Efficacy of soap and water based skin decontamination using<i>in vivo</i>animal models: a systematic review

Burli, Anuk; Kashetsky, Nadia; Feschuk, Aileen M.; Law, Rebecca M.; Maibach, Howard I.

doi:10.1080/10937404.2021.1943087

Cited by 12 publications

(8 citation statements)

References 29 publications

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“…The in vitro and in vivo studies reviewed above showed there are merits to data collection on the wash-in effect using either method, be it the cost-effective nature and specificity of mechanism afforded by in vitro studies, or the biological interactions present in in vivo studies. Both, however, have their drawbacks, including the possibility of an in vitro artifact influencing the wash-in effect, and no in vivo test being fully representative of human pharmacokinetics or physiology (Bronaugh and Maibach 2005 ; Burli et al 2021 ). To better understand the real-world relevance of the wash-in effect for mass decontamination, the goal needs to be to identify the wash-in effect using simulants in human volunteers.…”

Section: Discussionmentioning

confidence: 99%

“…This is a concern for first responders, as an increase in the dermal penetration of hazardous chemicals may elevate the risk or severity of harm. While previous literature reviews identified both in vivo (Burli et al 2021 ) and in vitro (Chiang et al 2021a ) decontamination studies that displayed wash-in effects, no apparent reviews have specifically investigated the wash-in effect since 2006. This literature review (1) assesses the current published information available to better understand this phenomenon, (2) describes the proposed mechanisms, and (3) explores whether the wash-in effect has implications for decontamination interventions.…”

Section: Introductionmentioning

confidence: 99%

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The wash-in effect and its significance for mass casualty decontamination

James¹,

Izon-Cooper²,

Collins³

et al. 2022

Journal of Toxicology and Environmental Health, Part B

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Decontamination of skin by washing may increase dermal absorption, a phenomenon known as the wash-in effect. The wash-in effect is frequently discussed in studies investigating casualty decontamination where potentially life-saving interventions may enhance the dermal penetration of toxic chemicals, leading to an increase in incidence of morbidity and rates of mortality. However, the wash-in effect is seldom investigated within the context of mass casualty decontamination and real-life consequences are therefore poorly understood. This paper reviews the existing literature on the wash-in effect to highlight the proposed mechanisms for enhanced absorption and evaluate the wash-in effect within the context of mass casualty chemical decontamination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The wash-in effect and its significance for mass casualty decontamination

James¹,

Izon-Cooper²,

Collins³

et al. 2022

Journal of Toxicology and Environmental Health, Part B

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“…This was later established and coined as the “wash‐in” effect, a phenomenon in which the process of skin washing paradoxically enhances skin penetration and systemic uptake, as summarized in a review by Moody and Maibach (2006). Additionally, prior reviews pending publication and conducted by Kashetsky et al (2021) and Burli et al (2021) examined the efficacy of decontamination using water‐only or water and soap solutions in in vivo human and animal models, respectively, and concluded that such methods resulted in incomplete removal of contaminants in the majority of cases. Additionally, firm conclusions regarding the efficacy of soap and water decontamination could not be drawn due to lacking absorption and excretion quantification.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of water‐only or soap and water skin decontamination of chemical warfare agents or simulants using in vitro human models: A systematic review

Chiang

Kashetsky

Feschuk

et al. 2021

J of Applied Toxicology

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Water-only or water and soap are widely recommended as preferred solutions for dermal decontamination. However, limited efficacy data exist. We summarized experimental studies evaluating in vitro efficacy of water-only or soap and water in decontaminating chemical warfare agents (CWA) or their simulants from human skin models. Embase, Covidence ® , MEDLINE, PubMed, Web of Science, and Google Scholar were searched for articles using water-only or soap and water decontamination methods for removal of CWA/CWA simulants in in vitro human skin models.Data extraction was completed from seven studies, yielding seven contaminants.Water-only decontamination led to partial decontamination in all skin samples (100%, n = 81/81). Soap and water decontamination led to partial decontamination in all skin samples (100%, n = 143/143). Four studies found decontamination to either paradoxically enhance absorption of contaminants or their penetration rates, known as the "wash-in" effect. Despite recommendations, water-only or water and soap decontamination were found to yield partial decontamination of CWA or their simulants in all human in vitro studies. Thus, more effective decontaminating agents are needed. Some studies demonstrated increased or faster penetration of chemicals following decontamination, which could prove deadly for agents such as VX, although these findings require in vivo validation. Heterogeneity in experimental setups limits interstudy comparison, and it remains unclear when water-only or water and soap are ideal decontaminants, which requires more studies. Pending manuscripts will summarize in vivo human and animal efficacy data. International harmonized efficacy protocol should enable more efficient public health decisions for evidence-based public health decisions.

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“…However, based on previous in vivo studies, the ‘wash‐in’ effect may be associated to a higher probability for a more rapid onset of cholinergic signs rather than considering the decontamination as ineffective (Bjarnason et al, 2008; Misik et al, 2012). The general efficacy of soap and water based skin decontamination has recently been reviewed (Burli et al, 2021; Chiang et al, 2021; Kashetsky et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Do cold weather temperatures affect the efficacy of skin decontamination?

Thors

Wästerby

Wigenstam

et al. 2021

J of Applied Toxicology

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Skin decontamination in cold weather temperatures might be challenging due to the aggravating circumstances. However, no information is available on the efficacy of commonly used procedures in winter conditions. Therefore, the efficacy of the reactive skin decontamination lotion (RSDL) and soapy water decontamination following skin exposure to the nerve agent VX was evaluated at three ambient air temperatures (À5 C, À15 C and room temperature). Experiments were performed in vitro using human dermatomed skin. The ability of RSDL to degrade VX at the three different air temperatures was separately evaluated. The ambient air temperature in experiments without decontamination did not influence the penetration rate of VX through skin. RSDL decontamination was highly efficient in removing VX from skin when performed in all three ambient temperatures, despite the slower agent degradation rate of VX at the lower temperatures. Decontamination with soapy water at RT resulted in an increased skin penetration of VX compared with the control without decontamination; however, in colder temperatures the VX skin penetration was similar to the corresponding control without decontamination.At RT, dry removal prior to washing with soapy water did not improve decontamination of VX compared with washing solely with soapy water. This study demonstrated high efficacy of RSDL decontamination following skin exposure to VX also at cold temperatures. The previously reported 'wash-in' effect of soapy water on VX skin penetration was reduced at cold temperatures. Altogether, this study found a scientific basis to establish guidelines for skin decontamination of chemical casualties at cold weather temperatures.

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Efficacy of soap and water based skin decontamination usingin vivoanimal models: a systematic review

Cited by 12 publications

References 29 publications

The wash-in effect and its significance for mass casualty decontamination

The wash-in effect and its significance for mass casualty decontamination

Efficacy of water‐only or soap and water skin decontamination of chemical warfare agents or simulants using in vitro human models: A systematic review

Do cold weather temperatures affect the efficacy of skin decontamination?

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