| stassicle | Date: Friday, 06/12/2013, 12:35 | Post # 1 |
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ithm was used to allocate each stain to one of five possible treatment conditions: alteplase, streptokinase, heparin, Neon "triple enzyme power" colour safe stain remover (Kiwi Brands, Clayton South, Victoria), and no treatment. Treatment involved applying 1 ml of the relevant substance in its standard formulation on to the centre of the blood stain (equating to 1 mg of alteplase, 50 000 units of streptokinase, and 1000 units of heparin).
In parallel with the treatment allocations, each of the 14 pillowcases was randomly allocated to either hot or cold cycles in a Simpson Genesis 525 heavy duty toploading washing machine (Simpson Manufacturing, Avalon, NSW) with the directed quantity of Hurricane super concentrate laundry detergent (Campbell Brothers, Bowen Hills, Queensland). The algorithm further allocated each pillowcase to either acute treatment (2-3 hours after blood stain deposition) or delayed treatment (6-7 hours after blood stain deposition). The cluster randomisation algorithm ensured that the five treatment conditions would be evenly distributed among the four combinations of temperature and timing conditions. The pillowcases were washed two hours after application of the treatment and then dried for 90 minutes on the half heat setting of a Simpson Maxidry 1200 dryer.
A panel of four professional laundry operators and stain removing staff assessed the resultant severity of each blood stain. The judges were blinded to the treatment allocation of the blood stains and pillowcases. Each judge gave every stain a rating of 0, 1, or 2 corresponding to the suggested descriptions of invisible, barely visible, or easily visible. The four judges' ratings were then combined to provide each stain with an outcome measure ranging from 0 to 8, where a lower score represents better stain removal. Agreement between the four judges was good (Cronbach's 伪=0.87).
Statistical considerations
The principal aim of this study was to compare stain severity after application of each of the treatments. Data were double entered and validated on an Excel spreadsheet and then imported into SPSS version 9.0 for further analysis. Multiple regression was used to assess the contribution of temperature, timing, and treatment on the severity of the stain. Although all pillowcases were identical, theoretical clustering effects were excluded by provisionally including pillowcase allocation in the regression. As there were no significant clustering effects, adjustment for pillowcase randomisation was not necessary. The sample size was restricted to 20-24 blood stains per group because of the limited availability of the pharmaceuticals. However, the sample size was deemed sufficient because of the limited variation expected from the standardised staining and washing conditions for each sample.
View this table:View PopupView Inline
Table 1. Mean (SD) stain severity by washing temperature, timing of treatment, and treatment condition*
Results
Table 1 shows the mean stain removal score for the 20 permutations of treatment, timing, and water temperature. Multiple regression controlling for the other variables (table 2) showed that acute treatment was significantly more effective than delayed treatment (mean stain score 3.82 v 6.04; Pv 5.61; P=0.0002).
Alteplase was significantly less effective than no treatment at all (5.29 v 3.68; P=0.009), and streptokinase was marginally less effective than no treatment, but this difference was not significant (3.98 v 3.68; P=0.4). Heparin was significantly less effective than no treatment (5.65 v 3.68; P=0.001) under all washing conditions as was Neon, the commercial enzymatic stain remover (5.85 v 3.68; P=0.0003). No interaction or clustering effects were detected.
Discussion
This study shows that treatment of blood stains requires early action, as is the case when treating heart attacks and strokes. Blood stains that were treated within three hours and washed within five hours after deposition were much less prominent than those treated seven hours and washed nine hours after deposition. Interestingly, only two of the 20 stain removal guides reviewed emphasised the importance of acting quickly. 9 10 One suggested a likely mechanism: "Keep the stain wet."10
Contrary to the convictions of most experts, it is not a good idea to wash blood stains in cold water. In this study hot water was much more effective. However, as some guides recommended washing in warm water after immediate treatment with cold water, 8 13 hot water may be harmful only when the blood is fresh.
Unfortunately for the pharmaceutical industry, thrombolytic drugs were not effective stain removers. Application of alteplase, streptokinase, and heparin all made the blood stains worse, although the effect of streptokinase was not significant. This is perhaps a reassuring result as alteplase costs over $1000 a dose, probably far more than the article of affected clothing. Nevertheless, thrombolytic drugs may still have a role in selected cases. In this study the treatment was applied to the blood stain without any rinsin
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