Removal of Dermal Exposure to Phthalate Ester by Hand Washing

Study Overview
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Brief Summary
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The aim of the study is to evaluate the effectiveness in removing chemical exposure on hand, the investigators compare removal efficiency of Di-(2-ethylhexyl)phthalate (DEHP) on hands by hand washing with soap and water vs. water only. In two three-day N-of-1 trials, residual DEHP was measured in a single female adult who washed exposed hands with soap-and-water or water-only. Subsequently, a crossover study was performed by randomly assigning another 28 subjects equally to wash with soap-and-water or with water-only, and then each one received the other treatment 24 hrs later.

Detailed Description
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Three studies, consisting of two N-of-1 trials and one crossover study, were used to compare the effect of handwashing with soap and water (intervention) and handwashing with water only (placebo) on phthalate removal from hands. The soap was plain soap, consisting of vegetable oil and sodium hydroxide. First, the investigators recruited one healthy female aged 25 yrs to participate in two N-of-1 trials. In each trial, her hands would be exposed to DEHP and then be treated with either soap intervention or placebo for three times over the course of three days. The first trial started on 15 May 2013. On day one, after the subject prewashed her hands, she allowed her hands to be exposed to a designated amount of DEHP. She then washed them with water only and rinsed them sequentially in three separate polyethylene (PE) bags, each containing 200 mL water to collect DEHP residue. One hour later, the same protocol was followed, except the exposed hands were treated with soap and water instead of water only (Figure 1a). The water rinsing in three separate bags remained the same. The pairs of studies were repeated on two subsequent days (16 and 17 May). In the second N-of-1 trial, which was also performed over three days (22-24 May), the protocol using the same subject remained the same for all three days, except that the subject underwent intervention first then placebo. The water rinsing remained the same. A randomized 2 × 2 crossover study was subsequently conducted between June and September 2013. The investigators assigned one group of 7 females and 7 males to perform handwashing with soap and water (intervention) and another group of 7 females and 7 males to perform handwashing with water only (placebo). Briefly, on the first day, the two groups washed their DEHP exposed hands using either soap and water or water only and then rinsed them in a PE bag with 200 mL water to collect DEHP. After 24 hrs, the experiment was crossed-over with the same two groups receiving the opposite treatments.

Official Title
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Soap and the Removal of Diethylhexyl Phthalate From Hands: N-of-1 and Cross-Over Designs

Conditions
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Environmental Exposure, Exposure to Pollution

Intervention / Treatment
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* Behavioral: handwashing with soap
* Behavioral: handwashing with water


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: healthy adult over age of 18 years BMI>18 Exclusion Criteria: diagnosis of any type of cancers, dermatitis, asthma cut, abrasion, and trauma on hands BMI <18

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>Subject was first exposed to 1000 microgram of diethylhexyl phthalate on both hands, and was asked to perform the intervention, handwashing with soap, by a standardized hand washing technique. Then the subjects in this arms are crossover to receive placebo, handwashing with water only. | Behavioral: handwashing with soap<br>* handwashing with soap by a standardized 6-step handwashing technique<br>Behavioral: handwashing with water<br>* handwashing with water by a standardized 6-step handwashing technique<br>|
| Placebo Comparator: Placebo<br>Subject was exposed to 1000 microgram of diethylhexyl phthalate on both hands, and was asked to perform the placebo, handwashing with water, by a standardized hand washing technique. Then the subjects in this arms are crossover to perform the intervention, handwashing with soap. | Behavioral: handwashing with soap<br>* handwashing with soap by a standardized 6-step handwashing technique<br>Behavioral: handwashing with water<br>* handwashing with water by a standardized 6-step handwashing technique<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Amount of Diethylhexyl Phthalate Removed From Hand | Water rinse were performed immediately after hand-washing, and the concentration of diethylhexyl phthalate in the soiled water is measured. | immediately right after hand-washing | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Diethylhexyl Phthalate, Hand hygiene, Soaps, N-of-1 design, Cross-Over Studies