Soap and syndets: differences and analogies, sources of great confusion.

OBJECTIVE: Soap has been used by humankind since ancient times and was probably already known to the Sumerians. It is a fatty acid salt obtained from the reaction of a strong base with a fatty substance of animal (tallow) or plant origin (oil). This reaction is called saponification. Syndets, on the other hand, are much more recent and have been in use for about a century. In the case of liquid syndets, they are mainly alkyl sulphates and their derivatives alkyl ether sulphates while isethionates and sarcosinates are more commonly found in solid syndets. Synthetic soaps and detergents are surfactants and, as such, they have detergent properties. The way soap works accounts for its antimicrobial properties. Thanks to its amphiphilic structure, it is able to interact with the lipid membranes of microorganisms (viruses, bacteria, etc.) and inactivate them. In this coronavirus pandemic period, health authorities worldwide recommend hand washing with soap and water. We therefore wanted to provide a summary of the chemical characteristics and applications of soaps, on the one hand, and synthetic detergents, on the other. Soap is not the only product used for hand hygiene and, given the current situation, alternatives are complex and varied.

Formative research to scale up a handwashing with soap and water treatment intervention for household members of diarrhea patients in health facilities in Dhaka, Bangladesh (CHoBI7 program).

BACKGROUND: During the time a diarrhea patient presents at a health facility, the household members of the patient are at higher risk of developing diarrheal diseases (> 100 times for cholera) than the general population. The Cholera-Hospital-based-Intervention-for-7-Days (CHoBI7) is a health facility-initiated water treatment and handwashing with soap intervention designed to reduce transmission of diarrheal diseases between patients and their household members. The present research aimed to (1) develop a scalable approach to integrate the CHoBI7 intervention program into services provided at government and private health facilities in Bangladesh; and (2) tailor the intervention program for the household members of all diarrhea patients, irrespective of the etiology of disease. METHODS: We conducted 8 months of formative research, including 60 semi-structured interviews, 2 group discussions, and a pilot study. Thirty-two interviews were conducted with diarrhea patients and their family caregivers, government stakeholders, and health care providers both to explore existing WASH and diarrhea patient care practices in health facilities and to identify considerations for scaling the CHoBI7 program. Fifty-two diarrhea patient households participated in a pilot study of a modified version of the CHoBI7 intervention program for tailoring. Twenty-eight interviews and 2 group discussions were conducted with pilot households to explore experiences with and recommendations for intervention delivery. RESULTS: The intervention program was modified based on formative research findings. Pilot study participants recognized the benefits of the CHoBI7 intervention program and made suggestions to improve the acceptability and feasibility of the intervention. Modifications included 1) providing additional pictorial modules, cues to action, enabling technologies, and supplies for safe drinking water and handwashing with soap behaviors in the health facility; 2) switching out technology prone to breaks and leaks as well as sourcing plastic technologies from a high-quality, local manufacturer; and 3) including instructions discouraging the non-use or misuse of technologies and supplies. Considerations for scalability include the local availability and marketing of enabling technologies and supplies, staff for program delivery in health facilities, and potential integration into existing government or health promotion programs. CONCLUSIONS: Formative research identified important considerations for the content, delivery, and scalability of the CHoBI7 health facility-initiated WASH intervention program.

Assessing the impact of handwashing soaps on the population dynamics of carbapenemase-producing and non-carbapenemase-producing Enterobacterales.

Carbapenemase-producing bacteria have persistent environmental reservoirs in handwashing sinks. This study assessed the impact of handwashing soaps on the population dynamics of carbapenemase-producing Enterobacterales (CPE) and non-CPE. A number of isolates were grown in minimal media with or without two hand soaps marketed for use in health care. Soap A led to increased growth of all isolates except for Escherichia coli. Soap B did not lead to increased growth. The main difference between the formulations was that Soap B contained DMDM hydantoin, a preservative agent and sensitizer. These results show that environmental persistence of CPE may be sustained by common handwashing practices with soap, but further research is required.

Comparison of the Effectiveness of Two Different Methods of Decreasing Pain During Phlebotomy in Children: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to examine the effect of the applications of external cold and vibration and blowing soap bubbles during phlebotomy in children aged between 3 and 6 years. DESIGN: This study is a randomized controlled trial. METHODS: The sample was obtained using block randomization. Children were divided into three groups: "external cold and vibration group," "blowing soap bubbles group," and "control group." Children, their parents, the nurse, and the researcher rated the children's pain during phlebotomy. FINDINGS: A statistically significant difference between groups was found on pain scores. Pain scores were lower in the groups of external cold and vibration, and blowing soap bubbles than the control group. CONCLUSIONS: The methods of external cold and vibration and blowing soap bubbles had a pain relieving effect in children aged between 3 and 6 years during phlebotomy.

Associations Between Hand Hygiene Education and Self-Reported Hand-Washing Behaviors Among Korean Adults During MERS-CoV Outbreak.

BACKGROUND: Hand washing is an effective way to prevent transmission of infectious diseases. Education and promotional materials about hand washing may change individuals' awareness toward hand washing. Infectious disease outbreak may also affect individuals' awareness. AIMS: Our study aimed to examine associations between hand-washing education and self-reported hand-washing behaviors among Korean adults during the year of the Middle East respiratory syndrome (MERS) outbreak. METHODS: Data from the 2015 Community Health Survey were used for this study. The total study population comprised 222,599 individuals who were older than 20 years of age. A multiple linear regression model was used to investigate associations between hand hygiene education and self-reported hand-washing behaviors. Subgroup analyses stratified by age, sex, income, and MERS outbreak regions were also performed. RESULTS: Individuals who received hand-washing education or saw promotional materials related to hand washing had significantly higher scores for self-reported use of soap or sanitizer (ß = 0.177, P < .0001) and self-reported frequency of hand washing (ß = 0.481, P < .0001) than those who did not have such experiences. The effect of hand-washing education on self-reported behavior change was greater among older adults, women, and lower income earners. The effect of hand hygiene education on self-reported use of soap or sanitizer was similar regardless of whether the participants lived in MERS regions. CONCLUSION: Our findings emphasize the importance of education or promotions encouraging hand washing, especially for older adults, women, and lower income earners. In addition, MERS outbreak itself affected individuals' awareness of hand-washing behaviors. Well-organized campaigns that consider these factors are needed to prevent infectious diseases.

Developing Product Environmental Footprint Category Rules (PEFCR) for shampoos: The basis for comparable life cycle assessment.

In 2013, the European Commission launched the Environmental Footprint Rules pilot phase. This initiative aims at setting specific rules for life cycle assessment (LCA: raw material sourcing, production, logistics, use, and disposal phase) studies within 1 product category, called product environmental footprint category rules (PEFCR), and for organizations, called organizational environmental footprint sector rules (OEFSR). Such specific rules for measuring environmental performance throughout the life cycle should facilitate the comparability between LCA studies and provide principles for communicating environmental performance, such as transparency, reliability, completeness, and clarity. Cosmetics Europe, the association representing the cosmetics industry in the European Union, completed a voluntary study into the development of PEFCR for shampoo, generally following the guidelines and methodology developed by the European Commission for its own pilot projects. The study assessed the feasibility and relevance of establishing PEFCR for shampoo. Specifically, the study defines a large number of modeling assumptions and default values relevant for shampoo (e.g., for the functional unit, the system boundaries, default transport distances, rinsing water volumes, temperature differences, life cycle inventory data sources) that can be modified as appropriate, according to the specificities of individual products, manufacturing companies, and countries. The results of the study may be used to support internal decision making (e.g., to identify "hotspots" with high environmental impact and opportunities for improvement) or to meet information requests from commercial partners, consumers, media, or authorities on product environmental characteristics. In addition, the shampoo study also highlighted many of the challenges and limitations of the current product environmental footprint (PEF) methodology, namely its complexity and resource intensiveness. It highlighted 2 areas where improvements are much needed: (1) data quality and availability, and (2) impact assessment methodologies and robustness. Many of the findings are applicable to other rinse-off cosmetic products, such as shower gels, liquid soaps, bath products, and hair conditioners. Integr Environ Assess Manag 2018;14:649-659. © 2018 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals, Inc. on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Development of a standardized procedure for testing the efficacy of workplace cleansers.

BACKGROUND: Occupational skin cleansing is a risk factor for cumulative irritant dermatitis. Standardized methods are required to assess the cleaning efficacy of occupational skin cleansers, allowing us to choose the optimal cleanser with minimal irritation for specific workplaces. OBJECTIVES: To develop a standardized procedure for testing the cleaning efficacy of occupational skin cleansers. METHODS: In this single-blind, randomized, monocentric clinical trial in 24 healthy volunteers, the cleaning efficacy of generic reference cleansers was assessed against standardized test dirts. The test procedure included standardized dirt application, standardized washing with an automated skin cleaning device, and quantification of the cleaning efficacy by chromametry. For two cleansers, reproducibility of the cleaning efficacy assessment was studied. Furthermore, the performance of two cleansers was compared with that of commercial skin cleansers. RESULTS: Cleaning factors ranged from 12% up to 97% for the respective model dirts. A high reproducibility of the washing and the assessment procedure could be shown. The comparison of the washing efficacies for two reference cleansers with those of commercial cleansers showed partly similar performances, but also a higher cleaning efficacy for some dirts of the reference cleansers. CONCLUSIONS: The testing procedure proved to be applicable to a wide spectrum of cleansers and model dirts.

[The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA]. / El Hijyen Ürünlerinin Saglik Çalisanlarinda MRSA Kolonizasyonuna Etkilerinin CHROMagar MRSA ile Arastirilmasi

The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization.

Molecular epidemiology of a Pseudomonas aeruginosa hospital outbreak driven by a contaminated disinfectant-soap dispenser.

BACKGROUND AND OBJECTIVE: Pseudomonas aeruginosa infection represents a main cause of morbidity and mortality among immunocompromised patients. This study describes a fatal epidemic of P. aeruginosa that occurred in a hematology unit in Italy. METHODS: Retrospective cohort study, prospective surveillance, auditing, extensive testing on healthcare workers and environmental investigation were performed to define the dynamics and potential causes of transmission. RAPD, macrorestriction analyses and sequence typing were used to define relationships between P. aeruginosa isolates. RESULTS: Eighteen cases of infection were identified in the different phases of the investigation. Of these, five constitute a significant molecular cluster of infection. A P. aeruginosa strain with the same genetic fingerprint and sequence type (ST175) as clinical isolates strain was also isolated from a heavily contaminated triclosan soap dispenser. DISCUSSION AND CONCLUSIONS: Our results are consistent with the hypothesis that patients became indirectly infected, e.g., during central venous catheter handling through contaminated items, and that the triclosan soap dispenser acted as a common continuous source of P. aeruginosa infection. Since P. aeruginosa is intrinsically unsusceptible to triclosan, the use of triclosan-based disinfectant formulations should be avoided in those healthcare settings hosting patients at high risk of P. aeruginosa infection.

Concentrations of synthetic musk compounds in personal care and sanitation products and human exposure profiles through dermal application.

Synthetic musks, such as 7-acetyl-1,1,3,4,4,6-hexamethyl-1,2,3,4-tetrahydronaphthalene (AHTN) and 1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethylcyclopenta-gamma-2-benzopyran (HHCB), musk ketone (MK) and musk xylene (MX), are used as an alternative for natural musk. Due to their widespread use, these synthetic compounds turned up in different environmental compartments, such as wastewater, human and animal tissues. Yet, little is known about their distribution and occurrence in personal care and household products, information needed in order to evaluate the different human exposure routes. This paper gives an overview of the synthetic musk levels in six different product categories: body lotions, perfumes, deodorants, hair care products, shower products and sanitation products. Especially body lotions, perfumes and deodorants contained high levels of synthetic musks. Maximum concentrations of HHCB, AHTN, MX and MK were 22 mg g(-1), 8 mg g(-1), 26 microg g(-1) and 0.5 microg g(-1), respectively. By combining these results with the average usage of consumer products, low-, medium- and high-exposure profiles through dermal application could be estimated. HHCB was the highest contributor to the total amount of synthetic musks in every exposure profile (18-23 700 microg d(-1)). Exposure to MK and MX did not increase substantially (10-20-fold) between low- and high-exposure profiles, indicating that these compounds cover a less broad range. In comparison, exposure to HHCB and AHTN increased up to 10 000 fold between low- and high-exposure.

Skin reactions related to hand hygiene and selection of hand hygiene products.

BACKGROUND: In October 2004, The World Health Organization (WHO) launched the World Alliance for Patient Safety. Within the alliance, the first priority of the Global Patient Safety Challenge is to reduce health care-associated infection. A key action within the challenge is to promote hand hygiene in health care globally as well as at the country level through the campaign "Clean Care is Safer Care." As a result, the WHO is developing Guidelines on Hand Hygiene in Health Care, designed to be applicable throughout the world. METHODS: This paper summarizes one component of the global WHO guidelines related to the impact of hand hygiene on the skin of health care personnel, including a discussion of types of skin reactions associated with hand hygiene, methods to reduce adverse reactions, and factors to consider when selecting hand hygiene products. RESULTS: Health care professionals have a higher prevalence of skin irritation than seen in the general population because of the necessity for frequent hand hygiene during patient care. CONCLUSION: Ways to minimize adverse effects of hand hygiene include selecting less irritating products, using skin moisturizers, and modifying certain hand hygiene practices such as unnecessary washing. Institutions need to consider several factors when selecting hand hygiene products: dermal tolerance and aesthetic preferences of users as well as practical considerations such as convenience, storage, and costs.

Microbiological evaluation of two hand hygiene procedures achieved by healthcare workers during routine patient care: a randomized study.

The aim of this study was to evaluate the comparative microbiological efficacy of hand rubbing and handwashing in healthcare workers from different wards, with particular emphasis on transient flora, and to assess predisposing factors for hand contamination after patient care in everyday practice. Over a six-month period, 50 healthcare workers were randomly assigned, using a crossover design, to perform handwashing with unmedicated soap and hand rubbing with an alcoholic solution following a healthcare procedure. Imprints of palms and fingertips were taken separately before and after each hand hygiene procedure. The number of colonies per plate was counted and transient pathogens were identified. Risk factors for hand contamination were determined. Hand rubbing produced a significantly greater reduction in microbiological load than handwashing (P<0.0001 for palms and P=0.0003 for fingertips). In multivariate analysis, working in a medical ward rather than in an intensive care unit was significantly associated with increased hand contamination (P=0.03 for palms and P=0.02 for fingertips). Transient pathogens were found on 15% of healthcare workers' hands before hand hygiene. The only factor associated with hand contamination by transient pathogens was the absence of gloving during the healthcare procedure (odds ratio 4.8; 95% confidence interval 1.2-19; P=0.03). After hand rubbing, no transient pathogens were recovered, while these were found in two cases after handwashing. Hand rubbing is more efficacious than handwashing for the decontamination of healthcare workers' hands following contact with patients and patients' environments. Gloving may reduce microbiological hand contamination by transient pathogens.

Alcohol-based hand disinfection: a more robust hand-hygiene method in an intensive care unit.

This study involved observation of hand-hygiene behaviour and evaluation of the effect of alcohol-based hand disinfection and handwashing with plain liquid soap on microbial flora. The study was performed in a combined medical and surgical intensive care unit. We demonstrated a crude compliance of hand hygiene of 50.4%, which was only performed adequately in 20.8% of cases. Of this group, handwashing and hand-disinfection procedures were performed properly 34.0% and 71.6% of the time, respectively. Hand samples for bacteriological examinations with the glove juice method demonstrated that whilst handwashing was sensitive to the way in which hand hygiene was performed, alcohol-based hand disinfection was less sensitive to such performance. Our study demonstrated that alcohol-based hand disinfection is a robust hand-hygiene method with many advantages in a practical setting. It is very feasible for use in hospital wards.

Handwashing: what is the best solution?

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.

Ineffectiveness of handwashing with lotion soap to remove nosocomial bacterial pathogens persisting on fingertips: a major link in their intrahospital spread.

The effectiveness of five 30-second handwashes with a non-antiseptic lotion soap to remove nosocomial pathogens (10(8) CFU) applied to fingertips was studied. CFU for all species dropped rapidly after the first handwash; persistence (10 to 15 CFU) was maintained thereafter. Wiping hands with an antiseptic (70% isopropyl or 10% povidone-iodine) sponge removed persisters.

Lavado de manos: un cambio de paradigma / Handwashing: a paradigm change

El lavado de manos es una de las principales medidas para el control de la infección nosocomial. En la actualidad diversos estudios evidencian que la descontaminación de las manos con una solución de base alcohólica es igual de eficaz, más rápida de utilizar y más fácil. Este hecho representa un cambio de paradigma importante en el control de la trasmisión de las infecciones. El objetivo de esta revisión es presentar y discutir los aspectos más relevantes de las nuevas recomendaciones (AU)

Short- and long-term effects of handwashing with antimicrobial or plain soap in the community.

Little is known about effects of public use of antimicrobial handwashing soap. A double-blinded, randomized clinical trial of hands of primary caretakers in 238 inner city households was conducted in which effects of plain or antimicrobial (containing 0.2% triclosan) handwashing soap on bacterial counts of the hands were compared before and after a single wash and before and after handwashing following a year of product use. The randomly assigned product was provided without cost to each household during monthly home visits, and compliance with product use was monitored. Households were contacted by telephone weekly and with a home visit monthly for 11 months. Hand cultures were obtained before and after handwashing at baseline and after 11 months, using a modified glove juice technique. Overall, there were no significant differences in pre-to-post handwashing counts at baseline (p = 0.41), but by the end of one year, post-wash counts were significantly lower than pre-wash (p = 0.000) for those using either antimicrobial or plain soap. There were no significant differences in mean log counts either before or after handwashing between those using the antimicrobial or plain soap at baseline or after a year of use (all p values > 0.28). For the group using antimicrobial soap, higher counts were observed post-handwashing in 31.3% of paired samples at baseline and 26.7% after one year (p = 0.03). A single handwash had minimal effect on quantity of hand flora, but there were significant effects over time, regardless of whether antimicrobial or plain soap was used. In the absence of more definitive evidence, the risk-benefit ratio argues in favor of targeted rather than ubiquitous, general household use of antimicrobial soap.

Intra-laboratory reproducibility of the hand hygiene reference procedures of EN 1499 (hygienic handwash) and EN 1500 (hygienic hand disinfection).

The bactericidal efficacy of hand antiseptic products is determined in Europe using two norms--EN1499 (hygienic handwash), and EN 1500 (hygienic hand disinfection) based on reducing the counts of bacteria on artificially contaminated hands. Each requires 12-15 data sets per test and comparison with a reference procedure. Recent research using EN 1500 suggested that most alcohol-based hand gels are significantly less effective than the reference alcohol (2-propanol 60%), whereas liquid alcohol-based rubs are not. However concerns about the accuracy and reproducibility of the norm reference procedures have been raised. We therefore analysed 23 experiments carried out using EN 1500 representing 342 hand disinfection procedures, and 12 experiments using EN 1499 representing 178 handwashes, all performed in the same laboratory for reproducibility of the reference procedures. The reference alcohol gave a mean log(10) reduction factor (RF) of 4.64 +/- 0.93; only one data set gave a significantly higher result (5.14, P = 0.034), and one significantly lower (4.05; P = 0.034). Analysis of all 23 means revealed no significant difference (P = 0.188; ANOVA model). The reference soap gave a mean reduction of 2.82 +/- 0.49. Two data sets were significantly higher than this (3.35,P < 0.001; 3.12, P < 0.001) and two significantly lower (2.55, P = 0.031; 2.47,P = 0.004). Analysis of all the means did reveal a significant difference (P < 0.001, ANOVA model), which is probably explained by the smaller standard deviations of these results. Pre-values (bacteria recovered from fingers before a reference procedure) correlated significantly with RFs for both hand disinfection (correlation coefficient: 0.291;P = 0.01) and handwash (correlation coefficient: 0.372, P = 0.01). Overall both procedures gave accurate and reproducible results.