USE OF ANTISEPTICS AND DISINFECTANTS
USE OF ANTISEPTICS AND DISINFECTANTS Introduction Disinfectants and antiseptics are an essential tool to control the spread of infectious agents. USE OF ANTISEPTICS AND DISINFECTANTS With its proper use, maximum benefits can be obtained, for which the following should be taken into account: No sanitizer is universally effective. Some chemical agents are good as antiseptics, but they are not effective as disinfectants, while other disinfectants are toxic as well as antiseptics. Not all items that come into contact with the patient need to be sterilized or require the same preparation. Antiseptics are used on the skin to eliminate or diminish its resident and transient flora . Disinfectants are widely used products for the destruction of microorganisms that live on an inanimate surface, with the exception of bacterial spores. Products to use a) Iodine-povidone: Iodine-povidone is a chemical compound between Polyvinylpyrrolidone (PVP) and Iodine or Triiodide ion, with a specific formula, on which many of its properties depend. It is a relatively toxic and irritation free antiseptic. The soap solution is useful for antiseptic hand washing and for pre-surgical bathing of patients. It can also be used as an intermediate level disinfectant. The topical solution is recommended for wound healing. It has a short residual action. It should not be used as a disinfectant. In addition to Gram positive and Gram negative bacteria, it eliminates fungal, protozoal and yeast viruses. It has also been described as a tuberculocidal. Iodine can rapidly penetrate the cell walls of microorganisms and be absorbed through any body surface except intact adult skin. Its frequent use does not generate more irritation than its specific application, as long as we are in the presence of original Povidone iodine and under national and international standards (ISO 9002 Standards, etc.) They should be kept in opaque containers and protected from light. b) Chlorhexidine gluconate 4%: It is a broad spectrum soapy antiseptic, effective bactericide against Gram positive and Gram negative germs. It is also effective against fungi and viruses (in vitro it is effective against encapsulated viruses including HIV, herpes simplex, cytomegalovirus and influenza). Its action is low on Mycobacterium tuberculosis . Its germicidal effect is fast and prolonged. It has a significant residual action on the skin, between three and six hours. It works by causing the microbial cell membranes to break down and precipitating their cellular content. It is not toxic and can be used in newborns. It is recommended for antiseptic hand washing of health personnel in intensive care units, operating rooms and isolation units. It is very useful in the decolonization of Gram positive germs from the skin of patients who are going to undergo surgery. A daily shower with this product has been shown to reduce Staphylococcus aureus colonization . In general rules, the response of the skin with successive use and repeated washing is adequate. It should be kept in its original container, at room temperature and protected from light. They should not be used for the disinfection of elements or surfaces as it has not been formulated for this purpose. c) Triclosan: It is broad spectrum and its activity is good against Gram positive and Gram negative bacteria, except for Pseudomonas species. It acts by breaking the cell wall of the microorganism, its activity against viruses and fungi seems to be reduced. Can be absorbed through intact skin. Commercial soap concentrations are generally presented at 1%. d) Iodized alcohol: It is a combination of iodine with 70% alcohol, it should be used in concentrations of 2%. It acts on Gram positive and Gram negative bacteria, Mycobacterium TBC and fungi. It is used as the antiseptic of choice for the preparation of the operative area of the skin. It must be kept in opaque containers to prevent its concentration from altering due to evaporation. e) Alcohol: It is an alternative for antisepsis of the skin in patients sensitive to iodine, with a contact time of not less than 60 seconds. 70% ethyl alcohol (ethanol) is more common in the hospital environment. 70/90% isopropyl alcohol (isopropanol) is somewhat more potent than ethyl. Both alcohols are fast bactericidal, rather than bacteriostatic, against vegetative forms of bacteria. They are also tuberculocidal, fungicidal, and virucidal, but they do not destroy bacterial spores. Isopropyl alcohol is unable to act against hydrophilic viruses ( Echo, Cocksackie ). Its destructive activity decreases markedly when it is diluted below 50%. The optimal concentration is in a range between 60 and 90%. Both alcohols dry out the skin, injure the epithelium and cause burning when applied to open wounds. The recommended concentration is 70% because it produces less dryness on the skin and less chemical dermatitis. 70% alcohol with the addition of emollients in gel form can be used with antiseptic wash (SEE RECOMMENDATIONS FOR HAND WASHING). It has no residual effect but several studies have shown that it is capable of reducing the microbial concentration of the skin of the hands by 99.7%. It works by denaturing proteins. This effect is achieved by reducing alcohol with water (70%). Recommended for respiratory therapy thermometers, stethoscopes, and external surfaces. They are flammable and should be kept in a clean, cool, well ventilated and hermetically closed place. f) Hydrogen Peroxide: Destroy hydroxyl radicals. Attacks lipid membranes, DNA, and other essential components of the cell. It is bactericidal, fungicidal, virucidal, tuberculous and in high concentrations with prolonged times it is sporicidal. It is used as a High Level Disinfectant (HLD). The concentration used should be 6 to 25% in stabilized solution, 3% is not sporicidal. It must contain a corrosion inhibitor. It is irritating to the mucous membranes. It should be protected from light and kept in an opaque and hermetically closed container. g) Sodium Hypochlorite (Lavandin Water): It is a disinfectant commonly used in the hospital environment. When used at 1%, its use is limited to laboratories or sectors where viral cultures or large areas contaminated with blood are handled. When used at 0.1%, it acts as a disinfectant as long as a good prior cleaning has been done on general surfaces. When used on surfaces, cleaning personnel who apply it should wear sturdy gloves. In this way, the balance of the normal flora of the hands is preserved. It is inactive against organic matter so it should not be mixed with detergents, it produces toxic and irritating vapors for operators. It must be kept in its original container (opaque plastic) and protected from light. Sunlight contributes to the early degradation of chlorine. The solutions are prepared with water and at the moment of being used, the rest must be discarded since it loses an active principle. In accordance with the latest national regulations in this regard, commercial bleach must be sold in a concentration of 60 grams of active chlorine per liter. Its biggest advantage, in addition to its low cost, is its fast action. Sodium hypochlorite is corrosive to medical instruments since it deteriorates quickly. 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