ANTISEPTIC TECHNIQUES

BY

DR. SB ZAILANI SENIOR LECTURER/CONSULTANT DEPARTMENT OF MEDICAL MICROBIOLOGY COLLEGE OF MEDICAL SCIENCES UNIVERSITY OF MAIDUGURI DATE: SEPTEMBER, 2008

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TERMINOLOGY Sterility Total absence of viable microorganisms as assessed by no growth on any medium. Bacteriocidal Kills bacteria Bacteriostatic Inhibits growth of bacteria Sterilization The use of physical and/or chemical procedures to completely eliminate or destroy all forms of microbial life. This term while absolute, is relative to our ability to detect microorganisms.

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 Disinfection a process that reduces or completely eliminate spores. An object that has been properly disinfected could theoretically transmit- producing organism, but the possibility is greatly reduced. Germicide- a substance that destroys microorganism, especially pathogenic microorganisms. Technically a germicide does not destroy, spores. However, the term may be used commonly to refer to substances with sporicidal activity. It applies to agents used both on living tissue and on inanimate objects. Antiseptic a substance that inhibit or destroys microorganisms. No sporicidal action is implied. The term is used specifically for substances applied topically to living tissue.

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 CHEMICAL DISINGECTANTS/STERILANTS 1. Alcohols are protein denaturants that rapidly kill vegetative bacteria when applied as aqueous solutions in the range of 70-95% alcohol They are inactive against bad spores and many viruses. * Ethanol (70-90% and isoproprpyl (90-95%) alcohol are widely used as skin disinfectant before simple invasive procedures such as venipuncture.

2. Phenolics They act by coagulating proteins. Phenol itself is not used as a disinfectant because of its toxicity, carcinogenicity, and corrosiveness. Clear soluble phenolic disinfectant such as clearsol, hycolin, or stericol are resistant to inactivation by organic matter and are active against a wide range of Gram positive and gram negative bacteria.
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Phenotics are reasonable effective against mycobacterium but have little activity against endospores, and Viruses. Their activity reduce by alkaline pH.

3. Aldehyde: * Gluteraldehyde is a relatively powerful agent that is considered a high level disinfectant and a sterilant when used appropriately. They usually supplied at the working conc. of 2%. Their ability to penetrate organic material is poor. It is usually used for the sterilization of objects not suitable for autoclaving e.g plastic prosthesis, thermometers, anaestetic equipment and endoscopes.

* *

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Iterms for steriliazation requires 3 hours immersion, for disinfection 15min is sufficient.
Formalin is a 40% solution of formaldehyde in water when diluted to 10%, it remains a true sterilizing agent and is lethal to bacteria, viruses, fungi and spores. It is slow in action and may require up to 24 hours to achieve it maximum affect.

4. Halogens- This group consist of bromine, chlorine, fluorine and iodine. Only iodine and chlorine, however, are commonly used for disinfection. * Halogens kill vegetative bacteria, fungi, viruses but not tubercle bacilli or endospores.

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Iodine is used chiefly for skin. Chlorine combine with water to form Hcl which is bacteriocidal. Chlorine is highly effective oxidizing agent. In conc. Less than one part per million, chlorine is lethal within seconds to most vegetative bacteria and it inactivate most viruses. Iodine is an effective disinfectant that acts by oxidizing essential component of microbial cell. It is commonly used as tincture of 2% iodine in 50% alcohol. It kills more rapidly than alcohol or iodine alone. Other preparations are available in which iodine is combined with organic compounds such as detergent in dissociable complex to form iodophors.

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5. Quaternary Ammonium Compounds * Cationic detergent, particularly quaternary ammonium compounds (quats) such as benzalkonium chloride, are highly bacteriocidal. Their hydrophobic and lipophilic groups react with lipid of the cell membrane of the bacteria, alter it surface properties and it permeability . These compounds have little toxicity to skin and mucous membranes, and thus have been used widely in conc. of 0.1% for their antibacterial effects. They are inactive against spores and most viruses.

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6. Peroxygen Compounds

*
*

Included among the perioxygen compounds disinfectants hydrogen peroxide and peracetic acid.

are

the

Both compounds are bacteriocidal, virucidal, sporucidal and fungicidal, but the activities against mycobacteria are not well documented.

7. Ethylene oxide Is an inflammable and potentially explosive gas. It is an alkylating agent that inactivate microorganisms by replacing labile hydrogen atoms on hydroxyl, carboxy or sulfohydryl groups. * Ethylene oxide sterilization resemble autoclaves, expose to 10% ethylene oxide or CO2 at 50oc for 4-6hrs and must be followed by prolonged period of aeration to allow the gas to diffuse out.

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Ethylene oxide is an effective sterilizing agent for heat labile devices such as prosthesis.

8. Plasma gas- Plasma gas sterilization gas recently bee applied to the treatment of medical devices. * In this process, H2O2 is injected into the sterilization chamber and vaporized. The vapor diffuses through the chamber and radio frequency energy is applied to the chamber to create gas plasma. The free radicals formed in the plasma gas are involved in microbial inactivation. The process temperature does not exceed 40oC.

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ANTISEPTICS

Antiseptics are found in the lab. Primarily in products used for hand washing. The necessity for hand washing is based on the fact that the hands become contaminated with pathogenic microorganisms during lab. Procedures
Whether the product used for hand washing in the laboratory needs to contain an antimicrobial agent has never been shown by any wellcontrolled studies. The proper technique involves a rigorous rubbing together of all surfaces of well-lathered hands for 10-15 see followed by rinsing under a stream of water. Particular attention should be paid to areas under the finger nails and around the cuticles.

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 Some of the same chemicals found in disinfectants are also found in and hand washing preparations. However, a hand- washing product should not be used as disinfectant, and a disinfectant should not be used for hand- washing.

Common chemicals found in hand washing products are: Alcohol Chlorhexidine gluconate,

Iodophors
Chloroxylenol Triclosan

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 Alcohols are very fast acting and effective against a broad spectrum of microorganism, including mycobacteria, fungi, and viruses. They are safe and inexpensive. Isopropyl and ethyl alcohols are used. They have tendency to dry the skin. Chlorhexidine gluconate is a broad spectrum (CHG) antiseptic with good activity against gram positive and negative bacteria, but poorer activity against viruses, mycobacteria and fungi. * * This antiseptic is generally used in a conc. Range of 2-4%. Chlorhexidine gluconate activity is affected by hard water, lotion and soap.

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 Iodophors while having good activity against both gram positive and gram negative bact. Fungi, mycobacteria and viruses, have the disadvantage of staining and causing irritation. They are generally available in conc. of 0.7% available iodine. Chloroxylend has good antiseptic activity but may not be as active as chlohexidine and iodophors. It is used in conc. ranging 1.5-3.5%.

Triclosan is commonly used in deodorant soaps. It is active against both gram positive nod gram negative organisms with the exception of pseudomonas spp. It activity against other organisms is not as good. It is generally used in a conc. range of 0.3 1.0%.

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Other chemical for hand washing include, hexachlorophene and benzalkonium chloride.

The type(s) of hand-washing agent to be used needs to be well thought out. Three key factors to be considered are:1.The type of microorganism 2.The acceptance of the agent b the personnel 3.The cost. ANTISEPSIS Most nosocomial infection (NI) are believed to be transmitted by the hands of health care workers. Many NI can be prevented by using hand-washing to interrupt the transmission of the pathogens on the hands.
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Despite the simplicity and effectiveness of hand washing (HW), several studies have documented poor compliance with recommendations concerning HW.

Improvement in the frequency of HW have resulted in decreased infection rates in intersive care units. Other data suggest that NI rates are reduced by the use of antiseptic HW. NO single antiseptic agent is ideal for use in all situations.

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CONTROL MEASURES * HW For general patient care, a plain non antimicrobial soap in any convenient form (bar, leaflet, powder, or liquid) is acceptable. If bar soap is used, the hospital should provide small bars that can be changed frequently and soap racks that promote drainage. Cleaning under the finger nails is a crucial part of HW, since the majority of organisms on the hand live in the subungual region. HW sinks should be conveniently located throughout the hospital to facilitate frequent and appropriate HW.

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* SURGICAL HAND SCRUB

A surgical hand scrub (SHS) for approximately 5 min is performed to remove transient flora and reduce resident floar for the duration of surgical procedure.
Agent with good antimicrobial activity and persistence, such as CHG or iodophors are acceptable products. An alcohol preparation yield excellent reduction in flora. This reduction is accomplished b first washing the hands and arms and cleaning the finger nails thoroughly, and then drying next, in alcohol solution. * PREOPERATIVE PATIENT SKIN PREPARATION

Antiseptics are also used for preoperative skin preparation to rapidly decrease the number of skin flora at the operative site.

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After the patients skin has been physically cleaned, and antimicrobial agent that rapidly reduces the level of skin microbial flora is applied.

Recommended agents include the alcohols, iodophors or CHG. * PATIENT SKIN PREPARATION AT CATHETER SITE Catheter-related bacteraemias or fungemias occur in 3-7% of central venous catheters and 1% of arterial catheters and are most commonly caused by skin microorganisms. A trail that investigated whether antiseptics used to disinfect the insertion site reduced catheter-related infection found that catheterrelated infection was higher in the 10% providone-iodine and 70% alcohol groups than in the 2% CHG group.
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The results suggest that use of CHG for cutanous disinfection helps protect against infection of central venous and arterial catheter.

* HAND LOTIONS Hand lotions are often recommended to minimize drying resulting from frequent hand washing. Outbreaks of bacterial infection have been caused by contaminated hand lotions. Concerns have also been expressed about the potential for oilbased lotion formulations (e.g petroleum jelly) to weaken latex gloves and cause increase permeability. Hand lotions designed to protect against latex sensitivity resulting from glove use are now being marketed

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