pharm 2 chapter 100 antiseptics and disinfectants

antiseptic

applied to living tissue

disinfectant

• applied to objects

• too harsh for living tissue

• applied most frequently to instruments and facilities

sterilization

complete destruction of all microorganisms

sanitization

reduction of contamination to a level compatible with public health standards

germicide

• kills microorganisms

• bactericides, virucides, fungicides, amebicides

germistatic drug

decreases growth and replication but does not kill germs

properties of an ideal antiseptic

• safe

• effective

• selective

• germicidal

• broad spectrum of antimicrobial activity

time course of action

• Toxicity to organisms determined by duration of exposure to antiseptic/disinfectant

• Example:

  • Ethanol 70% reduces bacterial count by 50% in 36 seconds

  • Benzalkonium chloride requires 7 minutes for same effect

Because such differences exist, effective use of antiseptics and disinfectants requires that healthcare personnel understand the exposure requirements of each agent.

antiseptics to treat established local infection

• Topical agents used in the past

• Systemic anti-infective drugs now the treatment of choice

  • More effective than topical agents

  • Do not damage inflamed/abraded tissue

most effective use of antiseptics and disinfectants

• antiseptics applied directly to patient contribute relatively little prophylaxis against infection (except neutropenic)

  • research shows that most postoperative infections are caused by organisms not present at the incision site

• use of antiseptics by nurses, physicians, and those who contact the patient offers much greater protection

common antiseptics and disinfectants

• Alcohol: Ethanol

• Aldehydes: Glutaraldehyde [Cidex Plus 28]

• Iodine compounds

• Chlorine compounds

• Phenols

• Miscellaneous agents

  • Chlorhexidine, hydrogen peroxide, thimerosal

  • Benzalkonium chloride

hand hygiene for healthcare workers

• Effective hygiene is the single most important factor in preventing the spread of infection in healthcare settings

• 2 million hospital-acquired infections a year

• Centers for Disease Control and Prevention (CDC) recommends alcohol-based handrubs for routine hand antisepsis

  • Accessible

  • Save time

  • Less skin damage

  • Greater efficacy

specific CDC hand-hygiene recommendations

• Categories: IA, IB, IC, II, and no recommendation/unresolved issue

• Indications for hand washing and antisepsis

• Hand-hygiene technique

• Surgical hand antisepsis

• Other aspects of hand hygiene

• Administrative measures regarding hand hygiene

hand hygiene and spores

• alcohol based handrubs do NOT kill spores of c diff, b anthracis, and other spore-forming bacteria

• washing with soap and water physically removes these spores and is the preferred mode of hand decontamination after contact with patients with c diff or b anthracis infection

key points

Because the various antiseptics and disinfectants require different durations of exposure to be effective, you must know the time course of action of the specific agent you are working with.

■ Although antiseptics can help prevent the development of a local infection, systemic antiinfective drugs are preferred for treating an established local infection.

■ Washing with antiseptics by nurses, physicians, and others who contact patients will do more to protect patients from infection than will the application of antiseptics to patients themselves.

■ For routine hand antisepsis, alcohol-based handrubs are preferred to soap and water.

■ Soap and water are preferred to alcohol-based handrubs when the hands are visibly dirty and after exposure to spore-forming bacteria, such as B. anthracis.