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The classical dansyl chloride test relies on visual assessment of the extinction of fluorescence in time. We introduce a microscopic and morphometric rating of this test. We show that soaps may remove the fluorescing dye from corneocytes. Therefore caution should be taken in interpreting fluorescence extinction only as an estimate of the stratum corneum renewal.
Scabies is endemic in Africa where living conditions make synchronous treatment of every member of the large extended family impossible. An open study was designed to investigate the optimum treatment of school children in rural Tanzania. In one school where 34 children (7%) were infested, treatment with benzyl benzoate was distributed to the affected child and those sleeping in close proximity. In another school where 29 pupils (6.4%) were affected, the above treatment was given along with soap and some scabicidal ointment (6% sulphur) to be used on residually affected areas. Again, the treatment was given to those sleeping in proximity. One month later 46% were clear at the first school and a significantly higher proportion (69%) at the second. I conclude that inefficient application of scabicidal treatment and lack of washing contribute to scabies treatment failures. Synchronous treatment of small groups within the extended family can be effective.
In an attempt to improve the in vitro test strategy for the estimation of eye irritation, a neuronal cell model has been developed, with cells expressing vanilloid receptor type 1 (VR1) nociceptors. The currently accepted method for measuring eye irritancy is the ethically and scientifically criticised Draize rabbit eye test, despite the fact that alternative in vitro methods are available which have proved to be reliable and reproducible for predicting severe ocular toxicity. However, no alternative tests for measuring neuronal stimulation have yet been developed, and the prediction of eye irritation in the mild range is therefore insufficient. VR1 is a nociceptor localised in C-fibre neurons innervating the cornea and the surrounding tissue, and it responds to potentially damaging stimuli by releasing Ca2+ into the cytoplasm. As a sensory endpoint, [Ca2+]i was measured in VR1 transfected cells, as well as in control cells. Short-term cell cytotoxicity studies (cell membrane rupture and morphological divergence) were used to determine the non-corrosive concentrations of the test chemicals. Preliminary results indicated that hygiene products used daily may induce eye irritation via VR1 nociceptors. The lowest toxic concentration (0.025%) of liquid hand soap, as determined by morphologic divergences of cells, generated an 80% increase in [Ca2+]i over the basal [Ca2+]i in VR1 transfected cells, whereas the non-specific [Ca2+]i increased by 33%. Furthermore, all the endpoints studied indicated that shampoo for children was less active than shampoo for adults. If this method is successfully validated with standardised reference chemicals, the model could complete the test battery of in vitro alternatives, resulting in the saving of thousands of laboratory animals.
BACKGROUND: Aim of the study was to determine the effect of the regular use of a hand cream after washing hands on skin hydration and skin roughness. METHODS: Twenty-five subjects washed hands and forearms with a neutral soap four times per day, for 2 minutes each time, for a total of two weeks. One part of them used a hand cream after each hand wash, the others did not (cross over design after a wash out period of two weeks). Skin roughness and skin hydration were determined on the forearms on days 2, 7, 9 and 14. For skin roughness, twelve silicon imprint per subject and time point were taken from the stratum corneum and assessed with a 3D skin analyzer for depth of the skin relief. For skin hydration, five measurements per subject and time point were taken with a corneometer. RESULTS: Washing hands lead to a gradual increase of skin roughness from 100 (baseline) to a maximum of 108.5 after 9 days. Use of a hand cream after each hand wash entailed a decrease of skin roughness which the lowest means after 2 (94.5) and 14 days (94.8). Skin hydration was gradually decreased after washing hands from 79 (baseline) to 65.5 after 14 days. The hand wash, followed by use of a hand cream, still decreased skin hydration after 2 days (76.1). Over the next 12 days, however, skin hydration did not change significantly (75.6 after 14 days). CONCLUSION: Repetitive and frequent hand washing increases skin dryness and roughness. Use of a hand cream immediately after each hand wash can confine both skin dryness and skin roughness. Regular use of skin care preparations should therefore help to prevent both dry and rough skin among healthcare workers in clinical practice.
The use of skin care regimes for the cleansing of skin when a patient has been incontinent is becoming accepted practice in maintaining healthy skin. Clinisan, produced by Venture Healthcare, is a soap-free, pH balanced foam which has been specifically formulated to cleanse the skin of incontinent patients who are vulnerable to skin breakdown.
It is estimated that 30% of nursing home residents may be faecally incontinent, with those figures rising to 60% for patients in long-stay hospitals (Royal College of Physicians, 1995). Maintaining skin integrity for these patients can be complex. With little clinical information to support carers, choosing a skin care regime that maintains skin integrity for this high-risk group can be difficult. This study aims to compare two recognized skin care regimes, used in the cleansing of patients' skin following an episode of incontinence, and their impact on patients' skin integrity. A total of 93 patients were recruited to the trial from five care of the elderly or dependent service providers. The subjects were randomly allocated to either group A (soap and water; n = 49), or group B (Clinisan (Vernacare); n = 44). Initially, 33 patients in both groups started with healthy skin. However, the results of the final assessment identified only 17 subjects in group A remaining healthy, compared with 27 in group B.
Hot water immersion and insecticidal coatings were tested to determine if they could be used to disinfest Persian limes, Citrus latifolia Tanaka, of the mealybug pests Planococcus citri Risso and Pseudococcus odermatti Miller & Williams. A 20-min 49 degrees C hot water immersion treatment is effective in killing mealybugs and all other arthropods tested found externally on limes, or under the calyx. No insects or mites were found to survive after the 20-min hot water treatment. In this test, 7,200 limes were treated with 1,308 insects killed and zero survivors. Treatment at 49 degrees C for 20 min did not significantly affect quality when treated fruit were compared with untreated control fruit. Four coatings were tested at a 3% rate: two petroleum-based oils (Ampol and Sunspray oil), a vegetable oil (natural oil), and a soap (Mpede). The coatings gave up to 94% kill (Ampol) of mealybugs, which is not sufficient to provide quarantine security. The coatings might be effective as a postharvest dip before shipment.
Although several health habits and behaviors are commonly cited in medical and nursing textbooks as potential causes of urinary tract infection (UTI) in women, few have been studied in a systematic fashion. In a case-control study, we evaluated the associations between UTI and the most commonly mentioned risk factors: urination habits, diet, clothing, and soaps. Because sexual intercourse and diaphragm use increase the risk of UTI, we assessed the effect of health habits and behaviors controlling for these two risk factors. Women with initial UTI were compared with controls with no UTI history; women with a second UTI were compared to those with initial UTI. For the 25 initial cases, 19 secondary cases, and 181 controls enrolled in the study from a university health service, we found using tampons and drinking soft drinks to be moderately associated (RR greater than or equal to 1.4) with both initial and recurrent UTI. Although several other individual habits had only small associations with UTI, several of these behaviors together might substantially increase risk of initial or recurring UTI.
Corynebacterium minutissimum is the bacteria that leads to cutaneous eruptions of erythrasma and is the most common cause of interdigital foot infections. It is found mostly in occluded intertriginous areas such as the axillae, inframammary areas, interspaces of the toes, intergluteal and crural folds, and is more common in individuals with diabetes mellitus than other clinical patients. This organism can be isolated from a cutaneous site along with a concurrent dermatophyte or Candida albicans infection. The differential diagnosis of erythrasma includes psoriasis, dermatophytosis, candidiasis and intertrigo, and methods for differentiating include Wood's light examination and bacterial and mycological cultures. Erythromycin 250mg four times daily for 14 days is the treatment of choice and other antibacterials include tetracycline and chloramphenicol; however, the use of chloramphenicol is limited by bone marrow suppression potentially leading to neutropenia, agranulocytosis and aplastic anaemia. Further studies are needed but clarithromycin may be an additional drug for use in the future. Where there is therapeutic failure or intertriginous involvement, topical solutions such as clindamycin, Whitfield's ointment, sodium fusidate ointment and antibacterial soaps may be required for both treatment and prophylaxis. Limited studies on the efficacy of these medications exist, however, systemic erythromycin demonstrates cure rates as high as 100%. Compared with tetracyclines, systemic erythromycin has greater efficacy in patients with involvement of the axillae and groin, and similar efficacy for interdigital infections. Whitfield's ointment has equal efficacy to systemic erythromycin in the axillae and groin, but shows greater efficacy in the interdigital areas and is comparable with 2% sodium fusidate ointment for treatment of all areas. Adverse drug effects and potential drug interactions need to be considered. No cost-effectiveness data are available but there are limited data on cost-related treatment issues. A guideline is proposed for the detection, evaluation, treatment and prophylaxis of this cutaneous eruption.
Exposure to water and detergents is an important factor for development of irritant contact dermatitis. The aim of the present study was to investigate the effect of temperature on the damaging effects of water and detergents on the skin. Twenty healthy volunteers participated in the study. Ten participants had right and left forearms immersed into a detergent (soap) solution for 2 days twice daily for 10 min. Another 10 participants had both forearms immersed into sterile water. Right and left forearms were randomized to immersion into 20 degrees C and 40 degrees C solutions, respectively. Reactions were evaluated clinically, and by measurement of transepidermal water loss, electrical capacitance and erythema. Immersions into 40 degrees C sodium lauryl sulphate solution caused significantly increased transepidermal water loss as compared to immersion into 20 degrees C sodium lauryl sulphate solution. Electrical capacitance and erythema were not significantly influenced by temperature. Immersion into water caused no significant changes in any observed parameter. Water temperature influences the irritant capacity of a detergent. Change of temperature may be a simple but important means for prevention of irritant contact dermatitis.
UNLABELLED: Health care personnel--particularly physicians--do a poor job of complying with national handwashing guidelines, yet handwashing is the cornerstone of infection control. New products designed to increase compliance are available, such as automated handwashing machines, but their clinical benefits have not been fully studied. The best solution for now may be to continue awareness campaigns and education programs, ensure access to sinks and appropriate antiseptic products, and promote the use of alcohol disinfectants when handwashing is not possible. KEY POINTS: Antiseptic products are now preferred over handwashing with plain soap, which does not reliably prevent transmission of bacteria. Because 100% compliance may not be realistic, interventions that improve compliance, such as the use of alcohol sanitizing products when handwashing is not possible, may be the best solution. A number of barriers deter compliance, including lack of access to handwashing stations and lack of time. Gloves are not a substitute for handwashing because they are not fully protective.
OBJECTIVE: To evaluate the effects of 4 different drying methods to remove bacteria from washed hands. SUBJECTS AND METHODS: One hundred adult volunteers participated in this randomized prospective study. All bacterial counts were determined using a modified glove-juice sampling procedure. The difference was determined between the amounts of bacteria on hands artificially contaminated with the bacterium Micrococcus luteus before washing with a nonantibacterial soap and after drying by 4 different methods (cloth towels accessed by a rotary dispenser, paper towels from a stack on the hand-washing sink, warm forced air from a mechanical hand-activated dryer, and spontaneous room air evaporation). The results were analyzed using a nonparametric analysis (the Friedman test). By this method, changes in bacterial colony-forming unit values for each drying method were ranked for each subject. RESULTS: The results for 99 subjects were evaluable. No statistically significant differences were noted in the numbers of colony-forming units for each drying method (P = .72). CONCLUSION: These data demonstrate no statistically significant differences in the efficiency of 4 different hand-drying methods for removing bacteria from washed hands.
STUDY OBJECTIVE: To evaluate the effectiveness of three different types of handcleansing agents in decontaminating gloved hands that were inoculated with a series of four nosocomial pathogens. DESIGN: A controlled, experimental trial. SETTING: Tertiary care referral center. PATIENTS OR OTHER PARTICIPANTS: Five healthy volunteers participated in all portions of the study. INTERVENTIONS: A standard concentration of one of four representative nosocomial pathogens was placed on the gloved hand, spread, and allowed to dry. One of three different handcleansing agents--a nonmedicated soap, a 60% isopropyl alcohol preparation, or 4% chlorhexidine gluconate--was used to cleanse the gloves, which were cultured using a broth-bag technique. The gloves were then removed and the hands were cultured in a similar manner. MEASUREMENTS AND MAIN RESULTS: The handwashing agents reduced the median log10 counts of organisms to 2.1 to 3.9 after an inoculation of 10(7) colony forming units. The proportion of positive glove cultures for Staphylococcus aureus, 8% to 100%; Serratia marcescens, 16% to 100%; and Candida albicans, 4% to 60% varied greatly after use of the different handcleansers (P less than 0.001), and varied considerably for Pseudomonas aeruginosa, 20% to 48% (P = 0.085). After the gloves were removed, the differences among the observed proportions of hands contaminated with the test organisms varied from 5% to 50%, depending on the handcleansing agent used (P less than 0.001). CONCLUSIONS: In the era of universal precautions these data suggest that it may not be prudent to wash and reuse gloves between patients. Further, handwashing is strongly encouraged after removal of gloves.
Occupational dermatological problems are common among dental health personnel. We conducted a questionnaire survey to investigate the frequency of occupational dermatological problems among dental health personnel in Hordaland county, Norway. 333 of 394 employees (85%) answered the questionnaire. 148 of 333 respondents (44%) reported skin complaints. The proportion of respondents with skin complaints was lower among those with more than 20 years experience in dental health care. Hands were almost always involved. Use of gloves were reported to be the main cause of skin problems, especially the use of powdered gloves. Other frequently reported causes were soaps and methacrylates. Skin complaints from methacrylates occurred more often among employees wearing gloves most past of the working day. 3% of the respondents reported test-proven rubber allergy and 1% a methacrylate allergy. Our study confirm that occupational dermatological problems among dental health personnel are frequent. Irritant reactions are probably much more common than allergy. The most important allergens causing allergic contact dermatitis are rubber and methacrylates. Dental personnel should use non-powdered non-latex gloves and use non-touch techniques while handling methacrylates.
Washing is usually used to reduce the risk of a skin contamination. Skin biopsies were used and contaminations were realised with 1) soluble radioactive calcium 2) insoluble particles of uranium. The result obtained with different wash liquids are presented here. Water and soap had no effect but hypertonic DTPA was the better therapy to remove uranium from skin.
Although studies on the chemistry of odors are expanding to identify the chemical structures of odorous substances, there are no universal standards as yet to measure odor and intensity of bromidrosis. Clinical evaluation can be made on a subjective scoring from 0 to 3 prior to prescription of an antiseptic soap. In order to appreciate the correlation between the intensity of bromidrosis (BI) and bacterial activity, a study was carried out with both clinical and bacterial assessment in thirty patients with axillary or plantar BI. Odor intensity was evaluated by two physicians using a score from 0 to 3 (i.e. absent, minor, moderate, major), meanwhile bacterial composition and density were assessed before and after 10 days of hygiene using an antiseptic detergent (trichlocarbanilide) provided on the first visit. Baseline count of diphtheroids/cm2 was 35.104 and baseline micrococci average was 32.104/cm2. At the end of the study, the reduction of odor intensity was observed in 20 patients (67%) without any change in sweat production. The clinical improvement correlated with a reduction of both micrococci (70%) or diphtheroids (73%) as compared with initial data. In patients presenting persistant bromidrosis, the bacterial count/cm2 did not significantly decrease and remained above 104 diphtheroids/cm2. Thus, this study suggests that body odor may be at least indirectly correlated to microbia counts with a bacteria threshold of BI ranging around and above 104.
The germ reducing efficacy of tap water, soap, pHisoHex, pHisoDerm and 70% ethanol was compared using the model of hands artificially contaminated with E. coli. Each of ten persons washed 1, 2 or 4 minutes. Reduction factors were calculated from pre- and post-values and were compared for each individual. After one minute the logarithms of the geometric means of the reduction factors amounted to 2,99, 3,23, 3,28, 3,61, 4,25 in the above used sequence (Table 2). After one minute the reductions came off more slowly and the slopes were linear and parallel as far as the mechanical germ reducing procedures are concerned (Fig. 2). In contrast, ethanol caused a steeper slope even after one minute wash. The strong reduction achieved by mechanical procedures (even with water for one minute 3 powers of ten were observed) demonstrates the high hygienic importance of hand washings for removal of the transient flora. Detergents like pHisoDerm produce further significantly higher reductions and seem to be more suitable than aggressive disinfectants for application in fields where bactericidal action is not imperative. The proposals for procedures aiming at disinfecting of the transient flora issued by the Austrian Society for Hygiene, Microbiology and Preventive Medicine require a reduction factor of at least 10(5) after two minutes hand wash. The results of this investigation show that this is practicable with ethanol and necessary, otherwise the bactericidal action would not be different from a mechanical removal of the transient flora.
The options for keeping hands clean in hospital include soap; antimicrobial solutions; iodine and iodophours; and alcohol solutions and rubs. Following the recent directive for alcohol rubs to be placed at hospital bedsides, this paper considers the pros and cons of these and other hand-hygiene methods.