PASTOREX™ STAPH-PLUS 5 x 50 56353 1 x 50 56356

Latex agglutination test for the identification of Staphylococcus aureus

881175 - 2015/01

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CONTENTS

1- INTENDED USE ...............................................................................3

2- SUMMARY AND EXPLANATION ....................................................3

3- PRINCIPLE ......................................................................................3

4- PRESENTATION ..............................................................................4

5- STORAGE ........................................................................................4

6- NECESSARY MATERIAL NOT PROVIDED .....................................4

7- PRECAUTIONS ................................................................................4

8- PROCEDURE ...................................................................................5

9- INTERPRETATION OF RESULTS ...................................................6

10- QUALITY CONTROL OF THE TEST ................................................6

11- QUALITY CONTROL OF THE MANUFACTURER ...........................6

12- PERFORMANCES ...........................................................................7

13- LIMITATIONS OF THE PROCEDURE .............................................8

14- BIBLIOGRAPHY ..............................................................................9

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1- INTENDED USEPASTOREX™ STAPH-PLUS is a rapid slide agglutination test for the simultaneous detection of the fibrinogen affinity (clumping factor), protein A, and capsular polysaccharides of Staphylococcus aureus.

2- SUMMARY AND EXPLANATIONStaphylococcus aureus is one of the most frequently encountered pathogens in clinical specimens. The rapid distinction between this species and other, less virulent, staphylococci is of great importance for an appropriate patient management. The test for the detection of free coagulase production permits the identification of Staphylococcus aureus (11, 12).However, this test takes 4 to 24 hours, and plasma may have lot-to-lot variation that can affect the reaction (16).Agglutination reagents have been developed, giving a more rapid and reliable detection of Staphylococcus aureus (3). These agglutination tests use latex sensitised with fibrinogen and IgG, in order to detect the clumping factor and protein A, which are biochemical characteristics of S. aureus.However, it has been observed that certain strains of Staphylococcus aureus (essentially the methicillin-resistant strains) are not agglutinated by these agglutination tests (15). A study of these strains has shown that they all possess capsular polysaccharide (4). It is therefore probable that the polysaccharide capsule which envelopes all the bacteria under certain conditions (direct specimens, culture isolation, and bacterial clone), masks protein A and clumping factor, thereby preventing agglutination of the latex particles only sensitised by fibrinogen and IgG.

3- PRINCIPLEThe PASTOREX™ STAPH-PLUS was designed to allow simultaneous detection of the following three components:1) the fibrinogen affinity factor, also referred to as bound coagulase or

”clumping factor“;2) protein A, which possesses an affinity for the crystallisable fragment (Fc)

of gamma immunoglobulins (IgG);3) capsular polysaccharides of Staphylococcus aureus.The reagent is made of latex particles sensitised by fibrinogen and IgG as well as specific monoclonal antibodies (Institut Pasteur patent) raised against capsular polysaccharides of Staphylococcus aureus (1, 5, 6, 8, 10). The combination of fibrinogen, IgG and anti-capsular monoclonal antibodies in the same reagent allows the recognition of highly encapsulated strains of Staphylococcus aureus as well as poorly encapsulated strains. For highly encapsulated strains, anti-capsular polysaccharide antibodies agglutinate the bacteria. For strains that have lost their polysaccharide capsule, the bacteria are agglutinated by fibrinogen and IgG.

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Culture isolates of Staphylococcus aureus are mixed with the latex reagent on a slide. Following complete mixing, the slide is evaluated visually for the presence of agglutination, which indicates the presence of Staphylococcus aureus organisms.

4- PRESENTATION1. PASTOREXTM STAPH-PLUS, 50-test kit, code 56356• Latex test: 1 dropper bottle of 1 ml of red latex sensitised by bovine

albumin solution, fibrinogen, IgG, and monoclonal antibodies directed against capsular polysaccharides of Staphylococcus aureus.

Preservative : <1.5 % ProClin™ 300• Negative control: 1 dropper bottle of 1 ml of negative control reagent of

red latex sensitised by bovine albumin solution. Preservative : <1.5 % ProClin™ 300.• 16 disposable agglutination cards• 150 rods

2. PASTOREXTM STAPH-PLUS, 5 x 50 test kit, code 56353• Latex test: test reagent, 5 dropper bottles (1 ml).• Negative control: negative control reagent, 5 dropper bottles (1 ml).• Disposable agglutination cards, 4 x 16 • Rods, 3 x 100

5- STORAGEOnce open, all reagents are stable until the expiry dates indicated on the label, if stored at +2-8°C and in absence of microbial contamination.Store the latex reagent bottles upright.THE LATEX REAGENTS SHOULD NOT BE FROZEN.

6- NECESSARY MATERIAL NOT PROVIDED• Loop for collection of bacterial colonies• Disinfectant tank or autoclave bag for disposal of used cards

7- PRECAUTIONSThe Pastorex™ Staph-Plus kit is intended for culture confirmation testing only, and should not be used on direct clinical samples.The quality of results depends on complying strictly with Good Laboratory Practice.• All the reagents and the sample should be used at a temperature of

between 18 and 30°C.• Do not touch the reaction surface of the agglutination cards.• Shake the bottles of latex before use.

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• Wipe the tip of the reagent dropper bottle in order to obtain well-calibrated drops.

• Hold the reagent bottle vertical to deposit drops.• Use the plastic stir rods supplied in the kit for mixing the latex reagent and

the bacterial colonies. Do not use wooden sticks.• Change of mixing stick for each reaction.• Discard all disposable material used in an autoclavable waste bin or

disinfectant bath.

HYGIENE AND SAFETY INSTRUCTIONSAlways observe the current techniques and precautions concerning protection against microbiological hazards.

Caution: These reagents contain ProClin™ 300 < 1.5%.

For hazard and precaution recommendations related to some chemical components in this test kit, please refer to the pictogram(s) mentioned on the labels and the information supplied at the end of instruction for use. The Safety Data Sheet is available on www.bio-rad.com.

8- PROCEDURE1) SPECIMEN PREPARATIONSpecimens used with this kit should be pure and fresh. Recommended isolation medias, or equivalent medias, are as follows:

Agar Media• Trypto-casein-soy agar• Columbia agar + sheep blood• Columbia agar• Blood agar• Mannitol salt agar• Baird-Parker media with additives• MRSASelect™Perform Gram stain and catalase testing on the cultured organisms. Colonies that are tested with the PASTOREX™ STAPH-PLUS reagent should be Gram positive cocci that are catalase positive.

2) AGGLUTINATION REACTION1. Thoroughly homogenize the latex reagents by shaking. Vortex reagent if

necessary.2. Deposit a drop of latex test reagent into one of the circles of the

agglutination card.

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3. Deposit a drop of negative control latex reagent in another circle.4. Take 1 to 3 Gram positive catalse positive colonies with a loop or plastic

stir rod and emulsify them in a drop of latex for 10 seconds.5. Repeat step 4 for the negative control latex.6. Homogenise by gently rotating the card. Results must be read within

30 seconds of beginning the card rotation.7. Evaluate results according to the following criteria and then discard the

card into a disinfectant container. Do not re-use the card.

9- INTERPRETATION OF RESULTSPositive reactionA positive reaction is evidenced by the formation of aggregates with the reagent test only, visible to the naked eye under normal lighting within 30 seconds of beginning the card rotation. The aggregates of latex particles may be of varying sizes with a more or less cloudy, pink background.A slow and weak agglutination could signify a non-specific agglutination.

Negative reactionIn a negative reaction, the suspension does not produce any aggregates and retains its milky appearance.

Non-interpretable resultsAn non-interpretable result corresponds to agglutination of the suspension by the negative control latex. In this case, identify using another method such as testing for the presence of free coagulase and heat-stable DNAse.

10- QUALITY CONTROL OF THE TESTEvaluate the latex reagent at each use by verifying the absence of any agglutination when depositing the latex on the card. The latex should be periodically tested with previously identified strains of Staphylococcus aureus and Staphylococcus epidermidis. The latex test reagent must show presence of agglutination with Staphylococcus aureus and absence of agglutination with Staphylococcus epidermidis. The negative control latex must show an absence of agglutination with both organisms.

11. QUALITY CONTROL OF THE MANUFACTURERAll manufactured reagents are prepared according to our quality system starting from reception of raw material to the final commercialization of the product.Each lot is submitted to quality control assessments and is only released to the market, after conforming to the pre-defined acceptance criteria.The records relating to production and control of each single lot are kept within Bio-Rad.

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12- PERFORMANCESThe performance of PASTOREX™ STAPH-PLUS has been evaluated in several different laboratories (2, 13, 14). A total of 440 strains of S. aureus and 138 staphylococcal strains other than S. aureus were tested with the kit. Culture identification was carried out using gram stain, catalase activity, and the coagulase tube test. Discrepant samples were subsequently tested by biochemical analysis and by a commercialized alternative rapid test. S. aureus strains were also checked for their susceptibility to methicillin. The results for sensitivity testing on methicillin-resistance S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA), as well as the total results for all Staphylococcus aureus, are reported in Table 1. The results for specificity testing on staphylococcal strains other than S. aureus are reported in Table 2.

Table 1

Performance of Pastorex™ STAPH-PLUS on MRSA and MSSA isolates

* one non-interpretable result was excluded

Methicillin resistant S. aureus As reported in Table 1, 217 of 217 well-defined MRSA isolates were correctly identified by the PASTOREX™ STAPH-PLUS kit. The sensitivity of PASTOREX™ STAPH-PLUS for MRSA was estimated to be 100%, excluding the non-interpretable result which represents 0.4% of the strains analyzed.

Methicillin sensitive S. aureusAll of the 222 MSSA that were cultured gave a positive result with the PASTOREX™ STAPH-PLUS, as shown in Table 1. The sensitivity obtained with this population of MSSA was 100%.

Total Positive NegativeRelative

Sensitivity

MRSA 217* 217 0 100%

MSSA 222 222 0 100%

Total S. aureus 439* 439 0 100%

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Other Staphylococci

Table 2

Performance of PASTOREX™ STAPH-PLUS on other staphylococcal strains

138 staphylococcal isolates other than S. aureus, including S. epidermidis, S. haemolyticus, S. hominis, S. saprophyticus, S. schleiferi, S. lugdunensis, and other species, were also analyzed with the PASTOREX™ STAPH-PLUS. A negative result was obtained for 137 of the 138 isolates, as shown in Table 2. The discrepant result was identified as S. lugdunensis and it was also positive with an alternative rapid test.

13- LIMITATIONS OF THE PROCEDUREStaphylococcus lugdunensis and Staphylococcus schleiferi have been reported to possess a fibrinogen affinity factor (7,9) and may react with the detection test for clumping factor, depending on the strains and the isolation medium. As some strains of Staphylococcus, are known to cause non-specific aggregation of latex particles, particularly staphylococcus saprophyticus, it is recommended that the control latex provided in the kit be used with each organism that is tested. Staphylococcus intermedius and staphylococcus hyicus, which are found in animal pathology but are very rarely isolated in man, may present a positive reaction with the classical coagulase tests and may therefore theoretically also react with fibrinogen affinity factor detection tests.The possibility of cross-reactions should not be forgotten. Certain streptococci possess a protein with an affinity for the Fc fragments of immunoglobulins and may therefore react with the latex. Non-specific reactions of latex techniques have also been reported for several species including Escherichia coli and Candida albicans (17). It is recommended to perform a Gram stain and catalase test on the colonies to be tested prior to the latex test. False negative reactions can occur if the Staphylococcus aureus that is isolated does not produce the fibrinogen affinity factor (clumping factor), protein A, or capsular polysaccharides against which the specific monoclonal antibodies were raised. False negative results can occur with an insufficient inoculum.

Total Positive NegativeRelative

Specificity

Other staphylococcal strains

138 1 137 99.3%

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14- BIBLIOGRAPHY1. Boutonnier A., Nato F., Bouvet A., Lebrun L., Audurier A., Mazie J.C.,

and Fournier J.M. Direct testing of blood cultures for detection of the serotype 5 and 8 capsular polysaccharides of Staphylococcus aureus. J. Clin. Microbiol. 1989. 27: 989-993.

2. Davies S. Detection of methicillin-resistant Staphylococcus aureus: the evaluation of rapid agglutination methods, Br. J. Biomed. Sci., 1997, 54:13-15.

3. Esserts I., and Radebold K. Rapid and reliable identification of Staphylococcus aureus by a latex agglutination test. J. Clin. Microbiol. 1980. 641-643.

4. Fournier J.M., Boutonnier A., and Bouvet A. Staphylococcus aureus strains which are not identified by rapid agglutination methods are of capsular serotype 5. J. Clin. Microbiol. 1989. 27:1372-1374.

5. Fournier J.M., Bouvet A., Boutonnier A., Audurier A., Goldstein F., Pierre J., Bure A., Lebrun L., and Hochkeppel H.K. Predominance of capsular polysaccharide type 5 among oxacillin-resistant Staphylococcus aureus. J. Clin. Microbiol. 1987. 25:1932-1934.

6. Fournier J.M., Hannon K., Moreau M., Karakawa W.W., and Vann W.F. Isolation of type 5 capsular polysaccharide from Staphylococcus aureus. Ann. Inst. Pasteur/Microbiol. 1987. 138:561-567.

7. Freney J., Brun Y., Bes M., Meugnier H., Grimont F., Grimont P.A.D., Nervi C., and Fleurette J. Staphylococcus lugdunensis sp. No. and Staphylococcus schleifer sp. Nov., two species form human clinical specimen. J. Clin. Microbiol. 1989. 38:2110-2111.

8. Hochkeppel H.K., Braun D.G., Vischer W., Imm A., Sutter S., Staeubli U., Guggenheim R., Kaplan E.L., Boutonnier A., and Fournier J.M. Serotyping and electron microscopy studies of Staphylococcus aureus clinical isolates with monoclonal antibodies to capsular polysaccharide types 5 and 8. J. Clin. Microbiol. 1987. 25:526-530.

9. Jean Pierre H., Darbas H., Jean-Roussenq A., and Boyer G. Pathogenicity in T cases of Staphylococcus schleiferi, a recently described species.

10. Karakawa W.W., Fournier J.M., Vann W.F., Arbeit R., Schneerson, R.S. and Robbins. J.B. Method for the serological typing of the capsular polysaccharides of Staphylococcus aureus. J. Clin. Microbiol., 1985, 22:445-447.

11. Kloos W.E. and Lambe D.W. (1991). Staphylococcus Manual of Clinical Microbiology, 5th Ed. Edited by Balows A., Hausler W.J., Herrmann K.L., Isenberg H.D., and Shadomy J.J. American Society for Microbiology, Washington, D.C., Pages 222-237.

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12. Kloos W.E., and Scleifer K.H. Staphylococcus Bergeyís manual of systematic bacteriology. 1986, vol. 2, 1013-1035.

13. Luijendijk AD., Alex van Belkum, Verbrugh H., and Kluytmans J. Comparison of Five Tests for Identification of Staphylococcus aureus from Clinical Samples. J. Clin. Microbiol., 1996, 34:2267-2269.

14. Neher C., Allerberger F., Prodinger W. Dierich M.P., Evaluation of commercially available agglutination tests for methicillin-resistant. 8th ECCMID Congress, Lausanne, 1997.

15. Ruane P.J., Morgan M.A., Citron D.M., and Mulligan M.E. Failure of rapid agglutination methods to detect oxacillin-resistant Staphylococcus aureus. J. Clin. Microbiol. 1986. 24:490-492.

16. Selepack S.T., and Witebsky F.G. Inoculum size and lot-to-lot variation as significant variables in the tube coagulase test for Staphylococcus aureus. J. Clin. Microbiol., 1985, 22:835-837.

17. Kronvall G. A Surface Component in Group A, C, and G Streptococci with Non-Immune Reactivity for Immunoglobulin G. J. Immunology., 1973, vol.11, 1401-1406.

(BG) •Този продукт съдържа човешки или животински компоненти. Бъдете внимателни при работа с него.

(CZ) • Tentovýrobekobsahujelidskénebozvířecíkomponenty.Zacházejtesnímopatrně.(DE) • Dieses Produkt enthält Bestandteile menschlichen oder tierischen Ursprungs. Vorsichtig

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forsigtighed.(EE) • Käesolev toode sisaldab inim-või loomseid komponente. Käsitseda ettevaatlikult.(EN) • This product contains human or animal components. Handle with care.(ES) • Este producto contiene componentes humanos o animales. Manejar con cuidado.(FI) • Tässä tuotteessa on ihmisestä tai eläimistä peräisin olevia osia. Käsittele varovasti.(FR) • Ce produit contient des composants d’origine humaine ou animale. Manipuler avec pré-

caution.(GR) • Αυτό το προϊόν περιέχει ανθρώπινα ή ζωικά στοιχεία. Χειριστείτε το με προσοχή.(HR) • Ovaj proizvod sadrži ljudske ili životinjske sastojke. Pažljivo rukovati.(HU) • A készítmény emberi vagy állati eredetű összetevőket tartalmaz. Óvatosan kezelendő.(IT) • Questo prodotto contiene componenti umane o animali. Maneggiare con cura.(LT) •Šiameprodukteyražmogiškosiosarbagyvūninėskilmėssudėtiniųdalių.Elgtisatsargiai.(NL) • Dit product bevat menselijke of dierlijke bestanddelen. Breekbaar.(NO) • Dette produktet inneholder humane eller animalske komponenter. Håndteres med forsik-

tighet.(PL) • Niniejszy produkt zawiera składniki pochodzenia ludzkiego lub zwierzęcego. Należy obcho-

dzić się z nim ostrożnie.(PT) • Este medicamento contém componentes de origem humana ou animal. Manuseie com

cuidado.(RO) •Acestprodusconţinematerialedeorigineumanăsauanimală.Manevraţi-lcugrijă.(SE) • Denna produkt innehåller beståndsdelar från människa eller djur. Hantera produkten

varsamt.(SI) • Izdelek vsebuje človeške ali živalske sestavine. Rokujte previdno.(SK) • Tentovýrobokobsahujeľudskéalebozvieraciezložky.Narábajtesnímopatrne.

H317 P280-P302+P352- P333+P313-P501

(BG)вниманиеМоже да причини алергична кожна реакция. Използвайте предпазни ръкавици/предпазно облекло/предпазни очила/предпазна маска за лице. ПРИ КОНТАКТ С КОЖАТА: Измийте обилно със сапун и вода. При поява на кожно дразнене или обрив на кожата: Потърсете медицински съвет/помощ. Изхвърлете съдържанието/контейнера в съответствие с местните/регионалните/националните/международните разпоредби.

(CZ)VarováníMůže vyvolat alergickou kožní reakci. Používejte ochranné rukavice/ochranný oděv/ochranné brýle/obličejový štít. PŘI STYKU S KŮŽÍ: Omyjte velkým množstvím vody a mýdla. Při podráždění kůže nebo vyrážce: Vyhledejte lékařskou pomoc/ošetření. Obsah/nádobu likvidujte v souladu s místními/regionálními/národními/mezinárodními předpisy.

(DE)AchtungKann allergische Hautreaktionen verursachen. Schutzhandschuhe/Schutzkleidung/Augenschutz/Gesichtsschutz tragen. BEI KONTAKT MIT DER HAUT: Mit viel Wasser und Seife waschen. Bei Hautreizung oder -ausschlag: Ärztlichen Rat einholen/ärztliche Hilfe hinzuziehen. Entsorgung des Inhalts / des Behälters gemäß den örtlichen / regionalen / nationalen/ internationalen Vorschriften.

(DK)AdvarselKan forårsage allergisk hudreaktion. Bær beskyttelseshandsker/beskyttelsestøj/øjenbeskyttelse/ansigtsbeskyttelse VED KONTAKT MED HUDEN: Vask med rigeligt sæbe og vand. Ved hudirritation eller udslet: Søg lægehjælp. Bortskaffelse af indholdet/beholderen i henhold til de lokale/regionale/nationale/internationale forskrifter.

(EE)Hoiatus Võib põhjustada allergilist nahareaktsiooni. Kanda kaitsekindaid/kaitserõivastust/kaitseprille/kaitsemaski. NAHALE SATTUMISE KORRAL: pesta rohke vee ja seebiga. Nahaärrituse või _obe korral: pöörduda arsti poole. Sisu/konteineri käitlus vastavuses kohalike/regionaalsete/rahvuslike/rahvusvaheliste nõuetega.

(EN)Warning May cause an allergic skin reaction. Wear protective gloves/protective clothing/eye protection/face protection. IF ON SKIN: Wash with plenty of soap and water. If skin irritation or rash occurs: Get medical advice/attention. Dispose of contents/container in accordance with local/regional/national/international regulations.

(ES)AtenciónPuede provocar una reacción alérgica en la piel. Llevar guantes que aíslen del frío/gafas/máscara. EN CASO DE CONTACTO CON LA PIEL: Lavar con agua y jabón abundantes. En caso de irritación o erupción cutánea: Consultar a un médico. Eliminar el contenido o el recipiente conforme a la reglamentación local/regional/nacional/internacional.

(FI)VaroitusVoi aiheuttaa allergisen ihoreaktion. Käytä suojakäsineitä/suojavaatetusta/silmiensuojainta/kasvonsuojainta. JOS KEMIKAALIA JOUTUU IHOLLE: Pese runsaalla vedellä ja saippualla. Jos ilmenee ihoärsytystä tai ihottumaa: Hakeudu lääkäriin. Säilytä säiliö(t) noudattaen paikallisia/alueellisia/kansallisia/kansainvälisiä määräyksiä.

(FR)AttentionPeut provoquer une allergie cutanée. Porter des gants de protection/des vêtements de protection/un équipement de protection des yeux/du visage. EN CAS DE CONTACT AVEC LA PEAU: laver abondamment à l’eau et au savon. En cas d’irritation ou d’éruption cutanée: consulter un médecin. Éliminer le contenu/récipient conformément à la réglementation locale/régionale/nationale/internationale.

(GR)Προσοχή Μπορεί να προκαλέσει αλλεργική δερματική αντίδραση. Να φοράτε προστατευτικά γάντια/προστατευτικά ενδύματα/μέσα ατομικής προστασίας για ταμάτια/πρόσωπο. ΣΕ ΠΕΡΙΠΤΩΣΗ ΕΠΑΦΗΣ ΜΕ ΤΟ ΔΕΡΜΑ: Πλύνετε με άφθονο νερό και σαπούνι. Εάν παρατηρηθεί ερεθισμός του δέρματος ή εμφανιστεί εξάνθημα: Συμβουλευθείτε/Επισκεφθείτεγιατρό. Απορρίψτε τα περιεχόμενα/δοχείο σύμφωνα με τους τοπικούς/εθνικούς/διεθνείς κανονισμούς.

(HR)UpozorenjeMože izazvati alergijsku reakciju na koži. Nositi zaštitne rukavice/zaštitnu odijelo/zaštitu za oči/zaštitu za lice. U SLUČAJU DODIRA S KOŽOM: oprati velikom količinom sapuna i vode. U slučaju

nadražaja ili osipa na koži: zatražiti savjet/pomoć liječnika. Odložite sadržaje /spremnike u skladu s lokalnim/regionalnim/nacionalni/međunarodnim odredbama.

(HU)Figyelem Allergiás bőrreakciót válthat ki. Védőkesztyű/védőruha/szemvédő/arcvédő használata kötelező. HA BŐRRE KERÜL: Lemosás bő szappanos vízzel. Bőrirritáció vagy kiütések megjelenése esetén: orvosi ellátást kell kérni. Az edény tartalmát / a tartályt a helyi/regionális/nemzeti/nemzetközi szabályozásoknak megfelelően kell hulladékként elhelyezni.

(IT)Attenzione Può provocare una reazione allergica cutanea. Indossare guanti/indumenti protettivi/Proteggere gli occhi/il viso. IN CASO DI CONTATTO CON LA PELLE: lavare abbondantemente con acqua e sapone. In caso di irritazione o eruzione della pelle: consultare un medico. Smaltire il prodotto/recipiente in conformità con le disposizioni locali / regionali / nazionali / internazionali.

(LT)Atsargiai Gali sukelti alerginę odos reakciją. Mūvėti apsaugines pirštines/dėvėti apsauginius drabužius/naudoti akių (veido) apsaugos priemones. PATEKUS ANT ODOS: Nuplauti dideliu kiekiu muilo ir vandens. Jeigu sudirginama oda arba ją išberia: kreiptis į gydytoją. Turinį/talpą išpilti (išmesti) - šalinti pagal vietines / regionines / nacionalines / tarptautines taisykles.

(NL)Waarschuwing Kan een allergische huidreactie veroorzaken. Beschermende handschoenen/beschermende kleding/oogbescherming/gelaatsbescherming dragen. BIJ CONTACT MET DE HUID: met veel water en zeep wassen. Bij huidirritatie of uitslag: een arts raadplegen. De inhoud en de verpakking verwerken volgens de plaatselijke/regionale/nationale/internationale voorschriften.

(NO)AdvarselKan forårsake allergiske hudreaksjoner. Bruk vernehansker/verneklær/vernebriller/ansiktsskjerm. VED HUDKONTAKT: Vask med store mengder vann og såpe. Ved hudirritasjon eller -utslett: Kontakt / tilkall lege. Innholdet / emballasjen skal avhendes i henhold til de lokale / regionale / nasjonale / internasjonale forskrifter.

(PL)Uwaga Może powodować reakcję alergiczną skóry.

Stosować rękawice ochronne/odzież ochronną/ochronę oczu/ochronę twarzy. W PRZYPADKU KONTAKTU ZE SKÓRĄ: Umyć dużą ilością wody z mydłem. W przypadku wystąpienia podrażnienia skóry lub wysypki: Zasięgnąć porady/zgłosić się pod opiekę lekarza. Zawartość / pojemnik usuwać zgodnie z przepisami miejscowymi / regionalnymi / narodowymi / międzynarodowymi.

(PT)Atenção Pode provocar uma reacção alérgica cutânea. Usar luvas de protecção/vestuário de protecção/protecção ocular/protecção facial. SE ENTRAR EM CONTACTO COM A PELE: lavar com sabonete e água abundantes. Em caso de irritação ou erupção cutânea: consulte um médico. Eliminar o conteúdo/recipiente de acordo com a legislação local/regional/nacional/internacional.

(RO)Atenţie Poate provoca o reacţie alergică a pielii. Purtaţi mănuşi de protecţie/îmbrăcăminte de protecţie/echipament de protecţie a ochilor/ chipament de protecţie a feţei. ÎN CAZ DE CONTACT CU PIELEA: spălaţi cu multă apă şi săpun. În caz de iritare a pielii sau de erupţie cutanată: consultaţi medicul. Aruncaţi conţinutul/containerul în acord cu regulamentele locale/regionale/naţionale/internaţionale.

(SE)Varning Kan orsaka allergisk hudreaktion. Använd skyddshandskar/skyddskläder/ögonskydd/ansiktsskydd. VID HUDKONTAKT: Tvätta med mycket tvål och vatten. Vid hudirritation eller utslag: Sök läkarhjälp. Innehållet / behållaren avfallshanteras enligt lokala / regionala / nationella / internationella föreskrifter. « «(Sl)Pozor Lahko povzroči alergijski odziv kože. Nositi zaščitne rokavice/zaščitno obleko/zaščito za oči/zaščito za obraz. PRI STIKU S KOŽO: umiti z veliko mila in vode. Če nastopi draženje kože ali se pojavi izpuščaj: poiščite zdravniško pomoč/oskrbo. Vsebino/vsebnik odstranite v skladu z lokalnimi/regionalnimi/narodnimi/mednarodnimi predpisi.

(SK)Pozor Môže vyvolať alergickú kožnú reakciu. Noste ochranné rukavice/ochranný odev/ochranné okuliare/ochranu tváre. PRI KONTAKTE S POKOŽKOU: Umyte veľkým množstvom vody a mydla. Ak sa prejaví podráždenie pokožky alebo sa vytvoria vyrážky: vyhľadajte lekársku pomoc/starostlivosť. Zneškodnenie obsahu/obalu v súlade s miestnymi/oblastnými/národnými/medzinárodnými nariadeniami.

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