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PubMed2002

Environmental risk assessment of phosphonates, used in domestic laundry and cleaning agents in The Netherlands.

In the long-term cooperative project Voluntary Plan of Action (1990) between the Dutch Soap and Detergent Association (NVZ) and the Dutch Ministry of Housing, Spatial Planning and the Environment (VROM) environmental risk assessments of several main components of laundry cleaning formulations were completed. As a part of that project the environmental risk assessment of HEDP, ATMP, EDTMP and DTPMP phosphonates used in detergent applications has been carried out according to the EU Technical Guidance Document for Environmental Risk Assessment for New and Existing Chemicals. All PEC/PNEC ratios were well below 1. Results of this assessment based on the total industry volumes from 1995 and 1998 indicate that the environmental risk of these phosphonates is low in The Netherlands with properly functioning sewage treatment plants.

Chelating Agents↗
PubMed2005

Cryoelectron microscopy of liposomes.

A thin aqueous film of suspended lipid vesicles?micelles is the object of choice for vitrification and subsequent study by cryoelectron microscopy. Just prior to vitrification, a thin film (compare with a soap film) is vulnerable to heat and mass exchange. Preparation of thin films in a temperature- and humidity-controlled environment is essential to prevent osmotic and temperature-induced alterations of the lipid structure, as will be explained in this chapter. Further automation of the preparative procedure by automatic blotting and PC control over the timing of critical steps (including vitrification) may further assist in the reproducible throughput of high-quality specimens. By cryotomography, taking a tilt series under low-dose conditions, a three-dimensional reconstruction of the specimen can be analyzed.

1,2-Dipalmitoylphosphatidylcholine↗
PubMed2000

Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.

BACKGROUND: Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel. METHODS: We monitored the overall compliance with hand hygiene during routine patient care in a teaching hospital in Geneva, Switzerland, before and during implementation of a hand-hygiene campaign. Seven hospital-wide observational surveys were done twice yearly from December, 1994, to December, 1997. Secondary outcome measures were nosocomial infection rates, attack rates of methicillin-resistant Staphylococcus aureus (MRSA), and consumption of handrub disinfectant. FINDINGS: We observed more than 20,000 opportunities for hand hygiene. Compliance improved progressively from 48% in 1994, to 66% in 1997 (p<0.001). Although recourse to handwashing with soap and water remained stable, frequency of hand disinfection substantially increased during the study period (p<0.001). This result was unchanged after adjustment for known risk factors of poor adherence. Hand hygiene improved significantly among nurses and nursing assistants, but remained poor among doctors. During the same period, overall nosocomial infection decreased (prevalence of 16.9% in 1994 to 9.9% in 1998; p=0.04), MRSA transmission rates decreased (2.16 to 0.93 episodes per 10,000 patient-days; p<0.001), and the consumption of alcohol-based handrub solution increased from 3.5 to 15.4 L per 1000 patient-days between 1993 and 1998 (p<0.001). INTERPRETATION: The campaign produced a sustained improvement in compliance with hand hygiene, coinciding with a reduction of nosocomial infections and MRSA transmission. The promotion of bedside, antiseptic handrubs largely contributed to the increase in compliance.

Anti-Infective Agents, Local↗
PubMed1995

Physical assessment in the community pharmacy.

As pharmacists continue to define their role in the health care system of the future and implement pharmaceutical care, they will need new or enhanced skills in managing patient care cost-effectively. Their ability to perform basic physical assessments will be a vital tool in managing their patients' health status. By using the SOAP method of evaluation and plan development and by using a systematic approach to obtaining physical data, pharmacists can properly perform initial assessment and monitor the patients they now serve. This enhanced level of care will be well accepted by patients and other health care team members when pharmacists provide them in a professional manner and serve as partners with these practitioners in developing and managing appropriate care plans.

Aged↗
PubMed2003

A questionnaire-based, retrospective field study of persistence of Salmonella Enteritidis and Salmonella Typhimurium in Danish broiler houses.

A questionnaire-based, retrospective field study was conducted in 78 Danish broiler houses (analytical units) on 42 farms. In spring 1997, all these broiler houses had been infected with Salmonella Enteritidis, phage type 8, and/or Salmonella Typhimurium, definitive-type 66, by day-old chicks delivered from the same hatchery. Because these two salmonella types had not been detected in the Danish broiler sector before and the broiler houses were infected in a period of low salmonella prevalence, the study could focus on farm-related factors, without being distorted by other salmonella infections. The same person visited all 78 broiler houses, and farm-related factors were listed both from personal observations and by interrogating the person in charge of attending to the broilers. Additional factors (noted at the visits) were recorded in a later telephone interview. Altogether, 187 variables were analyzed.Broiler houses were divided into single-infection houses (which had one or both of the salmonella types in only one crop), and multiple-infection houses (where infection occurred in multiple crops). This was done both generally and separately for each of the salmonella types. Factors associated with house status-but that were beyond the control of the farmer-were the salmonella type and the percentage of salmonella positive samples in the first crop. Factors which could be controlled by the farmer and which were associated with reduced prevalence of multiple-infection houses included antiseptic soap and water for washing hands in the anteroom, hygiene barriers when removing dead broilers, gravel alongside the broiler house, systematic checks of indoor rodent-bait depots, and combined surface and pulse-fogging disinfection.

Animal Husbandry↗
PubMed1998

Phase coexistence in cholesterol-fatty acid mixtures and the effect of the penetration enhancer Azone.

Small and wide-angle X-ray diffraction was used to study the phase behaviour of cholesterol-fatty acid mixtures in an attempt to understand lipid interaction occurring in the stratum corneum, the outermost layer of skin. The effect of the penetration enhancer Azone was investigated as well. It was found that equimolar mixtures of cholesterol, palmitic acid and oleic acid (with the acids neutralised to 41 mol%) in 25% (wt/wt) water typically showed three phases at room temperature, two crystalline and one gel phase. The crystalline phases consisted mainly of palmitic acid:soap and cholesterol, respectively. The water present was unevenly distributed and was associated with the gel phase. Both cholesterol and palmitic acid seemed to be depleted from their crystalline phases by Azone. The electrostatic effects on titration of fatty acids in lamellar aggregates were calculated in view of the present results, and the effects of phase separation were discussed.

Azepines↗
PubMed1998

ISCOMs and other saponin based adjuvants.

Saponins are chemically a heterogeneous group of sterol glycosides and triterpene glycosides which are common constituents of plants. One source of triterpenoid saponins obtained from the bark of Quillaia saponaria Molina (the soap bark tree) have been known to cause substantial enhancement of immune responses since the 1920s. Despite their use in animal vaccines, the development of saponin-based formulations for human vaccines has been impeded by their complexity and concerns about toxicity. This review briefly covers the use of saponins for animal vaccines but focuses mainly on the development of these adjuvants for use in man. Important aspects include preparation of purified or highly defined saponin fractions, improved understanding of the relationships between adjuvant activity, toxicity and structure of saponins and formulation of saponins into structures with reduced toxicity such as ISCOMs. Recent developments in the understanding of cellular interactions, cytokine induction and the in vivo localisation of saponin containing formulations will also be reviewed.

Journal Article↗
PubMed1998

Uptake and adjuvant activity of orally delivered saponin and ISCOM vaccines.

Saponins are a highly heterogenous group of glycosides which are common in plants and have been known to have adjuvant properties since the 1920s. The immunostimulating complex or ISCOM is a particulate adjuvant/antigen delivery system. ISCOMs are open cage-like complexes typically with a diameter of about 40 nm which are built up by cholesterol, lipid, immunogen and saponins from the bark of Quillaia saponaria Molina (soap bark tree). ISCOMs and saponins are used as adjuvants in some commercial veterinary vaccines and have been examined as adjuvants in a large number of human experimental vaccines. This review describes the current status and potential of saponin and ISCOMs as adjuvants for orally-administered vaccines with special reference to the induction of local and systemic immune responses and interactions with the intestinal epithelium. The structure and composition of saponins and ISCOMs will also be reviewed.

Journal Article↗
PubMed1980

The pumice stone in dermatologic therapy.

The pumice stone is very helpful in removing hyperkeratotic tissue and can be used alone or following treatment of the skin with a keratolytic agent. It is essential to scrub while the skin is wet in order to maximize the disintegration of excessive stratum corneum. The stone in combination with soap and water is very effective in removing stains from the hands in a number of occupations and may alleviate the need for harsher cleansers.

Callosities↗
PubMed1986

The child's conception of food: differentiation of categories of rejected substances in the 16 months to 5 year age range.

Children (N = 54) ranging in age from one year four months to five years were offered over 30 items to eat. The items included normal adult foods and exemplars of different adult rejection categories: disgust (e.g. grasshopper, hair), danger (liquid dish soap), inappropriate (e.g. paper, leaf) and unacceptable combinations (e.g. ketchup and cookie). We report a high to moderate level of acceptance (item put into mouth) of substances from all of these categories in the youngest children. Acceptance of disgusting and dangerous substances decreases with increasing age, while acceptance of inappropriate substances remains at moderate levels across the age range studied. Although the youngest children accepted more disgust items, the majority rejected most of the disgust choices. Almost all children at all ages tested accept combinations of foods which, although individually accepted by adults, are rejected in combination. No significant differences were observed between 'normal' children and those with a history of toxin ingestion, although there was a tendency of ingesters to accept more inedible items. In general, the results suggest that a major feature of the development of food selection is learning what not to eat.

Adult↗
PubMed2003

Evaluation of the bactericidal effect of five products for surgical hand disinfection according to prEN 12054 and prEN 12791.

Surgical hand disinfection (with an alcohol-based hand rub) and surgical handwash (with an antiseptic-based liquid soap) are accepted measures to reduce the risk for surgical site infections. The new European Standards allow a comparison of their antimicrobial efficacy. The bactericidal activity of surgical hand rubs [Sterillium and Softaman, (active ingredient=alcohols)] and handwashes [Derman plus (triclosan), Hibiscrub (chlorhexidine) and Betadine (PVP-iodine)] was tested according to the prEN 12054 suspension test using Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus hirae, and to prEN 12791 for the effect on resident skin flora in comparison with 1-propanol, 60% (v/v). All five products achieved a reduction of test bacteria within 3 min of >10(5)-fold so fulfilling prEN 12054. However, only Hibiscrub, Sterillium and Softa Man met the requirements of prEN 12791, giving a mean reduction of resident micro-organisms (immediate and sustained effect) which was not significantly lower than the reference alcohol (P>0.1; Wilcoxon matched-pairs signed-rank test). Sterillium was significantly more effective than the reference alcohol (immediate and sustained affect). Products for surgical hand disinfection may have equal antimicrobial activity in suspension tests but show large differences under practical conditions. Healthcare workers should not rely on results from suspension tests when deciding on a product for surgical hand disinfection.

1-Propanol↗
PubMed2003

In-use evaluation of Perasafe compared with Cidex in fibreoptic bronchoscope disinfection.

The mycobactericidal activity of Perasafe (0.26% peracetic acid) was compared with that of Cidex (2% alkaline glutaraldehyde) by an in-use test. Fibreoptic bronchoscopes were artificially contaminated with Mycobacterium tuberculosis or Mycobacterium avium-intracellulare in sputum and, after manual pre-cleaning with a neutral soap, 10 and 20 min disinfection periods were tested. Perasafe was as effective as Cidex, thus requiring a 10 min disinfection period against M. tuberculosis and 20 min against M. avium-intracellulare. The results demonstrate that Perasafe is an effective disinfectant for use in reprocessing fibreoptic bronchoscopes.

Bronchoscopes↗
PubMed2004

[Characteristics of the demand for medical attention in primary care of a health area in the Community of Valencia (SyN-PC study)].

OBJECTIVES: To quantify with primary data the various kinds of consultations, the reasons for them and the diagnoses; to measure preventive actions and diagnoses using machines. To check the recording of the kinds of consultations and reasons for them in the clinical notes and on the doctor's work-sheet. DESIGN: Observation, cross-sectional and multi-centre study. Clinical care activity was measured on two January days in 2002. SETTING: All the health centres in Area 17 of the Community of Valencia. PARTICIPANTS: Representative sample of 2051 patients belonging to 20 primary care medical clinics from the above area, selected by sampling stratified by health centres. MAIN MEASUREMENTS: The activity of a working day was recorded and structured as follows: a) care activity (scheduling, age, sex, records code, kind of consultation and motive, specifying whether this was care activity, preventive or bureaucratic); b) activity caused by main reason for consultation (anamnesis, examination and further tests); c) plan of action (hygienic and dietary measures, medication and referrals); d) use of the clinical records according to SOAP sections; e) interruptions during the consultation. RESULTS: Study of care activity and its correlation with the actions recorded in the clinical record with primary data enables the reality of health care to be fairly faithfully perceived. These results highlighted the usefulness of clinical record audits to measure health-care delivery and to identify patterns of consumption of health resources, as a necessary pre-condition of more efficient primary care management.

Adolescent↗
PubMed2005

[Validity of clinical records and information systems in studies of health-care delivery in primary care].

OBJECTIVES: To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. DESIGN: Multi-centred, observational, and cross-sectonal study. SETTING: Four medical clinics at 12 health centres in the Community of Valencia, Spain. PARTICIPANTS: There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). CONCLUSIONS: The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management.

Cross-Sectional Studies↗
PubMed2001

[Study of methicillin-resistant Staphylococcus aureus colonization among intermediate-care facility patients].

PURPOSE: Prevalence of methicillin-resistant Staphylococcus aureus is high in the Poitiers teaching hospital, particularly in the intermediate care facilities. We performed a survey of methicillin-resistant Staphylococcus aureus colonization in the intermediate care facilities and 265 patients were included. METHODS: Nasal, cutaneous and wound swab cultures were done at the time of admission and at the time of the patients' departure. A decolonization procedure of methicillin-resistant Staphylococcus aureus carriers was performed using nasal application of fusidic acid and different soaps for the skin. At entry, 17.7% of patients were methicillin-resistant Staphylococcus aureus carriers (of at least one location). At departure, 30.4% were methicillin-resistant Staphylococcus aureus carriers. Among methicillin-resistant Staphylococcus aureus non-carriers at entry, 24.3% became methicillin-resistant Staphylococcus aureus carriers. RESULTS: The principal risk factor of carriage was the initial presence of a wound (RR = 3.6). The incidence rate of methicillin-resistant Staphylococcus aureus infection among the 265 patients included was 3%. CONCLUSION: The systematic screening of patients at the time of admission is expensive and isolation technically hard to manage in the intermediate care facilities. The risk factor we found in this study allow us to propose a 'light' screening limited to patients with wounds.

Aged↗
PubMed2003

Cross-infection prevention, basic hygiene practices and education within nursing and health care in Latvia: a Swedish-Latvian practice development project.

The primary aim of this practice development project was to explore the level of knowledge of nursing and medical staff at the Infection Clinic at Liepaja regarding the spread of infectious diseases. Arrangements were also made for some of the Latvian health care staff to visit the Infection Clinic in Gothenburg to increase their knowledge about basic hygiene and to enable them to study the research in this area. Later we were able to formulate this new knowledge into written guidelines. The theoretical education started with questions regarding staffs expertise in preventing the spread of infections. Areas covered were handwashing, hand disinfection, use of disposable gloves and protective clothing. This revealed a need for development of both theoretical and practical knowledge in this area. However, hygiene practices improved after the theoretical education and the visits to the Infection Clinic in Gothenburg. On our return visit to Liepaja dispensers of liquid soap together with hand disinfectants were evident at every wash basin on the unit. Disposable gloves were also routinely used for the dressing of wounds and invasive procedures. Furthermore, disposable coats and masks were used when caring for highly infectious patients. The key cultural differences were the lack of nursing documentation and the relative absence of a dialogue directly between the nurse and the patient.

Clinical Competence↗
PubMed2001

Effect of slip on movement of body center of mass relative to base of support.

OBJECTIVE: The purpose is to investigate the effect of balance conditions and slippery perturbation on the position and velocity of the body's center of mass relative to the body's base of support. DESIGN: Twenty-two young and healthful subjects were investigated while their walk was perturbed by a soap patch applied over a force plate. A safety harness was used to prevent the subject from falling on knee or buttock. BACKGROUND: Appropriate postural response to meet physiological biomechanical requirements is mandatory in restoration of balance upon slip. METHODS: Twenty-two healthy subjects dressed with safety harness walked first without and then with slippery perturbation, guided by a metronome at 120 steps/min and 90 steps/min cadence. Data were collected from a motion analysis system and force plates. RESULTS: For slippery perturbation, the displacement and velocity of center of mass with respect to base of support became smaller from heel strike to contralateral toe off. Subject's balance condition correlated significantly to the displacement of center of mass with respect to base of support (r=-0.51 at 120 steps/min and r=-0.471 at 90 steps/min), as well as the velocity (r=-0.834 at 120 steps/min, r=-0.673 at 90 steps/min) at contralateral toe off. CONCLUSIONS: For slip during walking, smaller excursion and faster velocity of center of mass with respect to base of support were important for subjects regaining balance from heel strike to contralateral toe off. The critical time for subjects regaining stability is the first double support phase of the gait cycle. RELEVANCE: It is confirmed that two variables, the displacement and the velocity of center of mass with respect to base of support, are valuable biomechanical factors and provide quantifiable determination for investigation of the balance condition in slipping.

Accidental Falls↗
PubMed1997

Significance of rhizosphere microorganisms in reclaiming water in a CELSS.

Plant-microbe interactions, such as those of the rhizosphere, may be ideally suited for recycling water in a Controlled Ecological Life Support System (CELSS). The primary contaminant of waste hygiene water will be surfactants or soaps. We identified changes in the microbial ecology in the rhizosphere of hydroponical1y grown lettuce during exposure to surfactant. Six week old lettuce plants were transferred into a chamber with a recirculating hydroponic system. Microbial density and population composition were determined for the nutrient solution prior to introduction of plants and then again with plants prior to surfactant addition. The surfactant Igepon was added to the recirculating nutrient solution to a final concentration of 1.0 g L-1. Bacteria density and species diversity of the solution were monitored over a 72-h period following introduction of Igepon. Nine distinct bacterial types were identified in the rhisosphere; three species accounted for 87% of the normal rhizosphere population. Microbial cell number increased in the presence of Igepon, however species diversity declined. At the point when Igepon was degraded from solution, diversity was reduced to only two species. Igepon was found to be degraded directly by only one species found in the rhizosphere. Since surfactants are degraded from the waste hygiene water within 24 h, the potential for using rhizosphere bacteria as a waste processor in a CELSS is promising.

Biodegradation, Environmental↗