Antiseptics

Antiseptics are antimicrobial substances that are applied to living tissues and that tend to reduce the possibility of infection or microbial colonizing. Antiseptics are generally distinguished from antibiotics by the latter's ability to be transported through the lymphatic system to destroy bacteria within the body, and from disinfectants, which destroy microorganisms found on nonliving objects. Some antiseptics are true germicides, capable of destroying microbes (bactericidal), whereas others are bacteriostatic and only prevent or inhibit their growth. Antibacterials are antiseptics that have the proven ability to act against bacteria. Microbicides that kill virus particles are called viricides or antivirals.

Antiseptics are particularly important during medical procedures and are of utmost importance in medical hand washing. Appropriate hand washing can minimize microorganisms acquired on the hands by contact with body fluids and contaminated surfaces. Hand washing breaks the chain of infection transmission and reduces person-to-person transmission. All healthcare personnel and family caregivers of patients must practice effective hand washing. Patients and primary caregivers need to be instructed in proper techniques and situations for hand washing. Compliance with hand washing is, however, frequently suboptimal.

Reasons for this include lack of appropriate equipment; low staff-to-patient ratios; allergies to hand-washing products; insufficient knowledge among staff about risks and procedures; the time required; and casual attitudes among staff toward bio-safety.

The role of hands in the transmission of hospital infections has been well demonstrated and can be minimized with appropriate hand hygiene. Hand washing is the single most important means of preventing the spread of infection. Hands should be washed between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by these.

For hand washing, the following facilities are required:

• Running water: large washbasins with hands-free controls that require little maintenance and with anti-splash devices
• Products: dry soap or liquid antiseptic, depending on the procedure
• Suitable material for drying of hands: disposable towels, reusable sterile single-use towels, or roller towels that are suitably maintained

Specific antiseptics recommended for hand disinfection usually include 2 to 4 percent chlorhexidine, 5 to 7.5 percent povidone iodine, 1 percent triclosan, or 70 percent alcoholic hand rubs. Alcoholic handrubs are not a substitute for hand washing, except for rapid hand decontamination between patient contacts.

For surgical scrub (surgical care), training is needed in the current procedure for preparation of the hands prior to surgical procedures. Scrubbing of the hands for 3 to 5 minutes is [Page 33]sufficient. The recommended antiseptics are 4 percent chlorhexidine or 7.5 percent povidone iodine.

Equipment and products are not equally accessible in all countries or healthcare facilities. Flexibility in products and procedures and sensitivity to local needs will improve compliance. In all cases, the best procedure possible should be instituted.