Antiseptic solutions in Hospital

1. Antiseptic solutions
Dr VP Hathila

2. • Sterilization and asepsis principles were accepted
after Joseph Lister (Father of antiseptic surgery)
studied prevention of wound infection(1865-1891).

3. DEFINITIONS
Sepsis- describes real effect of infection, the
process of decomposition, putrefaction,
poisoning, if not treated can related to fatal
outcome.
CLEANING - It is a process which removes
visible contamination but does not
necessarily destroy micro organisms. It is
necessary prerequisite for effective
disinfection or sterilization.
ASEPSIS -Term used to describe methods
which prevent contamination of wounds and
other sites from the microorganism by
ensuring that only sterile object and fluids
come into contact with them.

4. ANTISEPSIS – It is the process of destruction of
disease causing microorganisms to prevent
infection in patient’s body surface. The process
may be either bactericidal or bacteriostatic.
 DISINFECTION - it is a process of killing
pathogenic organisms from inanimate objects
such as surgical instruments.
Disinfectant: it is chemical substance used on
inanimate objects to kill pathogens.
Antiseptic agent: it is a chemical substance
which kills the pathogenic organism or inhibits
growth.
STERILIZATIONSTERILIZATION -- it is the process of destruction
or removal of all microorganisms including
spores from article, surface or medium.

5. Sanitization - process that reduces
microbial population on object to a safe
level.
Decontamination - process that removes
pathogenic microorganisms from an
object to make it safe to handle.
Bactericidal: antibiotic which kills the
pathogens
Bacteriostatic: antibiotic which inhibits
the growth of pathogens.

6. Lysol( Cresol solution)
• Dilution in 1 : 100 water
• Uses: for sterilization of sharp instruments e.g:
needle, knives, scissors
• Time : for 30 mins duration for 100% solution
• 1-2 hours for 1: 100 solution
• Note: Lysol is an irritant chemical that causes
burns hence instruments should be cleansed
with sterile water or normal saline before use

7. Savlon
Composition: Chlorhexidine gluconate -7.5% +
Cetrimide -16% + Isopropyl alcohol -6.8%
• Action--- Germicide and detergent
• Uses: cleaning and disinfection of the equipment in the
vicinity of the patient
• Storage of previously sterilized instrument
• Cleaning and disinfection of postoperative wounds
• Scrubbing Soln. changed every weekly.
• Prolonged storage of thermometer
• Cleaning and disinfection of catheter and appliances
• Dilution;; 1:100 Aqueous solution 1ml soln.

8. Hydrogen peroxide(H2O2)
• It is not an antiseptic but a cleansing agent
• Uses : destroys anaerobic organisms, and
therefore used for cleaning the wounds.
• Produces frothing and brings out debris from
the depth of the wound
• Produces heat when it comes in contact with
tissues, thus prevents capillary oozing and
hence can be used as hemostatic
• Used to remove blood stains from clothes

9. Spirit
• Composition: alcohol(opt. conc. 70%)
• Uses: disinfection of skin before intramuscular and I V
injection
• Removal of iodine in preparation of skin for operation
• Cleaning the stitched wound
• Cleaning the skin of the surrounding ulcer or open
wounds
• Can be used for dissolving ear wax in lower conc.
• Used along with other disinfectants like iodine-spirit,
cetavlon-spirit for painting the parts before operation

10. Formalin solution
• 30% aldehyde + 10% methane
• Preservative for biopsy specimens
• Operation theatre sterilization
• 2-5% used for sterilization of gloves and
instruments

11. EUSOL(Edinburgh university solution)
• 1.25 gm Boric acid, 1.25 gm of bleaching
powder and sterile water up to 100ml.
• It releases nascent chlorine and becomes
useless after 24 hrs
• Uses: to separate slough from infected
wounds, ulcers, bed sores, and burn wounds
• Acidic in pH; therefore useful n wounds
infected with Pseudomonas bacteria

12. CIDEX
• Glutaraldeyde 2% aqueous solution
• Bactericidal, tuberculocidal, pseudomonocidal,
viricidal, fungicidal
• Complete disinfection in 10 mins, sporicidal in 4 hrs
• Uses: sterilization of large instruments fibre optic
scopes, endoscopes with lenses
• Catheter , thermometers, small and sharp
instruments
• Best disinfectant with rapid action
• To be changed every 15 days.

13. Turpentine
• Highly irritant mineral oil
• Diluted form is used to bring out and kill the maggots
from wounds and ears
• Used to remove zinc paste of sticking plaster form the
skin
Ether
• It is evaporable, highly inflammable. Makes the
surface cool
• Uses: surface and inhalation anaesthesia
• Used to clean dirty skin as it removes the greasy
substances by dissolving them

14. Potassium permanganate (KMnO4)
• It has an oxidizing effect,
• It is available in crystal form
• Concentration: 1:5000 to 1: 10000 solution in
water
• Uses: Used as mouth wash
Urinary bladder irrigation and wash

15. Mercurochrome
• It is an inhibitor of 5-Hydroxytryptamine
• Strong soln. kills WBCs and damages the
granulation tissue. It has astringent action
• Uses: bed sore dressing
• Diluted soln. applied on wounds with healthy
granulation tissue
• Strong soln. for wounds with hyper
granulation tissue
• Diluted soln. used as eye drops

16. Silver nitrate(AgNO3)
• 1:100 to1: 10000 soln. are available
• exposure to light cause its destruction hence
Kept in dark container
• Uses: chemical cauterization of warts and
hyper granulation tissue
• Used for dressing burns
• Useful in bladder irrigation in cases of
hematuria, due to its cauterizing effect

17. Povidone-Iodine (Betadine)
• Available as topical solutions(5% & 10%), surgical
scrub(7.5%), mouth wash, ointments, vaginal
pessaries
• Germicide, very effective against viruses, bacteria,
protozoa, yeast and fungi
• Frequent use contraindicated because of its
insolubility, instability, and its staining and irritating
properties.
• Uses: mouth rinse and gargle
• Local antiseptic and for wound dressing
• irrigation of bladder, pyothorax and peritoneal
cavity

18. Silver sulphadizine(SSD)
• Mostly used in major burns because of its profound
efficacy and less toxicity
• Composition: it is a 1% cream prepared by mixing silver
nitrate with weak acidic sulphadiazine
• Action: active agent are sulpha component and slow
release of silver from the cream
• Effective against a wide range of G+ve and G –ve
bacteria
• Thin layer of 1-2 mm is applied directly to burns
• Helps in softening of Eschar
• Old cream and loosened Eschar come out with change
of dressings.

19. Soframycin
• Framycetin sulphate cream
• Used as 1% cream or powder
• Effective against G+ve and G –ve organisms
• Does not irritate wound and hence is painless
on application
• Sensitivity reactions are uncommon

20. Neomycin, Polymixin, Bacitracin
combination (Neomycin)
• Antibacterial spectrum is mainly gram positive
• Eschar penetration is limited
• Nephrotoxic if absorbed in large amounts
• Used in minor superficial burns especially on
minor superficial burns on face and for small
open areas
• In contrast to SSD it does not cause
maceration

21. Gentamycin
• Used as 0.1% cream or ointment
• Its use as topical agent in burns should be avoided
as it is also used systematically otherwise
resistance develop easily
• Can cause ototoxicity and nephrotoxicity
• Uses: small wounds colonized with gram-negative
organisms’ resistance to other standard topical
agents
• Small superficial burns particularly involving ears
or perineum where G-ve infection is common

22. Care of Antiseptic solutions
The Do’s
• Always dilute concentrated Antiseptics before
use, as directed
• Prepare dilutions in small volumes
• Use all diluted solutions within 8 hrs and
discard the remaining
• Ensure that the mouth of the bottle is not
touched by hands or materials while pouring

23. Care of Antiseptic solutions
• The Dont’s
• Never mix up diluted solutions with
freshly prepared ones
• Never leave diluted solutions for more
than 1 working day
• Never use corks for sealing the bottles
• Never leave bottles open

24. To achieve sterilization of any instrument three
definite stages are to be completed-
 Pre sterilization cleaning
 Sterilization process
 Aseptic storage

27. Presterilization cleaning
• Objective-
Removal of the organic matters, blood and saliva
which provide protective barrier for
microorganisms and prevents its destruction.
• There are three methods for cleaning
-Manual
-Ultrasonic
-Mechanical washing

28. MANUAL CLEANING
• Simplest and the cheapest method, but time
consuming and difficult to achieve.
• heavy duty gloves and glasses must be worn to
protect needle stick injury and to protect eye.
• Material used for manual cleaning
-Soaps
-Detergents

29. ULTRASONIC CLEANING
Principle- conversion of
electrical energy into vibratory
sound waves which pass
through a soap solution
containing the instrument.
Used mainly for burs, bone
files, bone cutter, artery
forceps, saw etc.

30. MECHANICAL WASHING
Principle- High-pressure
jets of water with or
without a detergent which
removes debris from
instrument.
Small instrument like
burs, blade are not
suitable for this type of
cleaning.

31. Classification of the method of
sterilization/Disinfection
A. PHYSICAL
1- Sun Light
2- Drying
3- Heat i- Dry
ii-Moist
4- Filtration
5- Gas
6- Irradiation
7- Ultra sonic cleaning

32. B. CHEMICAL
1. Phenol Derivatives : Phenol, Cresol, resorcinol, chloroxylenol
2. Oxidizing agents :Pot.Permanganate, Hydrogen Peroxide,Benzoyol
Peroxide
3. Halogens : Iodine, chlorine
4. Biguanide : Chlorhexidine
5. Quarternary Ammonium (Cationic) : Cetrimide, Zephiran
6. Alcohols : Ethanol, Isopropanol.
7. Aldehydes : Formaldehyde, Glutaraldehyde
8. Acids : Boric acid, acetic acid
9. Metallic salts ; Silver Nitrate, Zince Sulfate, Zinc Oxide, calamine,
10. Dyes : Gentian violet, proflamine, Acriflamine
11. Furan derivatives : Nitro flurazone

33. HEAT
Most common and one of the most effective methods of sterilization.
Factors influencing sterilization by heat are : -
i. Nature of heat
a. Dry
b. Moist
ii.Temperature & time
iii. No. of organism present
iv.Whether organism has sporing capacity
v. Type of material from which organism is to be eradicated

34. A. DRY HEAT
Killing is due to :
- Dehydration and oxidation of organisms
- Protein denaturation
- Toxic effects of elevated levels of electrolytes
1. Red Heat : It is used to sterilize metallic objects by
holding them in flame till they are red hot. Example :
inoculating wires, needles, forceps etc.
2. Flaming : The article is passed over flame without
allowing it to become red hot. Example : Glass plates,
Cotton wool plays and glass slides.

35. 3. Hot air oven :
It is used to sterilize items, which do not get damaged by high temp.
such as laboratory glass, flasks, instruments with sharp cutting
edges, B.P. handles, Powders, Dapen dishes, mouth mirrors.

36. Temp. & Time: The sterilization is complete if these two
factors are achieved throughout the load.
Temperature Time(Min)
140o
C 180
150o
C 150
160o
C 60
170o
C 45
180o
C 18
190o
C 7.5

37. Sterilization Control of Hot Air Oven
• The spores of non-toxigenic strain of Bacillus subtilis and
Clostridium tetani are used as a microbiological test of dry heat.
• Browne’s test strip available that contain a chemical indicator.

38. AUTOCLAVE
1. Steam is the effective means of sterilization, because of its
2. High penetrating capacity.
3. It gives of large amount of heat to surface with which it comes in contact.
4. Principle: Sterilization is done by steam under pressure. It kills vegetative
bacteria, myco. Tb, viruses such as Hep B, C, A, HIV etc.
5. Heat resistant spores including Cl. Tetani and cl. Welchii

39. Autoclaves, or steam sterilizers essentially consist of following:
i) A cylindrical or rectangular chamber, with capacities ranging from 400 to 800
liters.
ii) Water heating system or steam generating system
iii) Steam outlet and inlet valves
iv) Single or double doors with locking mechanism.
v) Thermometer or temperature gauge
vi) Pressure gauges

40. • To achieve sterility, a holding time of at
least 30 minutes at 121 °C (250 °F) at 15
psi(pounds per square inch) (100 kPa)
above atmospheric pressure is required.
• Autoclave is used for sterilization of –
- All Surgical instruments except sharps
- Syringes,
- Needles,
- Linen including gown, mask
- Abdominal swabs

41. Sterilization control of the moist heat
Physical Indicator- an alloy designed to melt only after being subjected to
relevant holding time.
Chemical indicator- Strips or tapes that change color once the
correct conditions have been met. Signolac autoclave labels –
light green changes to  dark grey/black on sterilization
Biological indicator- Spores of Geobacillus stearothermophilus
are used as the test organisms as it is toughest organism for an
autoclave to destroy. Its spores require an exposure of 15 mins at
1210
c to be destroyed.
Paper strips impregnated with 106
spores are dried and placed in
paper envelopes. These envelopes are inserted in different parts of
the load and after sterilizing the strips are inoculated for test of
efficacy.

42. Boiling method of sterilization
• Heat at 100 degree C for 30 mins
• All surgical instruments except sharp
instruments
• Boiling is only done when autoclave is not
available
• Disadvantage: spore bearing organisms are
not killed.

43. IRRADIATION
Radiation used for sterilization is of two types
1. Ionizing radiation, e.g., X-rays, gamma rays, and high
speed electrons .
2. Non-ionizing radiation, e.g. ultraviolet light, and
infrared light.
These forms of radiation can be used to kill or inactivate
microorganisms.

44. 1. Ionizing Radiation
X-rays, gamma rays and cosmic rays are highly lethal to DNA and
other vital constituents.
They have high penetration power.
There is no appreciable increase in temperature, thus referred to as
cold sterilization.
Commercial plants use gamma radiation for sterilizing plastics,
syringes, swabs, catheters, suture materials and surgical
instruments, infusion sets, prosthesis etc.
.

45. 2. Non-ionizing radiation
Two types of non-ionizing radiations are used
for sterilization:-
• A. Ultraviolet -
Short range UV(UVC) is considered
“germicidal UV”.
UV waves destroys micro-organismal DNA.
Used mainly for air purification and water
purification AND WARDS AND O. T in
hospitals.
• B. Infrared –

46. Ethylene Oxide Sterilization (ETO)
• Used almost exclusively to
sterilize medical products
that cannot be steam
sterilized or sensitive to
radiation.
• Mechanism of action: It
destroys micro-organisms by
alkylation and cause
denaturation of nucleic acids
of micro-organisms.

47. • Ethylene oxide is a colorless liquid with a boiling
point of 10.7 °C.
• Highly penetrating gas with sweet ethereal smell.
• Plastics, rubber & photographic equipments can be
sterilized by this method.
• Also used for mass sterilization of disposable items,
plasticsyringes,needles,catheters,blades optical
lenses, endoscopes etc.

48. • Disadvantages
– Lengthy cycle time
– Cost
– Potential hazards to patients & staff
• Advantage:
Can sterilize heat or moisture sensitive medical
equipments.

49. Aseptic storage
The maintenance of sterility during transportation and storage is of
utmost importance.
• Instruments are kept wrapped until ready for use .
• To reduce the risk of contamination, sterile packs must be handled as
little as possible.
• Sterilized packs should be allowed to cool before storage; otherwise
condensation will occur inside the packs.
• To prevent contamination from rodents, ants, and cockroaches, the store
must be subjected to adequate pest control .
• Materials should be stored at least 8” off the floor and 18” from the
ceiling
• Sterile packs must be stored and issued in correct date order. The packs,
preferably, are stored in drums which can be locked. Preset trays and
cassettes, are useful as, the instruments can be organized as per the
procedure

50. Operation Theatre Sterilization by
Fumigation
• Formaldehyde fumigation is the accepted method of
sterilization. Formaldehyde vapor is an extremely
effective biocidal agent.
• Surgical site infections (SSIs) are the second most
common cause of hospital acquired (Nosocomial)
infections
• By maintaining sterile environment in surgical theater
we can control major part of exogenous infections.

51. Preparation for sterilization
• Thoroughly clean windows, doors, floor, walls,
surgery table and all washable equipments
with soap and water.
• Close windows and ventilators tightly. If any
openings found seal it with cellophane tape or
other material to avoid the leak of fume.
• Switch off all lights, A/C and other electrical &
electronical items.
• Calculate the room size (surgical theater only)

52. Precaution for sterilization
• Adequate care must be taken by wearing cap,
mask, foot cover, spectacle etc.,
• Formaldehyde is irritant to eye & nose; and it
has also been recognized as a potential
carcinogen.
• So the fumigating person must be provided
with the personal protective equipments
(PPE).
• Paste a warning notice on the front door
indicating fumigation is in progress

53. FUMIGATION OF OPERATION THEATRE
- Fumigation of the operation theatre is achieved by
formaldehyde(40%) and potassium permanganate reaction
technique.
- 500 ml formaldehyde(Formalin)+ 450gm KMnO4
for a 10 X 10 X 10 room .

54. procedure of fumigation
Potassium Permanganate Method:
Here the heat generation is induced by an oxidizer - Potassium
permanganate (KMnO4), which results in auto boiling and generates
fume from formaldehyde. Take 500 ml of formaldehyde (40%
solution) in 1000 ml of water in a heat resistant/steel bucket
and then add 450gm of KMnO4 for 1000 cubic feet of theatre volume.
Eg: Surgical Theater Volume = L×B×H = 20 × 15 × 10=3000 cubic feet
Formaldehyde required for fumigation = 500 ml for 1000 cubic feet
= So, 1500 ml of formaldehyde required (to be diluted in 3000 ml of
distilled water)
• After the initiation of formaldehyde vapor, immediately leave the
room and seal it for at least 12 to 24 hours.

55. Neutralization after fumigation
• Before neutralization, remove fumigating apparatus
from the surgical theatre.
• Then the toxicity of formaldehyde vapor should be
neutralized with ammonia solution.
• Place a cotton ball and pour 300 ml of 10% ammonia
(for each 500 ml of formaldehyde used) on the floor
of surgical theater, at least 4 hours before (07 a.m.)
the “Sterility Test”.
• Formaldehyde gas reacts with ammonia gas and
produce Hexamine which is considered a harmless
substance.

56. Factors influencing the fumigation of the theatre :
1. Relative humidity
Relative humidity plays a major role in fumigation. A
minimum of 70% is essential. Water used in fumigator
with fumigant helps to achieve and maintain humidity.
2. Temperature
temperature for effective fumigation is 300
-400
C.
3. Formaldehyde levels in the Air in the operation
theatre
The dose of formaline is usually decided by the size of
the room. As a rule, 280 ml is used for a room of the size
1000 cubic feet.

57. Emerging Compounds in use for Sterilization of
Operation theatres:
BACILLOCIDRASANT:
• A newer and effective compound in environmental
decontamination with very good cost/benefit ratio, good material
compatibility, excellent cleaning properties and virtually no
residues. It has the advantage of being a Formaldehyde-free
disinfectant cleaner with low use concentration.
Advantages
• - Provides complete asepsis within 30 to 60 minutes.
• - Cleaning with detergent or carbolic acid not required.
• - Formalin fumigation not required.
• - Shutdown of O.T for 24 hrs. not required.

58. CHEMICAL METHODS
No available chemical solution will sterilize instruments
immersed in it.
Secondly, there is a risk of producing tissue damage if residual
solution is carried over into the wound while it is being used.

59. Mechanism of action of chemical disinfectants :
The mechanism of action of most of the chemicals are
nonspecific and complex but most of them effect
microorganisms by one of the following mechanisms.
1. Cell membrane injury.
2. Coagulation and Denaturation.
3. Interactions with functional groups of proteins.

60. 1. ALDEHYDE COMPOUNDS
a. Formaldehyde:
A broad-spectrum antimicrobial agent, used for disinfection,
has limited sporicidal activity.
Hazardous substance, inflammable and irritant to the eye,
skin and respiratory tract.
a. Glutaraldehyde:
It is a high level disinfectant
A solution of 2% glutaraldehyde (Cidex), requires immersion
of 20 minutes for disinfection; and 6 to 10 hours of
immersion for sterilization.

61. 2. ALCOHOLS
Act by denaturing bacterial proteins.
Solutions of 70% ethanol are more effective than higher
concentrations, as the presence of water speeds up the
process of protein denaturation as reported by
Lawrence and Block (1968).
Frequently used for skin antisepsis prior to needle
puncture.
Isopropyl alcohol is preferred as it is a better fat solvent,
more bactericidal and less volatile. Used for disinfection of
clinical thermometer .

62. 3. IODOPHOR COMPOUNDS
Many studies have shown, that, iodophor compounds
are the most effective antiseptics,. Iodine is complexed
with organic surface-active agents, such as,
polyvinylpyrrolidone (Betadine, Isodine). Their activity is
dependent on the release of iodine from the complex.
These compounds are effective against most
bacteria, spores, viruses, and fungi. These are the most
commonly used surface disinfectants along with
hypochlorite.

63. 4. Biguanide :
Most commonly used biguanide compound is
chlorhexidine.
It is a powerful non-irritating antiseptic that disrupts
bacterial cell membrane.
It persists on skin for longer period of time and that is
why it is extensively used for surgical scrubbing,
neonatal bath, mouth wash and a general skin anti-
septic.

64. 5.Hydrogen peroxide
• Strong oxidant.
• Oxidizing properties allow it to destroy wide
range of pathogens.
• Biggest advantage is short cycle time.
• Used in 35% to 90% concentration.

65. Operation theatre procedure :
Antiseptic environment :
The principle is to minimize bacterial contamination,especially, in the
vicinity of operating table;the concept of zones is useful,and must be
employed.
Outer and general access zone- patient reception area and general
office.
Clean or limited access zone- the area between reception & general
office and corridors & staff room.
Restricted access zone-f or those properly clothed personnel
engaged in operating theatre activities,anesthetic room.
Aseptic or operating zone- the operation theatre.

66. HAND WASHING
• Three types of hand washing-
– Social hand washing
– Clinical hand washing
– Surgical hand washing

67. Social hand washing
• Recommended following social-type
contact with clients, after going to the
toilet and after covering a cough or sneeze.
• A plain liquid soap is often used.

68. Clinical hand washing
• A clinical hand wash is used before clinical
procedures on clients, when a client is being
managed in isolation, or in outbreak
situations.
• An anti-microbial soap, containing an
antiseptic agent, is used.

69. Surgical hand washing
• A surgical hand wash is required before any
invasive or surgical procedure requiring the
use of sterile gloves.
• An antimicrobial skin cleanser, usually
containing chlorhexidine or detergent-based
povidone-iodine, is used.

70. Surgical Scrubbing :
The purpose is to reduce resident and transient skin flora
(bacteria) to a minimum.
Proper hand scrubbing and the wearing of sterile gloves and
a sterile gown provide the patient with the best possible
barrier against pathogenic bacteria in the environment and
against bacteria from the surgical team.
The following steps comprise the generally accepted method
for the surgical hand scrub-

76. 1. Disinfection is :
a. removal of visible contamination but does not
necessarily destroy micro organisms
b. reduction of number of viable microorganisms
but may not inactive some viruses and bacterial
spores.
c. destruction or removal of all microorganisms
including spores.
d. destruction or removal of all microorganisms
excluding spores.
2. Sterility assurance level (SAL) acceptable for critical
item is :
a. 4
b. 5
c. 6
d. 7

77. 3. Which of the following is semicritical ?
a. mucous membrane
b. intact skin
c. tissue space
d. vascular space
4. Minimum Relative humidity essential in fumigation is :
a. 50%
b. 70%
c. 90%
d. 100 %
5. Cidex consist of
a. 2% glutaraldehyde
b. 4% glutaraldehyde
c. 2% chlorhexidine
d. 4% chlorhexidine

78. 6. Tyndallisation is :
a. Exposure of 100 C for 20 min for 3 successive day.
b. Exposure of 100 C for 10 min for 3 successive day
c. Exposure of 100 C for 30 min for 2 successive day
d. Exposure of 100 C for 10 min for 2 successive day
7. Which of these is an appropriate sterilizing cycle?
a. 121 degree centigrade for 15 min
b. 134 degree centigrade for 3 min
c. 109 degree centigrade for 10 min
d. A or B
e. all of these
8. Which of these is used for gas sterilization ?
a. Glutaraldehyde
b. Liquid Nitrogen
c. Ethylene oxide
d. All of these

79. 9. Which of these is used for liquid sterilization ?
a. Ethylene oxide
b. Liquid Nitrogen
c. Glutaraldehyde
d. All of these
10. What would you use to clean a flexible endoscope after use ?
a. Sterilization
b. Paracetic acid
c. Alcohol
d. Autoclave