ANTISEPTICS & DISINFECTANTS

Joseph Lister (1827 - 1912)

father of modern antisepsis 1867 - Antiseptic Principle of the Practice of Surgery - carbolic acid (phenol) as antiseptic

Antiseptics
applied to living tissue to kill microbes or to inhibit their growth

Disinfectants
to kill or inhibit microbes on inanimate objects Defined by their intended use and not by their chemical content

Ideal Antiseptic
broad spectrum of activity, Cidal and not merely static residual activity low toxicity high penetrability active in the presence of pus and necrotic tissue Chemically stable, non staining Cheap

Ideal Disinfectants
fast action should not corrode instrument or metallic surfaces Non irritating to tissues, should not delay healing active in the presence of organic material (blood, sputum, feces) compatible with soaps and detergents residual surface activity odorless

Order of killing
Sensitive Vegetative bacteria Lipophilic viruses (lipid containing, enveloped) Fungi Hydrophilic viruses (non-lipid, non-enveloped) Mycobacteria (Mycobacterium tuberculosis) Resistant Bacterial spores

Clinical Applications
before and after surgery

during catheterization or other invasive implants

in immunocompromised states immune defect, cytotoxic drug therapy, extreme old or young age, extensive skin damage (burn and wound)

Mode of Action of Antiseptics

The most important actions are observed on the cytoplasmic membranes & the respiratory system of microorganisms. Oxidation of bacterial protoplasm

Denaturation of bacterial proteins

The antiseptic activity depends on:- conc of agent and contact time - Temp and pH - Some antiseptics are inactivated by heat and light - The presence of pus and necrotic tissue - may be absorbed by plastics and can be unstable in diluted solutions - The major risk is the contamination by resistant microbes.

General side effects of antiseptic

-Cutaneous irritation -Allergic reactions

On skin and mucous membranes, repeated application leads to diminution of normal flora, which can be replaced by another virulent infectious germs.

Principal Groups of Antiseptics and disinfectants

I . Phenols & Derivatives. II. Oxidizing agents III. Quarternary Ammonium compounds. IV. Halogens. V. Alcohols. VI. Chlorhexidine. VII. Dyes VIII. Metallic salts

Phenol (Carbolic acid)

Phenol - first to be used in clinical practice (Joseph Lister, 1867) denatures proteins highly corrosive and toxic not considered effective against bacterial or fungal spores seldom used as antiseptic but is a preferred disinfectant cheap

Uses To disinfect urine, feces, pus, sputum Toxicity Buccal, esophageal and gastric burns if swallowed Excitation Convulsions Respiratory paralysis Vascular collapse

Other phenolic compounds

Cresol- (lysol) Methyl phenol More active Less damaging to tissues Disinfection of utensils, excreta and washing hands Chlorxylenol (Dettol) Non corrosive, non-irritating to intact skin For surgical antisepsis

Hexachlorophene chlorinated phenol Bacterial lysis Commonly incorporated in soap and other cleaning antiseptics for surgical scrub Effective for furunculosis and carbuncles Action is slow but persistent due to deposition on the skin as a fine film Odorless, non irritating to skin

Oxidizing agents
Potassium Permanganate Antiseptic and disinfectant Liberates oxygen which oxidizes bacterial protoplasm Slow action and high conc cause burns and blistering

 As antiseptic - 1:4000 to 1:10000 sol (Condys lotion) for gargling, douching, irrigating cavities, urethra nad wounds As disinfectant disinfect water (wells, ponds), for stomach wash in alkaloidal poisoning

Hydrogen peroxide wide germicidal activity Liberates nascent oxygen oxidizes necrotic matter and bacteria decomposed by catalase or other peroxidases in tissues loosening and removing slough, ear wax etc. damaging to tissues, not suitable for routine wound care In its concentrated form, extremely corrosive and irritating to skin, eyes and mucous membrane

Halogens
Iodine oxidizes proteins and other important biological macromolecules. wide germicidal activity including fungi, viruses and bacterial spores has a characteristic odor and is corrosive is insoluble in water and thus prepared in alcohol (tincture) or with solubilizing surfactants (tamediodine) limited activity when in the presence of organic matter

Uses on cuts, for degerming skin before surgery Mandels paint (1.25% Iodine) for sore throat Iodine ointment (Iodex 4%) antiseptic and counter-irritant

Iodophores- soluble complexes of iodine with large molecular organic compounds slow continuous release of free iodine excellent cleansing agents as well as antiseptic and disinfectants prolonged activity after application (4-6 hours) less irritating, allergenic, corrosive, and non staining Povidone I2 Non-irritating, non toxic, non-staining Used on boils, furunculosis, burns, otitis externa, ulcers, surgical scrubbing

Chlorine and chlorophores

formation of hypochlorous acid (HOCl) sodium hypochlorite (NaOCl, bleach), chlroamine-T provide wide germicidal activity and are relatively nontoxic limited activity when in the presence of organic matter poor residual activity corrosive to metals and destroy many fabrics

 fair effectiveness as sporicidal agents effective at low concentrations for disinfecting objects strong odor, light sensitive Uses Disinfectant for drinking water, swimming pools.

Chlorhexidine
disrupts the cell membrane and precipitates cell contents active against bacteria, fungi, and Mycobacterium tuberculosis poorly active against viruses and bacterial spores Long residual activity Active in the presence of blood and other organic materials Nontoxic Widely used as a presurgical antiseptic, wound flush, mouthwash

Alcohol
ethyl and isopropyl alcohol solubilizes the cell membrane and denatures proteins. wide germicidal activity, non corrosive, but poses a fire hazard limited residual activity due to evaporation alcohols provide limited activity in the presence of organic matter used as a 70-90% concentration irritating to tissues

Aldehydes
alkylates and crosslinks proteins, DNA, RNA formaldehyde (HCOH), glutaraldehyde not as antiseptics

Formaldehyde
very potent disinfectant, highly toxic to animals active as gas and liquid form (formalin) very wide germicidal activity (bactericide, fungicide, virucide, sporicide) slow, requiring 6-12 hours contact time relatively noncorrosive to metals, paint, and fabric slight to moderate efficiency in presence of organic matter slight residual activity irritating fume and pungent odor potential carcinogen

Glutaraldehyde
similar to formaldehyde without some of its shortcomings faster effects compared to formaldehyde moderate residual activity to be sporicidal, need to be activated by alkalizing agents irritating to the eyes and nasal passages 2% sol.- disinfects surgical instruments and endoscopes

Quarternary ammonium antiseptics

Cetrimide (1-3%) fishy odour Most popular hospital antiseptic and disinfectant for surgical instruments Removes dirt, grease, blood from road side accidents

Soaps
Anionic detergents Weak antiseptics Affect only gram positive bacteria

Dyes
Gentian violet Effective against gram positive bacteria and fungi (gram negative and mycobacteria are insensitive) 0.5-1% - furunculosis, chronic ulcers, bed sores, ringworm

Acriflavine and Proflavine Orange yellow acridine dyes Effective against gram positive bacteria and gonococci Efficacy not reduced by organic matter Non-iritant chronic ulcers and wounds burn dressing Triple dye lotion gentian violet+brilliant green+ acriflavine- burns and dressing umbilical stump in neonates

Acids
Boric acid- bacteriostatic, weak antiseptic 4% - irrigating eyes, mouthwash, douche. Boroglycerine paint (30%) stomatitis and glossitis Borocide -10% ointment cuts & abrasions Prickly heat powders and ear drops Systemic abs- vomiting, abd pain, diarhoea, visual disturbances

Metallic salts
Silver compounds Silver nitrate, silver sulfadiazine Zinc salts Zn sulphate, Calmaine and Zn oxide

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