1. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 43 Antiseptic and Disinfectant Agents

2. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Infections: Sites of Origin  Community-acquired infections  Acquired in the home or any place in the community other than a health care facility

3. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Infections: Sites of Origin (cont’d)  Nosocomial infections  Contracted in a hospital or institutional setting  Were not present or incubating in the patient on admission to the facility  More difficult to treat because the causative microorganisms are often drug resistant and the most virulent

4. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antimicrobials  Agents used to reduce the risk of nosocomial infections  Antiseptics  Disinfectants

5. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Topical Antimicrobials (cont’d)  Antiseptics  Inhibit growth of microorganisms but do not necessarily kill them  Used on living tissue  Disinfectants  Kill organisms  Used on nonliving surfaces

6. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications  Living tissue cannot be sterilized  Antiseptics are applied to living tissue, such as skin and mucous membranes, to reduce the risk of infection by reducing the number of microorganisms that can enter the body via an incision or injection site

7. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d)  Antiseptics may be used for:  Presurgical hand scrubs for members of the surgical team  Preoperative skin preparation  Irrigation of body cavities  Forms  Surgical soaps, ointments, mouthwashes, topical solutions, douches

8. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont’d) Disinfectants are used to remove microorganisms from inanimate objects such as tabletops and surgical equipment

9. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Acid Agents  Acetic acid (vinegar)  1% or 5% solution  Benzoic, boric, or lactic acids  Antibacterial, antifungal, bladder irrigation  Otic solution or irrigation solution in various strengths

10. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Alcohol Agents  Isopropyl alcohol or ethanol  Most effective at 60% to 70% concentrations  “Cidal” activity decreases at more than 95% or less than 60%  Used as a skin astringent, cleansing agent, and to disinfect utensils

11. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Aldehyde Agents  formaldehyde and glutaraldehyde (Cidex)  Caustic, and may cause burns to skin and mucous membranes  Used mostly as disinfectants  Cidex is used to sterilize surgical equipment

12. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Biguanide Agents  chlorhexidine gluconate (Hibiclens)  Used as a bactericidal skin-cleansing solution (surgical scrub, handwashing agent, and a skin wound cleanser)

13. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Dyes  Gentian violet, others  Gentian violet is used as a 1% or 2% solution  Topical antiinfective  Antibacterial and antifungal activity

14. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chlorine Compounds  Dilute sodium hypochlorite (Dakin’s solution)  Antibacterial antiseptic irrigation  5% solution used to disinfect utensils, floors, furniture, etc.  0.5% solution used topically on the skin  Household bleach solutions are 5.25%

15. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Chlorine Compounds (cont’d)  halazone: chloramine compound  Available in tablet form  Used to sanitize drinking water  1 or 2 tablets in a liter of water can kill water-borne pathogens within 30 to 60 minutes

16. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mercurial Agents  thimerosal (Merthiolate)  Organic mercurial agent  Topical antiseptic, primarily antibacterial  Ammoniated mercury  Inorganic mercurial agent  Used to treat impetigo, psoriasis, pediculosis, other skin conditions

17. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Iodine Compounds  Iodine tincture and solution  Kill all forms of microorganisms  Used as a topical antiseptic  povidone-iodine (Betadine)  Comes in various forms Aerosol, topical solution, mouthwash, surgical scrub Aerosol, topical solution, mouthwash, surgical scrub

18. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Oxidizing Agents  hydrogen peroxide  Bactericidal and virucidal; higher concentrations are sporicidal  Used as wound irrigation solution, but may be detrimental to wounds in that it can destroy newly forming cells as well as bacteria  benzoyl peroxide  potassium permanganate

19. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Phenolic Compounds  cresol, carbolic acid (phenol), Lysol  Used as disinfectants; can burn and blister skin  chloraseptic used as an oral antiseptic  hexachlorophene  Bacteriostatic skin cleanser and surgical scrub  resorcinol  Used for a variety of skin conditions

20. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Surface-Active Agents  benzalkonium chloride (Zephiran)  cetylpyridinium chloride  Bacteriostatic at low concentrations, bactericidal and fungicidal at high concentrations  Used as a skin cleanser, antiseptic irrigation solution, and for instrument storage

21. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications  Assess for drug and other allergies, or previous sensitivities to antiseptics or other topical agents  If an iodine-based agent is to be used, assess for allergies to iodine or seafood because such allergies are contraindications

22. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Before using antiseptics, assess:  The concentration of the medication  Length of exposure to the skin  Condition of the skin  Size of area affected  Hydration status of the skin

23. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Before applying a topical agent, ensure correct technique and adequate supplies needed for the procedure  Assess the area to be treated beforehand  Follow specific directions for cleansing the area

24. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Follow the manufacturer’s specific guidelines for administration of the agent  Protect the site as ordered with a dressing if needed  Teach the patient proper technique for application of the medication and dressings as needed

25. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d) When using these agents on inanimate objects, be sure to protect the patient (and yourself!) from accidental exposure

26. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic response  Improved healing of the affected area  Decreased symptoms of inflammation or infection  Prevention of infection  Monitor for adverse effects or reactions