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Background: Cleaning of re-usable medical devices is a critical control point in the decontamination cycle, although defined end-points of the process are controversial. Objective: Investigate cleaning efficacy and cost of different detergent classes in an automated washer disinfector (AWD) designed for dental practice. Methods: Loads comprised test soiled dental hand instruments in cassettes and extraction forceps. Residual protein assayed using the International standard method (ISO 15883-5:2005) 1% SDS elution with ortho-phthalaldehyde (OPA) or GBox technology (on instrument OPA analysis). Short (60 minutes) and long (97 minutes) AWD cycles were used with four different classes of detergents, tap water and reverse osmosis water. Results: SDS elution analysis (N = 612 instruments) demonstrated four detergents with both wash cycles achieved equivalent cleanliness levels and below a threshold of 200 µg protein/instrument. GBox methodology (N = 575) using UK Department of Health threshold of 5 µg/instrument side demonstrated that tap water performed with the greatest efficacy for all types of instruments and cycle types. Conclusions: Using International standard methodology, different detergent classes had equivalence in cleaning efficacy. Cheaper detergents used in this study performed with similar efficacy to more expensive solutions. Findings emphasise the importance of validating the detergent (type and concentration) for each AWD.

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OBJECTIVE: To develop a process to identify, adopt, and increase individual awareness of the use of chemical-free products in perinatal hospital units and to develop leadership skills of the fellow/mentor pair through the Sigma Theta Tau International Maternal-Child Health Nurse Leadership Academy (STTI MCHNLA). DESIGN: Pretest/posttest quality improvement project. SETTING: Tertiary care 80-bed perinatal unit. PATIENTS: Mothers and newborns on perinatal unit. INTERVENTIONS/MEASUREMENTS: The chemical hazard ratings of products currently in use and new products were examined and compared. Chemical-free products were selected and introduced to the hospital system, and education programs were provided for staff and patients. We implemented leadership tools taught at the STTI MCHNLA to facilitate project success. Pre- and postproject evaluations were used to determine interest in the use of chemical-free products and satisfaction with use of the new products. Cost savings were measured. RESULTS: Products currently in use contained potentially harmful chemicals. New, chemical-free products were identified and adopted into practice. Participants were interested in using chemical-free products. Once new products were available, 71% of participants were positive about using them. The fellow and mentor experienced valuable leadership growth throughout the project. CONCLUSIONS: The change to chemical-free products has positioned the organization and partner hospitals as community leaders that set a health standard to reduce environmental exposure for patients, families, and staff. The fellow and mentor learned new skills to assist in practice changes in a large organization by using the tools shared in the STTI MCHNLA.

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PURPOSE: To evaluate a 3% solution of household detergent viz., Surf Excel (Surf field mastitis test, SFMT) vis-à-vis California mastitis test (CMT), Whiteside test (WST), somatic cell counts (SCC; cut off limit = 5 x 10(5) cells per millilitre) and bacteriological cultures for the detection of subclinical mastitis in quarter foremilk samples (n=800) of dairy cows and buffaloes. METHODS: Culture and SCC were used as gold standards. All tests were evaluated parallel and serial patterns. The sensitivities of SFMT, SCC, culture, CMT and WST in parallel testing were 72.82, 81.55, 87.38, 75.73 and 54.37%, respectively in cows, while 66.22, 79.73, 82.43, 70.27 and 50.00, respectively in buffaloes. RESULTS: SFMT was significantly (p<0.05) more sensitive than WST and comparable to CMT in both species. In serial testing, percent specificity of SFMT (87.12 in cow; 85.16 in buffaloes) was significantly (P<0.05) higher than that of CMT (83.33 in cow; 80.64 in buffaloes). The negative predictive values of SFMT (93.50 in cow; 96.35 in buffaloes) differed non-significantly from that of CMT (94.02 in cow; 96.15 in buffaloes). The kappa index between the tests was moderate to perfect both in parallel (0.54 to >0.80) and serial (0.58 to >0.8) testing. CONCLUSION: On the basis of closely similar diagnostic efficiency of SFMT to CMT in terms of sensitivity, specificity, predictive values and kappa index together with inexpensive and ready availability of SFMT reagent, it tempting to suggest that SFMT can be use as a cheaper, user-friendly alternative animal-side subclinical mastitis diagnostic test in poor countries.

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Nowadays laundry detergents are becoming increasingly popular as they can be metered automatically into the washing machine, impart softness, antistaticness, resiliency to fabrics, mild to eyes and skins and shows good dispersibility in water. Because it is consumed when it is used, the sale of laundry detergent is a rather large business. There are many different kinds or brands of laundry detergent sold, many of them claiming some special qualities as selling points. A Laundry detergent composition is a formulated mixture of raw materials that can be classified into different types based on their properties and function in the final product. The different classes of raw materials are surfactants, builders, bleaching agents, enzymes, and minors which remove dirt, stain, and soil from surfaces or textiles gave them pleasant feel and odour. The physico-chemical properties of surfactants make them suitable for laundry purposes. Laundry detergent has traditionally been a powdered or granular solid, but the use of liquid laundry detergents has gradually increased over the years, and these days use of liquid detergent equals or even exceeds use of solid detergent. This review paper describes the history, composition, types, mechanism, consumption, environmental effects and consumption of laundry detergents.

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INTRODUCTION: The aim of our study was to evaluate the economic impact of atopic dermatitis (AD) on the family of young children affected by the disease in Italy. METHODS: Thirty-three families of young children affected by AD were asked to fill in a questionnaire about financial costs associated with providing health care during the past year for their child affected by AD. For each child AD severity was evaluated by using the SCORAD index. RESULTS: By analyzing the questionnaire, an annual average cost of 1254euro (about U.S. $1540) for each family was determined. Main expenses concern the use of moisturizing therapies, particular detergent, and private specialist consultations. Annual family average cost was lower for children with mild AD compared with those with moderate to severe AD. DISCUSSION: AD has a deep impact on the family budget, with an increasing cost in proportion to the increasing severity of the disease. These data support previous reports suggesting that the management of AD in children is complex and costly, altering the quality of life of children and their families.

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Skin cleansers may be an important adjunct to the regimen of those who use cosmetics, have sensitive or compromised skin, or utilize topical therapies. Cleansers emulsify dirt, oil and microorganisms on the skin surface so that they can be easily removed. During cleansing, there is a complex interaction between the cleanser, the moisture skin barrier, and skin pH. Cleansing, with water soap or a liquid cleanser, will affect the moisture skin barrier. Soap will bring about the greatest changes to the barrier and increase skin pH. Liquid facial cleansers are gentler, effecting less disruption of the barrier, with minimal change to skin pH, and can provide people with a cleanser that is a combination of surfactant classes, moisturizers and acidic pH in order to minimize disruption to the skin barrier.

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Perineal dermatitis due to urinary and/or fecal incontinence is a common problem. A multicenter, open label, phase II product evaluation was conducted to determine the effectiveness of a new cleanser protectant lotion in reducing perineal erythema and pain in patients at low-risk for perineal dermatitis and to compare the cost of this product to standard protocols of care. Nineteen elderly patients (14 male, 5 female, mean age 73.1 years) participated in the study. Average baseline scores for erythema and pain were 2.3 (+/- 0.5) and 1.5 (+/- 1.0), respectively (scale 0 to 4). After 7 days, both scores were significantly lower (mean scores 0.6 +/- 0.8 and 0.3 +/- 0.8, respectively; P < 0.01). Based on an average of 2.6 perineal episodes per day, the one-step product evaluated would cost $136 per patient/year less than standard protocols of care while reducing caregiver time (average 23 seconds per episode of care). Optimal perineal care may reduce the incidence of complications; studies to ascertain the safety and effectiveness of commonly used products and procedures are needed.

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Per capita boron loads reaching 48 sewage treatment works (STWs) in The Netherlands, Germany, Italy, and the UK have been determined from monitoring data. These have been compared with the per capita input predicted from boron in detergents, as determined from detergent product sales data. The resulting distribution of the ratios of measured boron to boron predicted from consumer usage has a 90th percentile of less than 1.5. Boron has previously been shown to be a good marker for substances contained in detergent products, as it cannot be biodegraded and is not substantially adsorbed in the sewer, and there is little or no removal during sewage treatment processes. The monitoring information on the distribution of boron loads found at the different STWs should thus be indicative of the distribution of other substances released to the environment by detergent products, as specified by the relevant industrial category (IC 5-personal/domestic) in the Technical Guidance Documents. Variation in detergent product consumption figures from 18 European countries is also low, with the country with the highest per capita detergent consumption having only 1.3 times the European average detergent use. Thus the present practice of determining a "reasonable worst case" by multiplying the average per capita consumption by a factor of four to account for geographic differences in distribution, is considered to be inappropriate. This should be replaced by a factor of less than two, which combines within country and between country variations to provide a reasonable worst case approximation of the load reaching the sewage treatment facility.

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This appendix lists reference Epstein-Barr virus (EBV)-transformed B lymphoblastoid cell lines (B-LCL) and the HLA types expressed by these cell lines. These B-LCL are useful for studies of cellular immunity (e.g., restriction of antigen-specific responses), biochemical characterization of histocompatibility molecules, and as controls for DNA-based typing methods.

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Soap and water can be harmful when used to cleanse patients with fragile skin. Two alternatives to soap and water were tested with elderly, incontinent patients. Further trials are needed with a larger sample and with different patient populations.

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Soap and water and a no-rinse cleanser, with and without a moisture barrier, were examined for their effects as cleansing regimens on the perineal skin of 10 older female residents of an extended care facility. Each cleansing regimen was used for 3 weeks, with two weekly measurements obtained for erythema, pH, and transepidermal water loss. Results indicated that soap and water was the least efficacious regimen unless used with a moisture barrier. The no-rinse cleanser was better than soap and water in terms of skin effects and cost savings. The findings suggest that a no-rinse cleanser in conjunction with a moisture barrier is a more skin-preserving and cost-effective incontinence care cleansing regimen than soap and water for older female nursing home residents with incontinence.

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