty acids were detected in other layers visible by light microscopy. The fatty acid lead soaps point toward a mature ionomeric oil paint system that developed over centuries. SIMS evidence for egg tempera, still used in the 15th century, is not detected in the paint cross section. SIMS images correlate well with SEM/EDX, FT-IR and light microscopic images and the SIMS spectral data additionally support the identification of pigment particles, lead soaps, and other binding medium components.

Journal Article↗
PubMed2005

An NMR study of translational diffusion and structural anisotropy in magnetically alignable nonionic surfactant mesophases.

The diffusion of both water and surfactant components in aqueous solutions of the nonionic surfactant "C12E6"--which includes hexagonal, cubic, lamellar, and micellar mesophases--has been studied by pulsed-field-gradient NMR. Diffusion coefficients were measured in unaligned samples in all of these phases. They were also obtained in the hexagonal and lamellar phases in oriented monodomain samples that were aligned by slow cooling from the micellar phase in an 11.7 T magnet. Measured water and soap diffusion coefficients in the NMR-isotropic cubic and (high-water-content) micellar phases as well as diffusion anisotropy measurements in the magnetically aligned hexagonal phase were quantitatively consistent with the constituent structures of these phases being identical surfactant cylinders, with only the fraction of surface-associated water varying with the water-soap molar ratio. The values of the water and soap diffusion coefficients in the oriented lamellar phase suggest an increase in defects and obstructions to soap diffusion as a function of increasing water content, while those in the low-water-content micellar phase rule out the presence of inverse micelles.

Journal Article↗