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PubMed1978

Reassessment of the surgical scrub.

This study was designed to reassess the efficacy and necessity of the preoperative ten minute, two brush scrub method currently required for all personnel at this hospital. Three scrub methods-the tem minute, two brush technique with an iodophor, Betadine surgical scrub; a five minute, no brush iodophor scrub with a new iodophor iodine scrub, and a three minute, no brush scrub with plain soap and Septisol Foam-were compared. Fingertip culture results obtained prescrub, immediately postscrub and one hour after wearing gloves revealed no significant differences in the three methods. The findings suggest that, one hour after scrubbing, a shorter, no brush scrub procedure with any of the antiseptics used in this study is as effective in reducing bacterial growth of the hands as the standard longer two brush method. By deletion of the use of scrub brushes and the improved efficiency from the reduced scrub time alone with the additional less likelihood of skin trauma and dermatitis, substantial financial savings may be realized.

Anti-Infective Agents, Local↗
PubMed1982

A proposed standard methodology for estimating the wounding capacity of small calibre projectiles or other missiles.

A standard methodology for estimating the energy transfer characteristics of small calibre bullets and other fast missiles is proposed, consisting of firings against targets made of soft soap. The target is evaluated by measuring the size of the permanent cavity remaining in it after the shot. The method is very simple to use and does not require access to any sophisticated measuring equipment. It can be applied under all circumstances, even under field conditions. Adequate methods of calibration to ensure good accuracy are suggested. The precision and limitations of the method are discussed.

Biophysical Phenomena↗
PubMed1977

[Photoallergy: results of photo patch testing in dermatological patients (author's transl)].

150 patients with light sensitivity of unknown aetiology were photo patch tested at the 2nd Department of Dermatology University of Vienna. 22 patients showed photoallergy. The identified photoallergens were mostly halogenated salicylanilides and other phenolic compounds. These substances are used as antimicrobials in soaps and cosmetics and as antimycotics in dermatological preparations. Four of the patients showed allergic contact photosensitivity to chlorpromazine. In two patients a new photoallergen has, perhaps, been discovered, namely a derivative of phthalic acid which is employed as fungicidal pesticide. The problems and consequences of photoallergy are discussed.

Adolescent↗
PubMed1997

Evaluation of doctors trained at Diarrhoea Training Unit of National Institute of Child Health, Karachi.

Diarrhoeal diseases are a major contributory factor for high infant mortality and morbidity in Pakistan. To overcome this, Government of Pakistan launched a National Programme for Control of Diarrhoeal Disease. A Diarrhoea Training Unit (DTU) was established at the National Institute of Child Health, Karachi, where apart from proper case management, 17 training workshops were held between July, 1989 to July, 1991. Eighty-five doctors from various facilities in Sindh were trained in proper management of diarrhoea and establishment of Oral Rehydration Therapy (ORT) units in their regions. Evaluation of DTU training, assessment of the knowledge of trained doctors, case management and function of ORT Units were done between September, 1992 and October, 1993. Two teams each consisting of a doctor and a lady health visitor, visited 30 such facilities. An observation check list was used for assessing the ORT unit and diarrhoea case management and a test questionnaire for the knowledge of facility physician and paramedic. Of the 29 facilities, 17 had DTU trained doctors. ORT corner had been established in 26, weighing scales were used in 21, record keeping in eight and soap and water was available for hand washing in seven centres. The presence of untrained doctors provided an opportunity to compare the two groups. Dehydration assessment was fairly good, weight was recorded in fewer cases than desirable, case management was similar in the two groups, except for infrequent use of antibiotics by the trained group. Prevention was poorly advised. Physicians' knowledge in both groups was similar but deficient in advising the use of ORS, feeding in diarrhoea and nutritional assessment. The trained ones had significantly better knowledge about drugs and this was reflected in their case management. Paramedic case management were similar to those in doctors. The study thus showed positive and beneficial effects of training.

Anti-Bacterial Agents↗
PubMed1998

Chloroxylenol causing hand dermatitis in a plumber.

Chloroxylenol use has increased and is found in many over-the-counter preparations. Although not a common sensitizer, chloroxylenol's role as a contact allergen and relevance, when positive patch tests are found, is often high. Pre-patch test assessment generally does not identify chloroxylenol as a causative agent. It is increasingly found in liquid soaps particularly in industry and specifically in the health care environment. Even as a wash-off product, this allergen can be a hidden cause of allergic contact dermatitis.

Allergens↗
PubMed1998

Individual skin care during radiation therapy.

BACKGROUND: In many clinical settings, the irradiated patient feels additional discomfort by the inhibition of washing the treatment portals and interruption of his adapted skin care habits. MATERIAL AND METHODS: An analysis of the scientific recommendations as well as an analysis of the skin dose to the irradiated portals has been performed. An individual scheme for skin care under radiation has been developed. RESULTS: A substantial decrease of the skin dose is achieved in many modern radiation techniques. The consequent reduction of severe skin reactions allowed the use of water and mild soaps as has been approved within many radiotherapy departments. This has lead to an individualized concept for skin care under radiation treatment including the allowance of gentle washing. The skin marks may be saved by using highly tolerable adhesive plasters or small tattoo points, if they are not superfluous by using masks or single referee points instead of marks for the field borders. CONCLUSIONS: The individualized concept for skin care during radiation may offer improved life quality to the patient and may decrease the acute reactions of the skin at least in some cases.

Baths↗
PubMed1976

Subcutaneous fat necrosis after paracentesis: Report of a case in a patient with acute pancreatitis.

A patient with acute pancreatitis developed subcutaneous fat necrosis of the anterior abdominal wall secondary to leakage of pancreatic enzymes through a rent in the peritoneum following paracentesis. The same patient also had another subcutaneous complication of pancreatitis, namely, nodular liquifying panniculitis of the lower extremities. The diagnosis was made by the typical histological findings of subcutaneous fat necrosis, foci of necrotic cells with a "ghost-like" appearance, and basophilic-staining calcium soaps deposited around the necrotic cells.

Abdominal Muscles↗
PubMed2000

Methicillin-resistant Staphylococcus aureus. Nosocomial acquisition and carrier state in a wound care center.

OBJECTIVE: To assess methicillin-resistant Staphylococcus aureus (MRSA) nosocomial acquisition and carrier state in a wound care center. DESIGN AND SETTING: The results of an intervention to control MRSA were compared with those of historical controls at the wound care center of university-based Hôpital Broussais, Paris, France. PATIENTS: Patients admitted for specific care of chronic ulcers and surgical wounds. MAIN OUTCOME MEASURES: Incidence rates of MRSA carriers and acquisition in wounds. RESULTS: Of 88 patients admitted during a 3-month preintervention period in 1993, 18 (21%) were MRSA carriers. Of 334 patients admitted in 1994 and 395 in 1996, 65 (19.5%) and 81 (20.5%) were MRSA carriers, respectively (P=.80). In 1993, 6 (9%) of 70 patients without MRSA acquired MRSA wound infections; the corresponding numbers were 6 (2.2%) of 269 in 1994 and 3 (0.9%) of 314 in 1996. Despite that the number of MRSA carriers remained stable at admission to the wound care center, the rate of MRSA infections in wounds per 100 noncarriers decreased significantly between the preintervention period and subsequent years: 1994 (P=.02) and 1996 (P=.002). CONCLUSIONS: Although our results are limited by the use of historical controls, they showed that simple infection control measures, such as the use of soap and water and barrier precautions associated with staff education, seemed to significantly reduce MRSA infection rates in patients with chronic skin breaks.

Aged↗
PubMed1997

The stethoscope. A potential source of nosocomial infection?

BACKGROUND: Stethoscope diaphragms have been shown to harbor potentially pathogenic bacteria. OBJECTIVES: To assess bacterial contamination on the diaphragm and under the plastic rim that secures the diaphragm of stethoscopes of physicians, nurses, medical students, and house staff in an intensive care unit and a general medical ward of a large university hospital. Also to compare the effectiveness of various cleaning agents and assess the transmissibility of bacteria from contaminated stethoscopes to human skin. METHODS: Aerobic and anaerobic bacterial cultures were performed on 40 randomly selected stethoscopes. We compared the effects of isopropyl alcohol, sodium hypochlorite (bleach), and benzalkonium chloride swabs, as well as soap and water, on reducing bacterial contamination on the stethoscope diaphragm and under the rim. The transmissibility of Micrococcus luteus inoculated onto a stethoscope diaphragm to clean human skin was also determined. RESULTS: Eleven genera and species of bacteria were isolated, with coagulase-negative staphylococcus present on 100% of stethoscopes and Staphylococcus aureus on 38%. Clostridium difficile was not isolated. The mean (+/-SE) number of total colony-forming units was 158 +/- 33 per diaphragm and 289 +/- 54 per rim. Physicians' stethoscope diaphragms had significantly more colony-forming units of coagulase-negative staphylococci than those of nurses: 163 +/- 44 vs 50 +/- 12, respectively (P = .02). The most effective cleaning agent was isopropyl alcohol after cleaning the diaphragm surface, the stethoscope diaphragms contained 0.2 +/- 0.2 colony-forming units and the rims contained 2.2 +/- 1.5 colony-forming units (P = .01). In addition, M luteus was transferred from inoculated stethoscopes to human skin. CONCLUSIONS: Most stethoscopes harbor potential pathogens but are not a source of C difficile. Physicians' stethoscopes generally had a higher bacterial load than nurses' stethoscopes. Isopropyl alcohol is an effective cleaning agent when applied to the stethoscope diaphragm. Stethoscopes transfer M luteus to human skin, making it likely that other bacteria can be transferred as well.

Cross Infection↗
PubMed1975

Neurotoxicity of hexachlorophene in humans. II. A clinicopathological study of 46 premature infants.

To assess neurotoxic effects of hexachlorophene in the human population previously shown to be most at risk, a blind clinicopathological analysis was made of all premature infants under 1,400 gm birth weight who survived at least four days and were examined by autopsy over a 7.5-year period. Repeated whole-body bathing of premature newborn infants in 3% hexachlorophene-bearing soap (undiluted pHisoHex) shows a significant statistical association with a vacuolar encephalopathy of the brain stem reticular formation. The prevalence of the vacuolar encephalopathy in premature infants on whom we have adequate brain stem histological information appears to be related to the number of exposures to hexachlorophene, the concentration of hexachlorophene, the thoroughness of rinsing, and other factors (including exposure to ultraviolet light).

Administration, Topical↗
PubMed1985

Laboratory detection of marijuana use. Experience with a photometric immunoassay to measure urinary cannabinoids.

The urinary excretion of cannabinoids was determined using a photometric immunoassay technique among adolescents and young adults who had an abrupt and closely supervised cessation of drug use on entering a strict rehabilitation program. No falsely positive urine test results were encountered among 70 persons admitted consecutively to the program. Among five subjects with a history of chronic, heavy marijuana use (approximately 56 g/mo [approximately 2 oz/mo]), urinary cannabinoids were detected for an average of 13 days (range, nine to 25 days), following cessation of use. Among four subjects with a history of moderate marijuana use (approximately 28 g/mo [approximately 1 oz/mo]), test results remained positive for an average of 4.7 days (range, two to eight days). Test results were negative 48 hours after cessation in two subjects with a history of infrequent use (less than 7 g/mo [0.25 oz/mo]), who had smoked marijuana within the preceding two days. The specificity of the method for detecting recent marijuana use appears excellent; the sensitivity depends on the potency of the cannabis preparation, the time of last use, the frequency of previous use, and the specific gravity of the urine specimen. On the basis of this preliminary experience, positive test results for more than eight consecutive days suggest either surreptitious continued use or previous chronic, heavy use in a newly abstinent person. Purposeful adulteration of known-positive urine specimens with bleach, blood, vinegar, salt, and liquid soap produced falsely negative results. Unless samples are collected under direct observation, urine color, temperature, specific gravity, and dipstick tests for blood and pH should be recorded.

Adolescent↗
PubMed2002

Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study.

CONTEXT: Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce. OBJECTIVE: To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice. DESIGN: Randomized equivalence trial. SETTING: Six surgical services from teaching and nonteaching hospitals in France. PATIENTS: A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001. INTERVENTIONS: Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate. MAIN OUTCOME MEASURES: Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points. RESULTS: The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P =.008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use. CONCLUSIONS: Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in preventing surgical site infections. The hand-rubbing protocol was better tolerated by the surgical teams and improved compliance with hygiene guidelines. Hand-rubbing with liquid aqueous alcoholic solution can thus be safely used as an alternative to traditional surgical hand-scrubbing.

Anti-Infective Agents, Local↗
PubMed2004

Risk factors for typhoid and paratyphoid fever in Jakarta, Indonesia.

CONTEXT: The proportion of paratyphoid fever cases to typhoid fever cases may change due to urbanization and increased dependency on food purchased from street vendors. For containment of paratyphoid a different strategy may be needed than for typhoid, because risk factors for disease may not coincide and current typhoid vaccines do not protect against paratyphoid fever. OBJECTIVE: To determine risk factors for typhoid and paratyphoid fever in an endemic area. DESIGN, SETTING, AND PARTICIPANTS: Community-based case-control study conducted from June 2001 to February 2003 in hospitals and outpatient health centers in Jatinegara district, Jakarta, Indonesia. Enrolled participants were 1019 consecutive patients with fever lasting 3 or more days, from which 69 blood culture-confirmed typhoid cases, 24 confirmed paratyphoid cases, and 289 control patients with fever but without Salmonella bacteremia were interviewed, plus 378 randomly selected community controls. MAIN OUTCOME MEASURES: Blood culture-confirmed typhoid or paratyphoid fever; risk factors for both diseases. RESULTS: In 1019 fever patients we identified 88 (9%) Salmonella typhi and 26 (3%) Salmonella paratyphi A infections. Paratyphoid fever among cases was independently associated with consumption of food from street vendors (comparison with community controls: odds ratio [OR], 3.34; 95% confidence interval [CI], 1.41-7.91; with fever controls: OR, 5.17; 95% CI, 2.12-12.60) and flooding (comparison with community controls: OR, 4.52; 95% CI, 1.90-10.73; with fever controls: OR, 3.25; 95% CI, 1.31-8.02). By contrast, independent risk factors for typhoid fever using the community control group were mostly related to the household, ie, to recent typhoid fever in the household (OR, 2.38; 95% CI, 1.03-5.48); no use of soap for handwashing (OR, 1.91; 95% CI, 1.06-3.46); sharing food from the same plate (OR, 1.93; 95% CI, 1.10-3.37), and no toilet in the household (OR, 2.20; 95% CI, 1.06-4.55). Also, typhoid fever was associated with young age in years (OR, 0.96; 95% CI, 0.94-0.98). In comparison with fever controls, risk factors for typhoid fever were use of ice cubes (OR, 2.27; 95% CI, 1.31-3.93) and female sex (OR, 1.79; 95% CI, 1.04-3.06). Fecal contamination of drinking water was not associated with typhoid or paratyphoid fever. We did not detect fecal carriers among food handlers in the households. CONCLUSIONS: In Jakarta, typhoid and paratyphoid fever are associated with distinct routes of transmission, with the risk factors for disease either mainly within the household (typhoid) or outside the household (paratyphoid).

Adolescent↗
PubMed1996

Role of television in adolescent women's body dissatisfaction and drive for thinness.

OBJECTIVE: Many authors have implicated the media's promotion of an unrealistically thin ideal for women as a major causal factor in the current high levels of body dissatisfaction and increasing incidence of eating disorders. The present study aimed to investigate the relationship between exposure to one medium, television, and body dissatisfaction and drive for thinness. METHOD: Questionnaires were administered to 94 adolescent women who reported how much and what television they had watched in the previous week. Body dissatisfaction and drive for thinness were also assessed. RESULTS: Amount of television watched did not correlate with either body dissatisfaction or drive for thinness, but category of program did. Specifically, amount of time spent watching soaps, movies, and (negatively) sport predicted body dissatisfaction, and the watching of music videos predicted drive for thinness. DISCUSSION: The results are consistent with sociocultural explanations for body dissatisfaction and for the emergence of eating disorders in young women.

Adolescent↗
PubMedDate not supplied

Percutaneous absorption and metabolism of Coumarin in human and rat skin.

Coumarin is widely used as a fragrance in cosmetics, perfumes and soaps. The food and Drug Administration banned coumarin use in food because of reports that coumarin produced hepatotoxicity in rodents. Concerns about coumarin's safety have also been raised by toxicity testing conducted by the National Toxicology Program. Therefore, we initiated studies to measure the extent of coumarin absorption and metabolism in skin. [14C]Coumarin (ca. 0.5 microCi per cell) absorption in skin was measured by using two vehicles: ethanol (15 microliters cm-2) and an oil-in-water emulsion (3 mg cm-2). Absorption was determined for 24 h by using flow-through diffusion cells (0.64 cm2, exposed skin) with a receptor fluid consisting of HEPES-buffered Hank's balanced salt solution (pH 7.4). Coumarin metabolism was determined by high-performance liquid chromatography methodology. In rat skin (n = 3), the percentages of applied dose absorbed after 24 h were 54.9 +/- 0.63 (mean +/- SEM) and 86.8 +/- 5.4 for the ethanol and emulsion vehicles, respectively, with ca. 5% remaining in skin. In human skin (n = 2), the percentages of applied dose absorbed after 24 h were 64.4 +/- 0.29 and 98.0 +/- 5.3 for the ethanol and emulsion vehicles, respectively, with ca. 1% remaining in skin. The extent of skin absorption was greater from the emulsion vehicle than from the ethanol vehicle in both human and rat skin. Coumarin rapidly penetrated both rat and human skin with > 75% and > 95%, respectively, of the absorbed dose found in the receptor fluid within 6 h. No evidence of coumarin metabolism was found in either skin or receptor fluid fractions. These studies indicate that coumarin absorption is significant in skin. Systemic coumarin absorption must be expected after dermal contact with coumarin-containing products.

Animals↗
PubMed2004

Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.

BACKGROUND: Peritoneal dialysis (PD) is used as substitutive treatment of renal function in a large proportion (15-50%) of the end-stage kidney disease (ESRD) population. The major limitation is peritonitis which leads to technique failure, hospitalisation and increased mortality. Oral, nasal, topical antibiotic prophylaxis, exit-site disinfectants and other antimicrobial interventions are used to prevent peritonitis. OBJECTIVES: The objective of this systematic review of randomised controlled trials (RCTs) was to evaluate what evidence supports the use of different antimicrobial approaches to prevent peritonitis in PD. SEARCH STRATEGY: The Cochrane CENTRAL Registry (issue 1, 2004), MEDLINE (1966-May 2003), EMBASE (1988-May 2003) and reference lists were searched for RCTs of antimicrobial agents in PD. SELECTION CRITERIA: Trials of the following agents were included: antibiotics by any route (oral, nasal, topical), exit-site disinfectants (chlorhexidine, povidone iodine, soap and water), vaccines, and ultraviolet germicidal devices. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data on the number of patients with one or more episodes and rates of peritonitis and exit-site/tunnel infection, catheter removal, catheter replacement, technique failure, toxicity of antibiotic treatments, all-cause mortality. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: Nineteen trials, enrolling 1949 patients met our inclusion criteria. Nasal mupirocin compared with placebo significantly reduced the exit-site and tunnel infection rate (one trial, 2716 patient months, RR 0.58, 95% CI 0.40 to 0.85) but not peritonitis rate (one trial, 2716 patient months, RR 0.84, 95% CI 0.44 to 1.60). Perioperative intravenous antibiotics compared with no treatment significantly reduced the risk of early peritonitis (four trials, 335 patients, RR 0.35, 95% CI 0.15 to 0.80) but not exit site and tunnel infection (three trials, 114 patients, RR 0.32, 95% CI 0.02 to 4.81). No intervention reduced the risk of catheter removal or replacement. REVIEWERS' CONCLUSIONS: This review demonstrates that nasal mupirocin reduces exit-site/tunnel infection but not peritonitis. Preoperative intravenous prophylaxis reduces early peritonitis but not exit-site/tunnel infection. No other antimicrobial interventions have proven efficacy. Given the large number of patients on PD and the importance of peritonitis, the lack of adequately powered RCTs to inform decision making about strategies to prevent peritonitis is striking.

Anti-Bacterial Agents↗
PubMed1993

Identification of formaldehyde releasers and occurrence of formaldehyde and formaldehyde releasers in registered chemical products.

Substances referred to as formaldehyde releasers were identified on review of the literature. Information on product categories and typical concentrations for chemical products containing formaldehyde and formaldehyde releasers was obtained from the Danish Product Register Data Base (PROBAS). As of February 1992, 62,000 products were registered in PROBAS, 30,900 of these with information on composition and product category. Among the components of these products, 19 of the 22 identified formaldehyde releasers were found. The number of products registered with each formaldehyde releaser varied from 4 to 171, with cleaning agents, soaps, shampoos, paint/lacquers, and cutting fluids as the most frequent product categories. The most frequently registered formaldehyde releasers were bromonitropropanediol, bromonitrodioxane, and chloroallylhexaminium chloride. Formaldehyde itself was registered in 1,781 products, and was found in all product categories included in the study. It is concluded that products for industrial use as well as household and personal care products should be considered as sources of formaldehyde exposure. The use of unsystematic chemical names in literature is discussed.

Chemical Industry↗
PubMed2006

Meta-analysis of preoperative antiseptic bathing in the prevention of surgical site infection.

BACKGROUND: Preoperative bathing with an antiseptic solution is widely used to prevent surgical site infection, but trial results are conflicting. METHODS: Trials were identified by searches of Medline, Embase and the Cochrane controlled trials register. Studies were eligible if they compared an antiseptic solution used in preoperative bathing with a non-antiseptic washing agent or with no bathing and if they reported data on surgical site infection. RESULTS: Six trials with a total of 10 007 patients were included; all of them used 4 per cent chlorhexidine gluconate. Three trials with 7691 patients compared chlorhexidine with placebo. Bathing with chlorhexidine did not reduce surgical site infection rate; the relative risk (RR) was 0.91. Including only trials of high quality, the RR was 0.95. Three trials with 1443 patients compared bar soap with chlorhexidine; no differences in the surgical site infection rates were detected, and the RR was 1.02. Two trials of 1092 patients compared bathing with chlorhexidine with no washing. The surgical site wound infection rate in the two groups was similar, and the RR was 0.70. CONCLUSIONS: The evidence does not support preoperative bathing with chlorhexidine as a means of reducing surgical site wound infection.

Anti-Infective Agents, Local↗