Improved skin decontamination efficacy for the nerve agent VX

Thors, Lina; Wigenstam, Elisabeth; Qvarnström, Johanna; Hägglund, Lars; Bucht, Anders

doi:10.1016/j.cbi.2020.109135

Cited by 19 publications

(35 citation statements)

References 40 publications

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“…The TRSDL-procedure also displayed significant decontamination efficacy compared to the control without decontamination (DF ¼ 13). These data confirm the previously reported efficacy of RSDL to decontaminate skin contaminated with VX, especially the improvement achieved by the slightly extended procedure compared to the protocol recommended by the manufacturer 10,13,14,17 . The training kit, TRSDL, containing only MPEG impregnated in the sponge and lacking active degradation ingredients, has previously never been evaluated for the skin removal ability of live agents.…”

Section: Discussionsupporting

confidence: 90%

“…The efficacy of three different decontamination protocols was evaluated following 5 min of in vitro human skin exposure to neat VX. The protocols for RSDL and TRSDL decontamination were based on the previously optimized procedure for decontamination of VX 17 . To address the potential wash-in effect, decontamination by repeated washing with soapy water was included.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies of VX degradation by RSDL have shown that the strong nucleophilic hydroxide ions formed at a high pH and that to a lesser extent the oximes, contribute to the fast degradation of the nerve agent 16,19 . The low water content prevents agent dilution and potential "wash-in," a penetration-enhancing effect, previously observed for decontamination procedures using soapy water 17,20 . The RSDL-kit includes two mechanisms for the absorption of agents from the skin; the plastic foam for physical removal and polyethylene glycol monomethyl ether (MPEG) which contributes to active agent absorption 16 .…”

Section: Introductionmentioning

confidence: 88%

“…The in vitro skin penetration experiments were performed utilizing a specifically designed diffusion cell containing a flowthrough receptor solution compartment 17 . The diffusion chamber was maintained at 32 C throughout the experiments (AccuBlock Digital Dry Bath; Labnet Int.…”

Section: In Vitro Skin Penetration Experimentsmentioning

confidence: 99%

“…Reactive Skin Decontamination Lotion (RSDL) has been shown to be the most efficient skin decontaminant of VX in vitro and in vivo 10,[13][14][15][16][17] . To avoid prolonged release of VX, a repeated RSDL-decontamination procedure has been demonstrated to be efficient 17,18 . The product is currently fielded in many countries around the world, primarily in the armed forces.…”

Section: Introductionmentioning

confidence: 99%

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Efficient agent degradation within skin is important for decontamination of percutaneously exposed VX

Thors

Wigenstam

Qvarnström

et al. 2021

Cutaneous and Ocular Toxicology

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Aim of the study: Following percutaneous exposure to the nerve agent VX, the remaining intact agent within the skin after decontamination is of great concern. Consequently, this leads to prolonged agent release to the blood circulation resulting in sustained intoxication, which may complicate the medical management. The decontamination procedure used should therefore possess the ability for agent removal both on and within the skin. The efficacy of three decontamination procedures was evaluated by measuring VX and the primary degradation product ethyl methyl phosphonic acid (EMPA) penetrated through human skin and the amount remaining within the skin. Materials and methods: Decontamination was initiated 5 min post-exposure to VX on human dermatomed skin. Experiments were conducted using an in vitro skin penetration model and the amount remaining within the skin was determined by combining the tape-stripping technique and acetylcholinesterase activity measurements. Results: In control experiments without decontamination, higher amounts of VX were recovered in the deeper layers of skin compared to EMPA, which was primarily located in the stratum corneum. Both Reactive Skin Decontamination Lotion (RSDL) and the RSDL training kit (TRSDL) significantly reduced the amount of VX within the skin and decreased the penetration through the skin. However, the degradation ability of RSDL was demonstrated to be beneficial by the reduction of intact agents remaining in the skin compared to TRSDL without agent degradation capability. Soapy water decontamination caused a "wash-in" effect of VX with decreased agent amounts within stratum corneum but increased the amount VX penetrated through the skin. Conclusion: Efficient skin decontamination of VX requires skin decontaminants reaching deeper layers of the skin, and that both absorption and degradation properties are important. In addition, the "washin" effect by using soapy water may enhance VX release to the blood circulation.

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Section: Discussionsupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Section: In Vitro Skin Penetration Experimentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficient agent degradation within skin is important for decontamination of percutaneously exposed VX

Thors

Wigenstam

Qvarnström

et al. 2021

Cutaneous and Ocular Toxicology

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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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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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Improved skin decontamination efficacy for the nerve agent VX

Cited by 19 publications

References 40 publications

Efficient agent degradation within skin is important for decontamination of percutaneously exposed VX

Efficient agent degradation within skin is important for decontamination of percutaneously exposed VX

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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