Efficacy of water skin decontamination in vivo in humans: A systematic review

Abstract

With the constant possibility of occupational exposures, chemical warfare, and targeted attacks, increased attention has been given to determining effective and timely dermal decontamination strategies. This systematic review summarises experimental studies reporting decontamination with water‐based solutions of dermal chemical contaminants with in vivo human data. Embase, MEDLINE, PubMed, Web of Science, and Google Scholar databases were comprehensively searched using search terms (“cutaneous” or “skin” or “dermal” or “percutaneous”) and (“decontamination” or “decontaminant” or “skin decontamination”) to include 10 studies, representing 18 chemical contaminants, 199 participants, and 351 decontamination outcomes. Three studies included data from decontamination with water (10.8%, n = 38/351 decontamination outcomes), seven with soap and water (68.4%, n = 240/351 decontamination outcomes), and two with 10% isopropanol distilled water (20.8%, n = 73/351 decontamination outcomes). Results of dermal decontamination using water showed complete decontamination (CD) outcomes in 52.6% (n = 20/38) and partial decontamination (PD) in 47.4% (n = 18/38); using soap and water showed PD outcomes in 92.9% (n = 223/240) and minimal to no effect in 7.1% (n = 17/240); and using 10% isopropanol distilled water achieved PD outcomes in 100.0% (n = 73/73). Available data show that decontamination with water, soap and water, and 10% isopropanol distilled water is incomplete. Much remains to be learned about decontamination of the large variety of chemical contaminants including a range of molecular weights, lipid and water solubilities, melting points, volatility, and hydrogen bonds, as well as clinically relevant anatomic sites. A major void exists in data confirming or denying the completeness of decontamination by measuring absorption and excretion. The development of effective decontamination solutions is of high priority.

Efficacy of soap and water‐based skin decontamination using in vitro animal models: A systematic review

“…Water decontaminates skin by diluting the chemical agent, rinsing of the contaminant, decreasing chemical reaction rates on the skin, minimizing metabolism and inflammation, and restoring the normal skin pH (Houston & Hendrickson, 2005). Systematic reviews by Kashetsky et al (2021), Burli et al (2021), and Chiang et al (2021), which summarize available studies with in vivo human and animal data, and in vitro human data respectively all concluded that these solutions achieve partial decontamination in the majority of decontamination outcomes (Burli et al, 2021; Chiang et al, 2021; Kashetsky et al, 2021). However, available in vivo animal data show mortality outcomes in approximately 6% of cases that used water‐only and soap and water decontamination solution.…”

“…Brent (2013) concluded through their review of clinical studies that aggressive water lavage was the best method for human corrosive dermal exposures; however, this review did not compare water lavage with other decontamination methods (Brent, 2013). Kashetsky et al (2021) summarized available in vivo human model data investigating decontamination with water‐only and soap and water solutions, finding that water alone achieved complete decontamination in only 52.6% of decontamination outcomes, whereas soap and water provided partial decontamination in 92.9% of decontamination outcomes (Kashetsky et al, 2021). Kashetsky et al (2021) concluded that water‐only and soap and water solutions provided incomplete decontamination.…”

“…Kashetsky et al (2021) summarized available in vivo human model data investigating decontamination with water‐only and soap and water solutions, finding that water alone achieved complete decontamination in only 52.6% of decontamination outcomes, whereas soap and water provided partial decontamination in 92.9% of decontamination outcomes (Kashetsky et al, 2021). Kashetsky et al (2021) concluded that water‐only and soap and water solutions provided incomplete decontamination. Similarly, reviews by Burli et al (2021) and Chiang et al (2021) investigated water‐only and soap and water solutions for decontamination of chemicals in in vivo animal models and in vitro human models, respectively, all concluding that these solutions yield incomplete 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

“…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.…”

Do cold weather temperatures affect the efficacy of skin decontamination?

“…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).…”