Single Wash Research Articles

Disinfection of the skin: an assessment of some new preparations.

Repeated hand washing with a detergent solution containing 0.75% chlorhexidine digluconate was found to cause a large reduction in the resident skin flora which was slightly though significantly smaller than that caused by the use of 3% hexachlorophane liquid soap containing a phenolic preservative, chlorocresol 0.3%. Both agents caused a greater immediate reduction of bacteria after a single hand washing than the hexachlorophane liquid soap without a phenolic additive had shown in earlier experiments; the soap base containing chlorocresol 0.3% but no hexachlorophane was also found to cause a large reduction in skin flora. The chlorhexidine detergent solution had no residual disinfectant action on the skin after rinsing and drying the hands.Disinfection of an operation site for two minutes with povidone-iodine containing 1% available iodine in 70% ethyl alcohol caused about as great a reduction in resident flora as a similar treatment with alcoholic 0.5% chlorhexidine. Both treatments were more effective than disinfection with aqueous 1% cetrimide or 0.1% benzalkonium chloride solutions.

Transfusion of long stored whole blood or washed red blood cells incubated with adenine and inosine.

Full unit autotransfusions of long stored ACD blood, incubated with adenine and inosine at 37 C., were given to healthy young male volunteers. Red cells of blood stored for 35 days showed, after regeneration, a significant increase in ATP and a 24‐hour posttransfusion survival of 78.8 per cent (70.9–85.9%); red cells of blood stored for 42 days, thus regenerated, showed a similar increase in ATP and a 24‐hour posttransfusion survival of 75.6 per cent (71.5–80.6%). These results were not significantly different from those obtained with 10‐ml token autotransfusions of blood similarly treated, the posttransfusion survival of red cells in token transfusions being 78.8 per cent for blood stored 35 days prior to regeneration with adenineinosine and 74 per cent for blood stored for 42 days prior to regeneration. Available data on toxicity of adenine and inosine have been critically reviewed: Chance of direct toxic effects with the small amounts involved may be dismissed when few transfusions are involved; however, uric acid overload must be considered when multiple transfusions are required within a short period of time. A single washing with saline‐glucose solution reduces by 90 per cent the concentration of un‐metabolized adenine and inosine, and of the product of their metabolism, hypoxanthine. The washing procedure involves a loss of only 0.55 per cent of the total red blood cell population; washing additionally reduces the amount of free hemoglobin. Washing has no effect on the ATP or red blood cell viability, and is recommended when multiple transfusions of cells treated with adenine and inosine are required in a short period of time.

Pulmonary Alveolar Proteinosis: Treatment of a Case Complicated by Tuberculosis

Observations over a ten-year period of a patient with pulmonary alveolar proteinosis complicated by pulmonary tuberculosis are presented. The mycobacterial infection responded well to chemotherapy, but the alveolar proteinosis rapidly progressed to the extent that the patient required continuous oxygen therapy. The progress of the disorder was not halted by six weeks of segmental irrigation with heparin and acetylcysteine. Dramatic restitution of a normal arterial oxygen saturation and complete resolution of acinar infiltrates was induced by a single washing of the lungs. The remission has persisted for four and one-half years.

Cold water detergency studies using radiolabeled soils

AbstractThe effects of single and multiple washing and of resoiling‐rewashing of cotton and synthetic fabrics have been studied in Tergotometer tests at various levels of temperature, detergent concentration and water hardness. The soiling mixture consisted of a seven component sebum tagged with tritium and carbon‐14; in some tests gammaray emitting Kaolinite clay was also used. Linear primary alcohol ethoxylate (LAEO) and linear alkylbenzene sulfonate (LAS) were used for surfactant type comparisons. In single wash tests in both hot and cold water, LAEO was generally more effective than LAS in removing sebum. This was particularly noticeable at low product concentration where insufficient sodium tripolyphosphate was present to sequester the water hardness. A 1/1 blend of the two surfactants approached LAEO in performance. The nonpolar sebum fraction was more readily removed from Dacron or nylon in cold water; otherwise, detergency was generally better at high temperatures. In rewash tests, using labeled lube oil, cholesterol and clay, a progressive increase in soil removal was found during five wash cycles. The nonpolar lube oil component was the most difficult to remove from permanent press Dacron‐cotton (PP), but was more readily removed from cotton. The more polar cholesterol and especially the clay were more easily removed from PP. LAEO gave better detergency both hot and cold than LAS, especially in hard water. On cotton swatches resoiled with sebum after each wash the residual sebum content was still increasing after five cycles. With PP in soft water, a steady state was reached after three to five cycles. Soil buildup was greater as hardness increased and as wash temperature and active matter concentration decreased, and was generally greater on cotton than on PP. LAEO allowed appreciably less soil buildup than did LAS especially at low concentration in hard water, indicating a reduced requirement for sodium tripolyphosphate.

Fluorometric detection of serotonin and serotonin-O.P.T.

Specifications and blank evaluations for the spectrophotofluorometric detection of serotonin and serotonin after reaction with ortho-phthaldialdhyde (O.P.T.) are presented. Sensitivity (detection limit) and precision for the serotonin-direct method were 55.9 ng./ml. and 2.7 ng./fluorescence intensity unit, respectively. There was a linear relationship between serotonin concentration and fluorescence produced in the range 2,797 ng./ml. to the detection limit. Blank fluorescence was composed of scattering, reagent, reagent and glassware contaminants and tissue components. The largest and most variable of these exhibited a peak of maximal fluorescence at ca. 400 nm. wavelength. It arose primarily from glassware and reagent contaminants and was not easily controllable. The blank altered the height and configuration of the serotonin spectrum producing atypicallity and resulting in inability to obtain an accurate reading for the serotonin component. No single common blank could be produced or described for correction of all specimens. The tissue blank for mid-jejunum was less than 0.2% of gross serotonin fluorescence at 545 nm. wavelength. Computer analyses indicated that the serotonin-O.P.T. blank was composed of peaks at the following wavelengths: 389, 407, 426, 448, 474 and 507 nm. A single chloroform wash was found to remove blanks peaking at 389, 426 and 474 nm. wavelengths eliminating atypicallity and permitting a more accurate reading of serotonin-O.P.T. at 473 nm. wavelength. A common reagent blank was also achieved. The chloroform wash produced a 17% loss of serotonin-O.P.T. Computer analyses further indicated that the characteristic serotonin-O.P.T. peak at 473 nm. wavelength was a composite of peaks at 459 and 490 nm. The use of O.P.T. permitted the fluorometric detection of serotonin down to a concentration of 12.3 ng./ml. with a precision of 0.1 ng./fluorescence intensity unit, and with standard linearity from 313 ng./ml. to the detection limit. These specifications represented 4.5- and 27.3-fold increases in sensitivity and precision, respectively, over the serotonin-direct method. The use of O.P.T. with a chloroform wash increased detection sensitivity to 75 ng./ml.; precision remained unaffected.

Comparative enumeration of lipophilic and nonlipophilic cutaneous diphtheroids and cocci.

Swabbing skin to collect bacteria for enumeration revealed that a single washing or rinsing of the swab in buffer removed between 90 and 95% of the bacteria collected. Further removal of the remaining bacteria from the initial swab by repeated washings of the swab produced plate counts that showed nearly proportional decreases in the numbers and types of bacteria retained or eluted from the swab. None of the commonly isolated cutaneous bacteria was retained or eluted from the single swab in numbers that misrepresented measurement of their proportions present in the sample. Populations of nonlipophilic bacteria on skin when present were mainly gram-positive catalase-producing cocci. Diphtheroids when present were chiefly lipophilic. Media containing furoxone were selective for cutaneous diphtheroids. The concentration of furoxone used affected isolation and enumeration of the diphtheroids. Lipophilic diphtheroids from the stratum corneum were basically aerobic and anaerobic incubation reduced or eliminated this group from enumeration studies. Lipophilic furoxone-resistant aerobic diphtheroids from several areas, particularly the nasal passages, occurred in numbers inversely proportional to the numbers of staphylococci for periods up to 11 months. The cocci-diphtheroid relationships occurred independently of the total number of aerobic bacteria present, the transient appearance of yeasts or gram-negative bacilli, the required use of certain antibiotics by the subjects, climate, age, and sex.

Comparative Enumeration of Lipophilic and Nonlipophilic Cutaneous Diphtheroids and Cocci

Swabbing skin to collect bacteria for enumeration revealed that a single washing or rinsing of the swab in buffer removed between 90 and 95% of the bacteria collected. Further removal of the remaining bacteria from the initial swab by repeated washings of the swab produced plate counts that showed nearly proportional decreases in the numbers and types of bacteria retained or eluted from the swab. None of the commonly isolated cutaneous bacteria was retained or eluted from the single swab in numbers that misrepresented measurement of their proportions present in the sample. Populations of nonlipophilic bacteria on skin when present were mainly gram-positive catalase-producing cocci. Diphtheroids when present were chiefly lipophilic. Media containing furoxone were selective for cutaneous diphtheroids. The concentration of furoxone used affected isolation and enumeration of the diphtheroids. Lipophilic diphtheroids from the stratum corneum were basically aerobic and anaerobic incubation reduced or eliminated this group from enumeration studies. Lipophilic furoxone-resistant aerobic diphtheroids from several areas, particularly the nasal passages, occurred in numbers inversely proportional to the numbers of staphylococci for periods up to 11 months. The cocci-diphtheroid relationships occurred independently of the total number of aerobic bacteria present, the transient appearance of yeasts or gram-negative bacilli, the required use of certain antibiotics by the subjects, climate, age, and sex.

Brick Cheese: pH, Moisture, and Quality Control

This study was designed to measure the effects of using cool wash water and curd particles of three sizes to control acid precursors, pH, moisture, and quality of Brick cheese containing the maximum amount of moisture. Curd cut with 6-mm knives was given a single washing treatment at 35.6C for 15min before hooping; the resulting cheese was compared with that obtained by cutting curd with 3-, 6-, or 9-mm knives, heating to 35.6C, then treating with water before hooping. Curd of each size was divided into three lots and submerged in water equal to 50, 25, or 12.5% of the volume of the original milk; these lots of curd were subdivided, so that portions were held in the water at 14, 21, or 29C for 15, 30, 45, or 60min. Moisture, 8 wk after making, was increased by using less wash water, larger knives, and short exposures to water. The pH of the cheese was lowered by using smaller amounts of water, larger knives, and shorter periods of washing. Effects of temperature of washing on pH were insignificant. Effects of treatments on salt absorption could not be detected by judges. Quality of the control lots was superior to that obtained by the experimental variations. Variation in size of knives, amount and temperature of water alone did not affect the differences in quality from the control. Prolonging the washing treatment decreased quality, especially with smaller curd particles and larger volumes of water. A schedule for commercial manufacturing is recommended.

FLUOROMETRIC DETERMINATION OF CORTICOSTEROIDS IN HUMAN BLOOD: COMPARISON OF RESULTS WITH THE SILBER-PORTER METHOD.

A method for determining corticosteroid concentrations in 1 ml samples of serum is described. The initial purification depends upon successive extractions with 2,2,4-trimethylpentane and chloroform. The chloroform extract is subjected to a single alkaline wash and the steroid is extracted directly into the final fluorescence reagent (75% ethanolic H2SO4) v/v). The influence of varying concentrations of sulfuric acid and ethanolic sulfuric acid upon the development of fluorescence has been explored in order to ascertain an optimum reaction with cortisol. Recoveries of cortisol from plasma are virtually complete (95.5–105.4%). The proportionate standard deviation of duplicate analyses varied from 0.163 at concentrations in the range of 9.7 μg/100 ml to 0.018 at a mean concentration of 76.3 μg/100 ml. The activation and fluorescence spectra of normal plasma extracts consistently paralleled those observed with crystalline cortisol and corticosterone. The nonsteroid background fluorescence extracted from plasm...

Activation of Soil Microflora by Fungus Spores in Relation to Soil Fungistasis

Summary: Bacterial numbers in natural soil supplemented with living fungus spores or cell-free aqueous washings of spores, then incubated for 8 hr or more, were several-fold higher than those in non-supplemented soil. Rates of oxygen uptake in natural soil supplemented with washed or unwashed fungus spores, cell-free aqueous washings of spores, killed spores, or diluted nutrients, were several-fold higher than those in non-supplemented soil. Increased respiration occurred rapidly on addition of these supplements to soil. A single brief water washing of urediospores of Puccinia rubigo-vera or of conidia of Neurospora sp. extracted about 10% of the spore dry weight. Washed bacteria or Streptomyces spp., when incubated with fungus spores in absence of added nutrients, inhibited fungus spore germination, whereas sterile filtrates of bacteria were not inhibitory. The results indicate that fungus spores, by virtue of nutrients in their exudates, stimulate rapid activity of microbes in soil, and that the enhanced microbial activity causes inhibition of fungal spore germination.

The multiplication of vaccinia virus in suspended KB cells

The multiplication of vaccinia virus was investigated in suspensions of KB cells, assays being made by infectivity titrations and by staining cells with fluorescent antibody. Under the conditions described, 50–60% of the input virus was absorbed in 30 minutes, free virus was reduced to less than 1% by a single wash, and virus multiplication was restricted to a single cycle. Adsorbed virus became serum resistant, and soon afterward there was a fall of 80–90% in the infectivity titer of cell-associated virus. Assay of single cells in the early stages of the growth cycle indicated the existence of a true eclipse phase. Infectivity began to rise between the fifth and seventh hours, and when all infected cells were producing virus the infectivity titer rose logarithmically between the tenth and thirtieth hour. The maximum titer reached was approximately 150 PFU per infected cell and was independent of the multiplicity of infection between m = 1.5 and m = 15 at least. Most of the newly formed infectious virus was not accessible to antibody, a result showing that maturation was an intracellular process and mature virus remained in an intracellular location. The proportion of infected cells could be determined by a fluorescent cell count at the end of the growth cycle, and from this an estimate of the multiplicity of infection could be made.

Disinfectants for use in bar-soaps.

Part I1. The following disinfectants were investigated for use in bar-soaps: Hexachlorophene (G11) (2:2′-dihydroxy-3:5:6:3′5′:6:′-hexachlorodiphenylmethane); Actamer (2:2′-thiobis, 4-6-dichlorophenol); DCMX (dichloro-m-xylenol); TMTD (3:4:5-tetramethyl thiuram disulphide); TCC (3:4:4′-trichlorcarbanilide); TBS (3:4′:5-tribromsalicylanilide) and TCS (3:3′:4′:5-tetrachlorsalicylanilide).2. The concentration required for bacteriostasis of Staph. aureus was 2·5 p.p.m. for DCMX and 0·1 p.p.m. for TCS, the other disinfectants falling between these values. None were effective against E. coli, 12·5–50 p.p.m. being required for bacteriostasis (Tabel 1).3. In the presence of serum the concentration required for bacteriostasis was increased (Table 4).4. The soap inactivation coefficient (S.I.C.) is a value derived from zone diffusion tests. Zone diameters of the same disinfectant are compared in soap and soap-free solution so that the S.I.C. measures the effect of soap on disinfectant activity.5. DCMX is inactivated by soap (S.I.C. = ∞). The activity of G 11 is much reduced by soap (S.I.C. = 200). Actamer and TMTD are active in soap, whereas TCC, TBS and particularly TCS is more active in soap than soap-free solution (S.I.C. = 0·32) (Table 3).6. Another test based on zone diffusion is described which measures the effect of soap-soluble skin substances on disinfectant activity. Zone diameters of the same disinfectant are compared in fresh soap and used soap solutions.7. Of the disinfectants tested only TMTD lost some of its activity in the presence of soap-soluble skin substances (Table 5).Part II8. Conventional bacteriological plate-counting technique was used to enumerate bacteria in wash-water. The bacteria were removed from hands by using a standardized washing procedure with bar-soap but without scrubbing.9. Bacteria were not removed uniformly when washing was carried out twelve times in succession, significantly more bacteria being removed at the beginning of of the washing procedure.10. When the same individuals were tested at weekly intervals the rate at which bacteria were removed in successive washes was found to vary significantly.11. Using a single standardized wash the variation in the count of twenty individuals was followed for a period of 16 months. The count from one individual could vary by a factor of 10.12. A design for a handwashing test, to take account of these variables is described. The bacterial counts of the wash-water when subjects used control soap for 1 week was compared with counts obtained from subjects using disinfectant soap. Subjects and soaps were randomized according to multiple Latin squares.13. This handwashing technique was used to test the disinfectants described in Part I of this paper. All these disinfectants were effective but tetrachlorsalycilanilide (TCS) was the best. Soap containing 0·5% TCS caused an 84% reduction (Table 9).The authors wish to thank Dr H. Wilkinson for the ideas he contributed and the interest he has shown in this work, and the Directors of Unilever Limited for permission to publish this paper.

Serologic Comparisons with Lines of Influenza Virus Isolated and Serially Transferred in Different Experimental Hosts

Summary Lines of virus derived from a single throat washing by isolation and transfers in different hosts were compared in cross tests with antisera from several species. Variations in antigenic potency and avidity for antibody were noted especially with viruses after passages in mice or in chorioallantoic membrane tissue culture.

OBSCURE MAXILLARY INFECTION

My purpose is not to discuss maxillary sinus infection in detail but to present a helpful routine for determining its presence and importance. The positive diagnosis of a maxillary infection frequently is difficult to reach, and the importance of such infection to other disease is difficult to determine. Experience has shown that no one or two diagnostic procedures can be relied on, especially a single negative washing; nor is any one procedure more important than the other. It is only by viewing the case through all the diagnostic aspects that one can arrive at a true picture, accurate in diagnosis and in prognosis, as to both outcome and most satisfactory method of care, and still avoid overemphasis of the importance of a maxillary infection, coincident, but not directly associated, with some other illness. I want to stress especially the importance of history, not only from the first statement but from