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STATUS OF LITHIUM PATIENTS AS BLOOD-DONORS
860 available dressing measures 8 in. x 13 in.! Following the example of the North Yorks Road-Accident After-Care Scheme and others,2 I tried to improve on this by designing an inexpensive simple dressing, easily reproducible in any hospital central sterile supply department. Such a dressing has been tested and approved by a motor-race rescue unit on the racing circuit. The basis of the dressing (see accompanying figure) is the maternity accouchement pad (Bailey & Son), consisting
HEXACHLOROPHANE DUSTING-POWDER FOR NEWBORN INFANTS - SIRi--Reports of the neurotoxic effects of hexachlorophane 1-5 have caused much concern about its use as a local antibacterial agent in newborn infants. A committee of the American Academy of Pediatrics 6 recommended that the use of hexachlorophane should be restricted to fullterm infants in concentrations not exceeding 3% and that hexachlorophane should be used for short periods only during staphylococcaloutbreaks. At our hospital the withdrawal of powders and soaps containing hexachlorophane resulted in an increase in staphylococcal colonisation or infection among newborn infants in lying-in wards. Since the withdrawal of hexachlorophane, infants in the lying-in wards were washed once a day in a dilute solution of Savlon’ (containing chlorhexidine gluconate 7.5% w/v, cetrimide 15% w/v), 5 ml. in 1500-2000 ml. of warm water, and methylated spirit was applied to the cord. For a four-week period, ’Ster-zac’ powder (containing hexachlorophane 0-33% w/w, zinc oxide 3-00% w/w, and talc 88-67% w/w) was introduced to find out whether it had The any effect on staphylococcal-colonisation rates. powder was applied to the cord and adjacent skin, groins, and perineum in all infants after their daily bath. 137 mothers and infants were investigated for staphylococcal colonisation towards the end of the four-week period and the results were compared with those from 101 mothers and infants similarly studied during a two-week period before the introduction of hexachlorophane. ’
Accouchment pad adapted
as
large field dressing.
of a double-thickness rectangle, 18 in. x 16 in., of in. cotton-wool and - in. gamgee bound in thin cotton-weave gauze. To two corners of this are sewn or pinned 3 in. ’Kling’ or’Crinx’ loose-weave cotton bandages. The whole is folded, bandages outermost, and double-packed in autoclave bags before sterilisation. The pad can be cut if necessary to provide 9 in. x 16 in. dressings. In our experience such a dressing is easily applied, is well tolerated, absorbs blood or exudate in large amounts, and is suitably
TABLE I-STAPHYLOCOCCAL COLONISATION IN MOTHERS AND INFANTS BEFORE OR AFTER USING HEXACHLOROPHANE
protective. I am grateful for help from the Central Sterile ment, General Infirmary at Leeds. 22 Moorhead Terrace,
Shipley, Yorkshire BD18 4LB.
ANDREW K.
Supply Depart-
MARSDEN,
Medical Adviser, Northern Race and Rally Rescue Marshals Club.
STATUS OF LITHIUM PATIENTS AS BLOOD-DONORS SIR,—The efficacy of lithium carbonate in the prophylaxis of affective disorders has resulted in the widespread use of this compound.3 Some of the patients attending our lithium clinic were disappointed when they were rejected by blood-banks because they were on lithium. The authorities were probably apprehensive of the effects on the recipients of the lithium in the donor’s blood. The steady-state plasma-lithium concentrations are on average about 1 meq. per 1. A unit of blood-transfusion will contain, therefore, about 0-4 meq. of lithium in total. We know that lithium is fairly evenly distributed in the body-water both intracellularly and extracellularly.4 It can be assumed that the 0-4 meq. from the donor’s blood will be diluted in the recipient’s body-water. The resultant dilution will reduce the lithium concentration to levels which In fact, probably the are of no biological significance. is on some kind of medicaof the adult majority population tion which will be present in the blood given for transfusion, but we think there is no reason why subjects on lithium therapy should not volunteer to donate blood. M.R.C. Neuropsychiatry Laboratory, R. K. GUPTA West Park Hospital, STUART MONTGOMERY. Epsom, Surrey. 1. Ambulance Pad. Robert Bailey & Son Ltd., Stockport. 2. London, P. S. Br. med. J. 1969, iv, 284. 3. Coppen, A., Peet, M., Bailey, J., Noguera, R., Burns, B. H., Swani, M. S., Maggs, R., Gardner, R. Psychiat. Neurol. Neurochir.
4.
1973, 76, 501. M. J. psychiat. Res. 1968, 6, 67.
Schou,
*
Significant reduction in staphylococcal colonisation,
p <
0025, X2
test.
TableI shows that the proportion of nasal or perineal swabs from mothers from which staphylococci were cultured before or after using hexachlorophane was statistically similar. By contrast, in infants the proportion of nasal or umbilical swabs from which staphylococci were cultured was significantly reduced when hexachlorophane was used. Staphylococcal colonisation in infants was not related to staphylococcal colonisation in mothers either before or after using hexachlorophane. Staphylococcal colonisation in breast or bottle fed infants was similar and unaffected by hexachlorophane. Hexachlorophane only had a beneficial effect in infants discharged during the first week (table II). Hexachlorophane can be absorbed through skin; the mean
Alder
blood-hexachlorophane concentration, according to et al.,’ being 0.180±0.037 µg. per ml. (s.E.) on the
Lustig, F. W. Med. J. Aust. 1963, i, 737. Pilapil, R. Am. J. Dis. Child. 1966, 111, 333. Plueckhahn, V. D., Banks, J. Med. J. Aust. 1972, i, 897. Powell, H., Swarner, O., Gluck, L., Lampert, P. J. Pediat. 1973, 82, 976. 5. Shuman, R. M., Leech, R. W., Alvord, E. S. Pediatrics, Springfield, 1974, 54, 689. 6. Committee on the Fetus and Newborn, American Academy of Pediatrics. ibid. p. 682. 7. Alder, V. G., Burman, D., Corner, B. D., Gillespie, W. A. Lancet, 1972, ii, 384. 1. 2. 3. 4.
HEXACHLOROPHANE DUSTING-POWDER FOR NEWBORN INFANTS - SIRi--Reports of the neurotoxic effects of hexachlorophane 1-5 have caused much concern about its use as a local antibacterial agent in newborn infants. A committee of the American Academy of Pediatrics 6 recommended that the use of hexachlorophane should be restricted to fullterm infants in concentrations not exceeding 3% and that hexachlorophane should be used for short periods only during staphylococcaloutbreaks. At our hospital the withdrawal of powders and soaps containing hexachlorophane resulted in an increase in staphylococcal colonisation or infection among newborn infants in lying-in wards. Since the withdrawal of hexachlorophane, infants in the lying-in wards were washed once a day in a dilute solution of Savlon’ (containing chlorhexidine gluconate 7.5% w/v, cetrimide 15% w/v), 5 ml. in 1500-2000 ml. of warm water, and methylated spirit was applied to the cord. For a four-week period, ’Ster-zac’ powder (containing hexachlorophane 0-33% w/w, zinc oxide 3-00% w/w, and talc 88-67% w/w) was introduced to find out whether it had The any effect on staphylococcal-colonisation rates. powder was applied to the cord and adjacent skin, groins, and perineum in all infants after their daily bath. 137 mothers and infants were investigated for staphylococcal colonisation towards the end of the four-week period and the results were compared with those from 101 mothers and infants similarly studied during a two-week period before the introduction of hexachlorophane. ’
Accouchment pad adapted
as
large field dressing.
of a double-thickness rectangle, 18 in. x 16 in., of in. cotton-wool and - in. gamgee bound in thin cotton-weave gauze. To two corners of this are sewn or pinned 3 in. ’Kling’ or’Crinx’ loose-weave cotton bandages. The whole is folded, bandages outermost, and double-packed in autoclave bags before sterilisation. The pad can be cut if necessary to provide 9 in. x 16 in. dressings. In our experience such a dressing is easily applied, is well tolerated, absorbs blood or exudate in large amounts, and is suitably
TABLE I-STAPHYLOCOCCAL COLONISATION IN MOTHERS AND INFANTS BEFORE OR AFTER USING HEXACHLOROPHANE
protective. I am grateful for help from the Central Sterile ment, General Infirmary at Leeds. 22 Moorhead Terrace,
Shipley, Yorkshire BD18 4LB.
ANDREW K.
Supply Depart-
MARSDEN,
Medical Adviser, Northern Race and Rally Rescue Marshals Club.
STATUS OF LITHIUM PATIENTS AS BLOOD-DONORS SIR,—The efficacy of lithium carbonate in the prophylaxis of affective disorders has resulted in the widespread use of this compound.3 Some of the patients attending our lithium clinic were disappointed when they were rejected by blood-banks because they were on lithium. The authorities were probably apprehensive of the effects on the recipients of the lithium in the donor’s blood. The steady-state plasma-lithium concentrations are on average about 1 meq. per 1. A unit of blood-transfusion will contain, therefore, about 0-4 meq. of lithium in total. We know that lithium is fairly evenly distributed in the body-water both intracellularly and extracellularly.4 It can be assumed that the 0-4 meq. from the donor’s blood will be diluted in the recipient’s body-water. The resultant dilution will reduce the lithium concentration to levels which In fact, probably the are of no biological significance. is on some kind of medicaof the adult majority population tion which will be present in the blood given for transfusion, but we think there is no reason why subjects on lithium therapy should not volunteer to donate blood. M.R.C. Neuropsychiatry Laboratory, R. K. GUPTA West Park Hospital, STUART MONTGOMERY. Epsom, Surrey. 1. Ambulance Pad. Robert Bailey & Son Ltd., Stockport. 2. London, P. S. Br. med. J. 1969, iv, 284. 3. Coppen, A., Peet, M., Bailey, J., Noguera, R., Burns, B. H., Swani, M. S., Maggs, R., Gardner, R. Psychiat. Neurol. Neurochir.
4.
1973, 76, 501. M. J. psychiat. Res. 1968, 6, 67.
Schou,
*
Significant reduction in staphylococcal colonisation,
p <
0025, X2
test.
TableI shows that the proportion of nasal or perineal swabs from mothers from which staphylococci were cultured before or after using hexachlorophane was statistically similar. By contrast, in infants the proportion of nasal or umbilical swabs from which staphylococci were cultured was significantly reduced when hexachlorophane was used. Staphylococcal colonisation in infants was not related to staphylococcal colonisation in mothers either before or after using hexachlorophane. Staphylococcal colonisation in breast or bottle fed infants was similar and unaffected by hexachlorophane. Hexachlorophane only had a beneficial effect in infants discharged during the first week (table II). Hexachlorophane can be absorbed through skin; the mean
Alder
blood-hexachlorophane concentration, according to et al.,’ being 0.180±0.037 µg. per ml. (s.E.) on the
Lustig, F. W. Med. J. Aust. 1963, i, 737. Pilapil, R. Am. J. Dis. Child. 1966, 111, 333. Plueckhahn, V. D., Banks, J. Med. J. Aust. 1972, i, 897. Powell, H., Swarner, O., Gluck, L., Lampert, P. J. Pediat. 1973, 82, 976. 5. Shuman, R. M., Leech, R. W., Alvord, E. S. Pediatrics, Springfield, 1974, 54, 689. 6. Committee on the Fetus and Newborn, American Academy of Pediatrics. ibid. p. 682. 7. Alder, V. G., Burman, D., Corner, B. D., Gillespie, W. A. Lancet, 1972, ii, 384. 1. 2. 3. 4.