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ANTISEPTIC TECHNIQUES
BY
DR. SB ZAILANISENIOR LECTURER/CONSULTANT
DEPARTMENT OF MEDICAL MICROBIOLOGYCOLLEGE 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 itmaximum affect.
4. Halogens- This group consist of bromine, chlorine, fluorine and
iodine. Only iodine and chlorine, however, are commonly used fordisinfection.
* 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 toform Hcl which is bacteriocidal.
* Chlorine is highly effective oxidizing agent. In conc. Less thanone part per million, chlorine is lethal within seconds to mostvegetative 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. Itkills more rapidly than alcohol or iodine alone.
* Other preparations are available in which iodine is combinedwith organic compounds such as detergent in dissociablecomplex 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 are the
disinfectants hydrogen peroxide and peracetic acid.
* 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. Itis an alkylating agent that inactivate microorganisms by replacing
labile hydrogen atoms on hydroxyl, carboxy or sulfohydryl groups.
* Ethylene oxide sterilization resemble autoclaves, expose to10% 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 gasplasma.
* 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 microorganismsduring lab. Procedures
Whether the product used for hand washing in the laboratory needs
to contain an antimicrobial agent has never been shown by any well-controlled studies.
The proper technique involves a rigorous rubbing together of all
surfaces of well-lathered hands for 10-15 see followed by rinsingunder 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 thehands 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 firstwashing 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 catheter-
related 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 helpsprotect 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 oil-based lotion formulations (e.g petroleum jelly) to weaken latexgloves and cause increase permeability.
Hand lotions designed to protect against latex sensitivity resultingfrom glove use are now being marketed
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