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PubMed1999

Effectiveness of hand-cleansing agents for removing Acinetobacter baumannii strain from contaminated hands.

BACKGROUND: The effectiveness of hand-cleansing agents (plain liquid soap, 70% ethyl alcohol, 10% povidone-iodine, and 4% chlorhexidine gluconate) for removing a hospital strain of Acinetobacter baumannii from artificially contaminated hands of 5 volunteers was studied. METHODS: The experiments were performed by using a Latin square statistical design, with two 5 x 4 randomized blocks, and the results were estimated by ANOVA. In the first and second blocks, the fingertips of the volunteers were contaminated with approximately 10(3) colony-forming units (light contamination hand) and 10(6) colony-forming units (heavy contamination hand), respectively. RESULTS: In the first block, all products tested were effective, almost completely removing the microbial population of A baumannii artificially applied to the hands. In the second block, the use of hand-cleansing agents resulted in 91.36% (4% chlorhexidine), 92.33% (liquid soap), 98.49% (10% povidone-iodine), and 98.93% (70% ethyl alcohol) reduction in counts of A baumannii cells applied to the fingertips. The ethyl alcohol and povidone-iodine had significantly higher removal rates than plain soap and chlorhexidine (P <.05). CONCLUSIONS: These results suggest that 70% ethyl alcohol and 10% povidone-iodine may be the most effective hand-cleansing agents for removing A baumannii strain from heavily contaminated hands (10(6) colony-forming units/fingertip).

Acinetobacter↗
PubMed2003

Diffuse lamellar keratitis: evaluation of etiology, histopathologic findings, and clinical implications in an experimental animal model.

PURPOSE: To induce diffuse lamellar keratitis (DLK) and investigate the potential causative agents in an animal model. SETTING: Magill Research Center for Vision Correction, Storm Eye Institute, Medical University of South Carolina, Charleston, South Carolina, USA. METHODS: In 70 eyes of 35 Dutch Belted rabbits, a corneal flap was cut and the interface randomly exposed to 1 of 7 substances: Pseudomonas aeruginosa endotoxin, 1 of 2 Staphylococcus aureus exotoxins, meibomian gland secretion, povidone-iodine 10%, Palmolive Ultra soap, and Klenzyme soap. Slitlamp examinations were performed 1, 3, 5, and 7 days postoperatively. The DLK was staged from 1 to 4. On day 7, the rabbits were killed and the eyes enucleated and processed for histopathologic examination. RESULTS: At the end of the study, 54 eyes (46 exposed, 8 control) were available for evaluation. The 8 eyes studied concurrently in the control group remained clear and did not show interface inflammation. Thirty-one of 46 eyes (67%) treated with the various test substances developed DLK. The highest DLK rates were found with the cleaning soap Palmolive Ultra (100%; P =.022) and P. aeruginosa lipopolysaccharide endotoxin (90%; P =.026). CONCLUSIONS: Interface inflammation was consistently induced in the animal model. All 7 agents caused DLK in at least some eyes. The histopathologic evaluation showed the morphologic profile of the marked inflammatory cellular reaction that occurred in almost all the specimens.

Animals↗
PubMed1985

Efficacy of low-concentration iodophors for germicidal hand washing.

The efficacy of iodophor germicides containing different concentrations of available iodine against transient (inoculated) bacteria and the natural hand microflora was compared with chlorhexidine gluconate (2 and 4%) liquid detergent (Hibitane), non-germicidal soap and a tap water rinse. The tap water rinse was ineffective compared with all other treatments. Only 4% chlorhexidine gluconate liquid detergent and iodophor containing 0.75% available iodine were significantly better than the non-germicidal soap for reduction of transient bacteria, Escherichia coli and Pseudomonas fluorescens, that had been inoculated onto hands. These agents also caused a significant reduction in the number of 'natural' microorganisms released from hands after a standard 15 s hand wash. The low-concentration iodophor products and the product containing 2% chlorhexidine gluconate failed to give results significantly better than the non-germicidal control soap. Baird-Parker medium and standard aerobic plate counts were highly correlated (r = 0.82), so that for studies of Gram-negative bacteria inoculated onto hands as a transient microflora, counts on Baird-Parker medium give a reasonable indication of the natural (residual) hand microflora.

Chlorhexidine↗
PubMed1984

Effect of antiseptic agents on skin flora of the perineum of men with spinal cord injury.

Male patients with spinal cord injury are frequently colonized with P. aeruginosa and K. pneumoniae on the perineum. Regular bathing with bar soap has not influenced this colonization. We have attempted to remove these bacteria using antiseptic agents. The number of P. aeruginosa, K. pneumoniae and total aerobic bacteria on the perineum and the penile shaft was determined before and after cleaning with bar soap, chlorhexidine, povidone-iodine and pHresh. Povidone-iodine and chlorhexidine had no advantage over bar soap or pHresh in the removal of P. aeruginosa or K. pneumoniae from the perineum of patients with spinal cord injury.

Adolescent↗
PubMed2005

Effect of bathing on skin flora of preterm newborns.

OBJECTIVE: To assess the effect of bathing with water only or with mild pH neutral soap and water on skin flora of preterm newborns. METHOD: Randomized blinded clinical trial that enrolled 73 preterm newborns whose gestational age was between 28 and 35 weeks and birth weight between 800 and 1800 g. At the age of 3 days the infants were randomly assigned to a group that was given daily baths either with water only, or with soap and water for 7 or more days. Antibiotic treatment delayed onset of the trial in some preterm infants. On the final day of bathing axillary bacterial cultures were obtained before and 30 minutes after bathing. RESULTS: At the time of axillary culturing, the mean age of the newborns was 19 days. Coagulase-negative Staphylococcus was the most prevalent microorganism in both groups. No significant difference was found in the count of microorganism colonies between both groups. The comparison of the number of bacterial colonies between the time before and after bath, carried out by repeated-measures ANOVA showed a significant difference over time in the two groups, without a significant difference between the two groups. CONCLUSIONS: Bathing preterm newborns with water only or with soap and water produces similar effects on skin colonization of a preterm neonate. Both are effective to decrease the number of colonies of Gram-positive and Gram-negative bacteria.

Baths↗
PubMed2001

Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center.

BACKGROUND: In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center. METHODS: We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions. We reviewed procedures and cultured samples of water, medications, soaps, and hand lotions and swabs from the hands of personnel. RESULTS: We analyzed 208 sessions involving 48 patients. In 12 sessions, patients had S. liquefaciens bloodstream infections, and in 8, patients had pyrogenic reactions without bloodstream infection. Sessions with infections or reactions were associated with higher median doses of epoetin alfa than the 188 other sessions (6500 vs. 4000 U, P=0.03) and were more common during afternoon or evening shifts than morning shifts (P=0.03). Sessions with infections or reactions were associated with doses of epoetin alfa of more than 4000 U (multivariate odds ratio, 4.0; 95 percent confidence interval, 1.3 to 12.3). A review of procedures revealed that preservative-free, single-use vials of epoetin alfa were punctured multiple times, and residual epoetin alfa from multiple vials was pooled and administered to patients. S. liquefaciens was isolated from pooled epoetin alfa, empty vials of epoetin alfa that had been pooled, antibacterial soap, and hand lotion. All the isolates were identical by pulsed-field gel electrophoresis. After the practice of pooling epoetin alfa was discontinued and the contaminated soap and lotion were replaced, no further S. liquefaciens bloodstream infections or pyrogenic reactions occurred at this hemodialysis facility. CONCLUSIONS: Puncturing single-use vials multiple times and pooling preservative-free epoetin alfa caused this outbreak of bloodstream infections in a hemodialysis unit. To prevent similar outbreaks, medical personnel should follow the manufacturer's guidelines for the use of preservative-free medications.

Adult↗
PubMed1988

The impact of preoperative skin disinfection on preventing intraoperative wound contamination.

The efficacy of total body showering and incision site scrub with disinfectant agents was evaluated in a randomized, prospective study of 575 patients undergoing selected surgical procedures. Patients who showered twice with 4% chlorhexidine gluconate had lower mean colony counts of skin bacteria at the surgical incision site in the operating room prior to the final scrub than patients who showered twice with povidone-iodine solution or medicated bar soap. Patients in the chlorhexidine group had no growth on 43% of the incision site skin cultures compared with 16% in the povidone-iodine group and 6% in the soap and water group. Patients who showered and who were scrubbed with chlorhexidine also had lower rates of intraoperative wound contamination. Bacteria were recovered from the wounds of 4% of patients using this regimen compared with 9% for patients who used povidone-iodine and 15% for patients who showered with medicated soap and water and were scrubbed with povidone-iodine. We noted no difference in surgery-specific infection rates among patients in the three treatment groups; however, our sample sizes were too small to evaluate this outcome parameter adequately. These data suggest that preoperative showering and scrubbing with chlorhexidine is an effective regimen to reduce extrinsic intraoperative contamination of the surgical wound from skin bacteria. The efficacy of this regimen to prevent postoperative wound infection needs to be evaluated in a well-designed, carefully controlled prospective trial with adequate numbers of patients to achieve statistically valid conclusions.

Baths↗
PubMed1983

A suspected hospital outbreak of pseudobacteremia due to Pseudomonas stutzeri.

Pseudomonas stutzeri was recovered from blood cultures of 24 patients from 1977 through 1979 at one Mayo Clinic-affiliated hospital. During the investigation it was determined that aqueous green soap--used throughout the hospital to prepare the skin for iv insertions--had probably become contaminated with P. stutzeri. The use of aqueous green soap was discontinued, but eight additional cases of pseudobacteremia occurred in 1980-1981 and one case occurred in 1982. With one exception, all of the patients appeared to have pseudobacteremia rather than true bacteremia; the outbreak ceased only after aqueous green soap was deleted as a standard stock item from the hospital formulary.

Adolescent↗
PubMed1976

A liquid film model of tetrakaidecahedral packing to account for the establishment of epidermal cell columns.

The possiblity that the organization of cells into columns in the mammalian epidermis may be a result of the close packing of these cells has been investigated in a model system involving the association of randomly produced soap bubbles into a stable froth. Upon floating to the surface of a liquid, soap bubbles have been found to spontaneously assemble into precise columns of interdigitating bubbles. The tetrakaidecahedral shape and the spatial configuration of these bubbles closely resemble those of stacked epidermal cells, although the columns of a froth were oriented at a 60degrees angle to their substratum rather than at right angles as occurs in the epidermal cell columns. These observations lend support to the theory that the organization of the cells in the epidermis into columns is due to the assumption of the keratocytes of a minimum surface-close packing array. Such an organizing mechanism would be independent of both positional control of the underlying mitoses and active guidance of the cells as they become superficially displaced within the epidermis. The observation that a high rate of cell turnover is incompatible with the epidermal column structure may be related to the finding that rapidly produced soap bubbles do not, at least initially, assemble into a columnar array.

Animals↗
PubMed2004

Methyldibromoglutaronitrile in rinse-off products causes allergic contact dermatitis: an experimental study.

BACKGROUND: The frequency of sensitivity to the cosmetic preservative methyldibromoglutaronitrile (MDBGN) has increased significantly in Europe. Most cases of allergic contact dermatitis from MDBGN are caused by leave-on cosmetic products. The risk of developing allergic contact dermatitis from rinse-off products has been less studied. OBJECTIVES: To investigate the allergic response elicited in presensitized individuals from exposure to a rinse-off product preserved with the maximum permitted level of MDBGN. METHODS: Nineteen contact allergic individuals and nine controls participated in a double-blind, randomized repeated open application test (ROAT) using two coded liquid soaps with and without MDBGN. Areas of 50 cm2 on the lower arms were washed with the soaps twice a day for up to 28 days; two of the subjects continued for 34 days. The subjects were also patch tested with a dilution series of MDBGN to determine their patch test threshold values. RESULTS: Seven presensitized individuals (37%) developed allergic contact dermatitis from the soap containing MDBGN. The mean dose of MDBGN per application was 2.2 micro g cm-2 and the reactions appeared between days 6 and 34. All nine controls had negative ROATs. The difference in reactivity between test subjects and controls was significant (one-sided Fisher's exact test, P = 0.04). Patch test threshold values ranged from < 0.001% to 0.2% MDBGN in ethanol/water. CONCLUSIONS: This study shows that the exposure to a rinse-off product containing the maximum permitted level of MDBGN can easily elicit an allergic response in presensitized individuals. Along with reported cases of induction and elicitation caused by MDBGN in rinse-off products the study indicates that the permitted level of MDBGN in rinse-off products is too high. We recommend that this level should be re-evaluated.

Adult↗
PubMed1978

The use of non-ionic detergents in sanitary cleansing: a report of a preliminary trial.

A preliminary trial was carried out to establish the most suitable hygienic wipe for sanitary cleansing in incontinence and to study and compare the difference between cleansing with soap and non-ionic detergents in incontinent patients. Four non-ionic detergents were tested against National Health toilet soap in 290 incontinent episodes. Other observations were made on the skin condition following cleansing, the ease of cleansing, odour control, detergency, and allergenicity. The results showed that a scrim wipe was the best for this purpose and also indicated that the non-ionic detergent Cetomacrogol 1000 B.P.C. to be preferential to all other creams and soap in the time taken for cleansing. The skin condition, odour control and detergent ability were all superior with this cream. It was revealed by the trial that in cleansing faecal incontinence with non-ionic detergent, an initial wipe, followed by about 7.0 grams of detergent on a moistened wipe to achieve emulsification and than followed by another dry wipe, is all that is required. The condition of the skin was recorded as excellent and the figures indicated a possible saving of 20% in nursing time.

Cetomacrogol↗
PubMed1999

Irritancy ranking of anionic detergents using one-time occlusive, repeated occlusive and repeated open tests.

Discrepancies between the one-time patch test and the wash test regarding the ranking of irritancy of detergents have been found in the literature. The aim of the present study was to investigate the concordance of irritancy rank order of 4 anionic detergents tested by 3 different exposure methods, namely one-time occlusive, repeated short-time occlusive and repeated short-time open tests. These detergents were sodium cocoyl isethionate (ISE), sodium lauryl sulfate (SLS), soap and disodium lauryl 3-ethoxysulfosuccinate (SUC). The reactions were evaluated by visual scoring and by transepidermal water loss (TEWL) measurement. When scored visually, the rank order in the one-time test was: SOAP > or = SLS > or = ISE > SUC. The other test methods yielded a different order: SLS > ISE > or = SOAP > SUC. A similar rank order was obtained with TEWL measurement for all exposure methods. Generally, the concordance among the different exposure methods was high when evaluated by TEWL. The concordance was lower when evaluation was performed by visual scoring. The present study demonstrates that the choice of exposure model and evaluation method may be important variables influencing the outcome of irritancy testing. It is proposed that the repeated open test is the best way to simulate most in-use situations where the uncovered skin is exposed to detergents. The repeated occlusive test or the one-time patch test may be better to simulate situations in which the skin is occluded after irritation by detergents.

Adolescent↗
PubMed1968

Calcium carbonate concretions formed by the decomposition of organic matter.

Bacterial decomposition of butterfish and smelts in small sealed jars containing seawater and other solutions, for periods ranging from 65 to 205 days, results in a large increase in concentrations of dissolved bicarbonate, carbonate, and ammonia (plus volatile amines). Accompanying this is a rise in pH and the precipitation of Ca(++) ion from solution. The Ca(++) is not precipitated as CaCO(3) but instead as a mixture of calcium fatty acid salts or soaps with from 14 to 18 carbon atoms. This can be explained by the thermodynamic instability of CaCO(3) relative to Ca soaps in the presence of excess free fatty acid. It is suggested that some ancient CaCO(3) concretions, especially those enclosing fossils of soft-bodied organisms, may have formed rapidly after death in the form of natural Ca soap (adipocere) which was later converted to CaCO(3).

Ammonia↗
PubMed1989

In vivo protocol for testing efficacy of hand-washing agents against viruses and bacteria: experiments with rotavirus and Escherichia coli.

Ten antiseptic formulations, an unmedicated liquid soap, and tap water alone were compared for their capacities to eliminate human rotavirus from the finger pads of adult volunteers; three of the antiseptics, the soap, and the tap water alone were also tested against Escherichia coli. A fecal suspension of virus or bacterium was placed on each finger pad and air dried. The contaminated site was exposed to the test product for 10 s, rinsed in tap water, and dried on a paper towel. The residual virus or bacterium was then eluted. Selected agents were also tested by an analogous whole-hand method by which the entire palm surfaces of both hands were contaminated. Alcohols (70%) alone or with Savlon reduced the virus titer by greater than 99%, whereas the reductions by Proviodine, Dettol, and Hibisol ranged from 95 to 97%. Aqueous solutions of chlorhexidine gluconate were significantly less effective for virus removal or inactivation than 70% alcohol solutions. Furthermore, Savlon in water (1:200) was found to be much less effective in eliminating the virus (80.6%) than the bacterium (98.9%). The tap water alone and the soap reduced the virus titers by 83.6 and 72.5% and the bacterial titers by 90 and 68.7%, respectively. The results of the whole-hand method agreed well with those of the finger pad protocol. We conclude that the finger pad method is a suitable model for testing the in vivo efficacy of hand-washing agents and emphasize the need for using appropriate test viruses and bacteria.

Anti-Infective Agents, Local↗
PubMed1973

Use of 4 per cent chlorhexidine detergent solution (Hibiscrub) and other methods of skin disinfection.

In a comparison of three antiseptic detergent preparations for hand washing, Hibiscrub, a 4% chlorhexidine detergent solution, caused a significantly greater estimated immediate reduction of skin flora (86.7% +/- 3.0) than was obtained with Dermofax, a 0.75% chlorhexidine detergent solution (55.5% +/- 5.1), or with Disadine scrub, a povidone iodine detergent preparation (68% +/- 6.8). After six applications the mean estimated reductions of skin flora were 99.2% +/- 0.2 for Hibiscrub, 97.7% +/- 0.7 for povidone iodine, and 91.8% +/- 1.6 for Dermofax.After a series of hand washings with Hibiscrub, as with a hexachlorophane detergent preparation, a further large reduction of skin flora, shown by bacterial counts of hand sampling, was obtained by a second phase of disinfection consisting of two minutes' application on gauze swabs of 0.5% chlorhexidine digluconate in 70% ethanol; a further wash with Hibiscrub, in place of alcoholic chlorhexidine, for the second phase of disinfection caused an increase rather than a reduction in the yield of bacteria on skin sampling. Unlike this "two-phase" disinfection, the application for 30 minutes of compresses soaked in 10% aqueous povidone iodine or in 0.5% aqueous chlorhexidine digluconate did not cause a greater reduction in skin flora than that obtained by the conventional two minutes' application on gauze of 0.5% chlorhexidine in 70% ethanol.Chlorocresol (0.3%) liquid soap (the base used for Ster-Zac liquid hexachlorophane soap) caused a mean reduction of skin flora when used for hand washing of 29% after one application and 72% after six applications spread over two days. This formulation, though less active and more variable as a detergent skin antiseptic than chlorhexidine, hexachlorophane, or povidone iodine detergent preparations, is an inexpensive disinfectant soap which could be useful in catering establishments. Alcoholic cetrimide applied as for disinfection of an operation site caused a reduction of skin flora greater than that shown by aqueous cetrimide but comparable to that shown by 70% ethyl alcohol in previous experiments.

Analysis of Variance↗
PubMed1971

Disinfection of the skin: an assessment of some new preparations.

Repeated hand washing with a detergent solution containing 0.75% chlorhexidine digluconate was found to cause a large reduction in the resident skin flora which was slightly though significantly smaller than that caused by the use of 3% hexachlorophane liquid soap containing a phenolic preservative, chlorocresol 0.3%. Both agents caused a greater immediate reduction of bacteria after a single hand washing than the hexachlorophane liquid soap without a phenolic additive had shown in earlier experiments; the soap base containing chlorocresol 0.3% but no hexachlorophane was also found to cause a large reduction in skin flora. The chlorhexidine detergent solution had no residual disinfectant action on the skin after rinsing and drying the hands.Disinfection of an operation site for two minutes with povidone-iodine containing 1% available iodine in 70% ethyl alcohol caused about as great a reduction in resident flora as a similar treatment with alcoholic 0.5% chlorhexidine. Both treatments were more effective than disinfection with aqueous 1% cetrimide or 0.1% benzalkonium chloride solutions.

Anti-Infective Agents, Local↗
PubMed1974

Disinfection of the skin with detergent preparations of Irgasan DP 300 and other antiseptics.

An evaluation of the relative effectiveness of 2% hexachlorophane and 0.75% Irgasan DP 300 bar soaps in disinfection of the hands showed that the former caused a significantly larger reduction in natural skin bacteria than the latter after one handwash and after six handwashings, three on each of two successive days. Repeated use of Irgasan DP 300 bar soap caused a significantly greater reduction in skin flora than repeated handwashings with unmedicated bar soap, but a single handwash gave no significant reduction in skin flora compared with a single use of the unmedicated soap.In a comparison of a 4% chlorhexidine detergent solution a 3% hexachlorophane detergent cream and a 2% Irgasan DP 300 detergent solution the 4% chlorhexidine detergent gave the largest mean reduction in skin bacteria after one handwash and after six handwashings and 2% Irgasan DP 300 a poor and erratic reduction after a single handwash. After six handwashings all three preparations gave large reductions in skin bacteria. The 2% Irgasan preparation showed some residual activity on the skin after handwashing though less than that with chlorhexidine and with hexachlorophane-chlorocresol detergent preparations.

Anti-Infective Agents, Local↗
PubMed1978

Transient skin flora: their removal by cleansing or disinfection in relation to their mode of deposition.

A suspension of Staphylococcus aureus deposited on the skin was much more effectively removed by soap-and-water washing when it had been spread and allowed to dry (mean survival 2%) than when it had been rubbed on to the skin (mean survival 29.9%); when antiseptics (70% ethyl alcohol, Hibiscrub without added water) were used, there was no difference between their action against bacteria dried on and bacteria rubbed on to the skin; both of these methods, and especially alcohol, were more effective than soap and water. When a detergent-disinfectant method (washing with Hibiscrub and water) was used, there was a significantly greater effect against rubbed-on than against dried-on bacteria; soap and water was slightly more effective than Hibiscrub and water against the latter. The need to reappraise methods of reducing transient skin flora in 'hygienic' hand cleansing and the tests used for this purpose are discussed.

Bacteriological Techniques↗