Antiseptic

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Antiseptics (from Greek : anti, '"against"[1] + : sptikos, "putrefactive"[2]) are antimicrobial substances that are applied
to living tissue/skin to reduce the possibility of infection, sepsis, or putrefaction. 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 non-living objects.
Disinfectants do not kill bacterial spores e.g., on surgical instruments; a sterilization process is required for that.
Even sterilization may not destroy prions.
Some antiseptics are true germicides, capable of destroying microbes (bacteriocidal), while others are bacteriostatic and only
prevent or inhibit their growth.
Antibacterials are antiseptics that have the proven ability to act against bacteria. Microbicides which destroy virus particles are
called viricides or antivirals.
Contents
[hide]

1 Usage in surgery

2 Functionality

3 Some common antiseptics

4 Evolved resistance

5 See also

6 Notes

7 References

8 External links
Usage in surgery[edit]

Joseph Lister
The widespread introduction of antiseptic surgical methods followed the publishing of the paper Antiseptic Principle of the Practice
of Surgery in 1867 by Joseph Lister, inspired by Louis Pasteur's germ theory of putrefaction. In this paper, Lister advocated the use
of carbolic acid (phenol) as a method of ensuring that any germs present were killed. Some of this work was anticipated by:

Ancient Greek physicians Galen (circa 130200) and Hippocrates (circa 400 BC) and Sumerian clay tablets dating from
2150 BC that advocate the use of similar techniques.[3]

Medieval surgeons Hugo of Lucca, Theoderic of Servia, and his pupil Henri de Mandeville were opponents of Galen's
opinion that pus was important to healing, which had led ancient and medieval surgeons to let pus remain in wounds. They

advocated draining and cleaning wound lips with wine, dressing the wound after suturing it if necessary, and leaving the
dressing on for ten days, soaking it in warm wine all the while, before changing it. Their theories were bitterly opposed by
Galenist Guy de Chauliac and others trained in the classical tradition. [4]

Joseph Smith, Jr., alluded to the use of alcohol as an antiseptic in February 1833, when he wrote what is now section 89
of the Doctrine and Covenants, popularly known as the "Word of Wisdom". Specifically, verse 7 states: "And, again, strong
drinks are not for the belly, but for the washing of your bodies."[5]
Oliver Wendell Holmes, Sr., who published The Contagiousness of Puerperal Fever in 1843

Florence Nightingale, who contributed substantially to the report on the Royal Commission on the Health of the
Army (18561857), based on her earlier work

Ignaz Semmelweis, who published his work The Cause, Concept and Prophylaxis of Childbed Fever in 1861,
summarizing experiments and observations since 1847[6]

George H. Tichenor, who experimented with the use of alcohol on wounds circa 18611863 during the American Civil War

Functionality[edit]
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Bacterial growth requires a food supply, moisture, oxygen (if the bacteria are obligate aerobes), and a certain minimum temperature
(see bacteriology). These conditions have been studied and dealt with in food preservation and the ancient practice
of embalming the dead, which is the earliest known systematic use of antiseptics.
In early inquiries before microbes were understood, much emphasis was given to the prevention of putrefaction, and procedures
were carried out to determine the amount of agent that must be added to a given solution to prevent the development
of pus and putrefaction; however, due to a lack of a developed understanding of germ theory, this method was inaccurate and,
today, an antiseptic is judged by its effect on pure cultures of a defined microbe and/or its vegetative and spore forms. The
standardization of antiseptics has been implemented in many instances, and a water solution of phenol of a certain fixed strength is
now used as the standard to which other antiseptics are compared.
The fundamental idea of all anti-pathogenic agents is to exploit a difference between parasite and host. For bacteria, that may
involve interfering with their cell walls or internal biochemistry which differs from humans'.
Pathogens show a total-dose response: if you expose them to a dilute solution for a long time, its equivalent to dosing them with a
strong solution for less time. This makes the pre-industrial medical notion ofpoultice clear: weaker antiseptics require longer
exposure. This is true for many chemical antibiotics as well as heat and UV exposure.
Some common antiseptics[edit]

A bottle of ethanol (95%) an antiseptic

Alcohols, most commonly ethanol (6090%), 1-propanol (6070%) and 2-propanol/isopropanol (7080%) or mixtures of
these alcohols, are commonly referred to as "surgical alcohol", and are used to disinfect the skin before injections are given,
often along with iodine (tincture of iodine) or some cationic surfactants (benzalkonium chloride 0.050.5%,chlorhexidine 0.2
4.0% or octenidine dihydrochloride 0.12.0%).

Quaternary ammonium compounds, also known as quats or QACs, include the chemicals benzalkonium chloride, cetyl
trimethylammonium bromide, cetylpyridinium chloride, andbenzethonium chloride. Benzalkonium chloride is used in some
preoperative skin disinfectants (0.050.5%) and antiseptic towels. The antimicrobial activity of quats is inactivated by anionic
surfactants, such as soaps. Related disinfectants include chlorhexidine and octenidine.

Boric acid is used in suppositories to treat yeast infections of the vagina, in eyewashes, as an antiviral to shorten the
duration of cold sore attacks, in creams for burns, and trace amounts in eye contact solutions.

Brilliant green is a triarylmethane dye still widely used as 1% ethanol solution in Eastern Europe and ex-USSR countries
for treatment of small wounds and abscesses. It is efficient against Gram-positive bacteria.

Chlorhexidine gluconate, a biguanidine derivative, is used in concentrations of 0.54.0% alone or in lower concentrations
in combination with other compounds, such as alcohols as a skin antiseptic and to treat inflammation of the gums (gingivitis).
The microbicidal action is somewhat slow, but remanent. It is a cationic surfactant, similar to quats.

Hydrogen peroxide is used as a 6% (20 Vols) solution to clean and deodorize wounds and ulcers. More commonly, 3%
solutions of hydrogen peroxide have been used in household first aid for scrapes, etc. However, even this less potent form is
no longer recommended for typical wound care, as the strong oxidization causes scar formation and increases healing time.
[7]
Gentle washing with mild soap and water or rinsing a scrape with sterile saline is a better practice.

Hydrogen peroxide vapor at high concentrations (> 50%) in mild vacuum can be used to sterilize surgical instruments with long
thin lumens in under an hour without damage to temperature-sensitive electronics.
Hydrogen peroxide and acetic acid make peracetic acid which is more anti-microbial (antiseptic) than peroxide itself.
The above peroxide antimicrobials have the advantage of being cheap and decomposing to biologically harmless water and oxygen
(and CO2, acetate, etc.)

Iodine is usually used in an alcohol solution (called tincture of iodine) or as Lugol's iodine solution as a pre- and
postoperative antiseptic. Some people do not recommend disinfecting minor wounds with iodine because of concern that it
may induce scar tissue formation and increase healing time. However, concentrations of 1% iodine or less have not been
shown to increase healing time and are not otherwise distinguishable from treatment with saline.[8] Novel iodine antiseptics
containing povidone-iodine (an iodophor, complex of povidone, a water-soluble polymer, with triiodide anions I3-, containing
about 10% of active iodine) are far better tolerated, do not negatively affect wound healing, and leave a deposit of active
iodine, thereby creating the so-called "remnant", or persistent, effect. The great advantage of iodine antiseptics is their wide
scope of antimicrobial activity, killing all principal pathogens and, given enough time, even spores, which are considered to be
the most difficult form of microorganisms to be inactivated by disinfectants and antiseptics.

Mercurochrome is not recognized as safe and effective by the US Food and Drug Administration (FDA) due to concerns
about its mercury content. Other obsolete organomercury antiseptics include bis-(phenylmercuric) monohydrogenborate
(Famosept).

Manuka honey is recognized by the FDA as a medical device for use in wounds and burns. Active +15 is equal to a 15%
solution of phenol.

Octenidine dihydrochloride, a cationic surfactant and bis-(dihydropyridinyl)-decane derivative, is used in concentrations of

0.12.0%. It is similar in its action to the quats, but is of somewhat broader spectrum of activity. Octenidine is currently
increasingly used in continental Europe as a QAC and chlorhexidine (with respect to its slow action and concerns about
the carcinogenic impurity 4-chloroaniline) substitute in water- or alcohol-based skin, mucosa, and wound antiseptic. In
aqueous formulations, it is often potentiated with addition of 2-phenoxyethanol.

Phenol is germicidal in strong solution, and inhibitory in weaker ones. It is used as a "scrub" for preoperative hand
cleansing, and in the form of a powder as an antiseptic baby powder, where it is dusted onto the navel as it heals. Also used
in mouthwashes and throat lozenges, it has a painkilling effect, as well as an antiseptic one. Example: TCP. Other phenolic
antiseptics include historically important, but today rarely used (sometimes in dental surgery) thymol, today
obsolete hexachlorophene, still used triclosan, and sodium 3,5-dibromo-4-hydroxybenzenesulfonate (Dibromol).

Polyhexanide (polyhexamethylene biguanide, PHMB) is an antimicrobial compound suitable for clinical use in critically
colonized or infected acute and chronic wounds. The physicochemical action on the bacterial envelope prevents or impedes
the development of resistant bacterial strains.[9][10][11]

Sodium chloride (salt) is used as a general cleanser and as an antiseptic mouthwash. Its weak antiseptic effect is due
to hyperosmolality of the solution above 0.9%.

Sodium hypochlorite was used in the past, diluted, neutralized, and combined with boric acid in Dakin's solution.

Calcium hypochlorite was used by Semmelweis, as "chlorinated lime", in his revolutionary efforts against childbed fever.

Sodium bicarbonate (NaHCO3) has antiseptic and disinfectant properties.[12][13]

Balsam of Peru is a mild antiseptic.[14][15][16]

Evolved resistance[edit]
See also: Antibiotic resistance and Multiple drug resistance
By continued exposure to antibiotics, bacteria may evolve to the point where they are no longer harmed by these compounds.[17]
In contrast, bacteria can develop a resistance to antiseptics, but the effect is generally less pronounced.[18]
The mechanism by which bacteria evolve may vary in response to different antiseptics. Low concentrations of an antiseptic may
encourage growth of a bacterial strain that is resistant to the antiseptic, where a higher concentration of the antiseptic would simply
kill the bacteria. In addition, use of an excessively high concentration of an antiseptic may cause tissue damage or slow the process
of wound healing.[8]Consequently, antiseptics are most effective when used at the correct concentrationa high enough
concentration to kill harmful bacteria, fungi or virii, but a low enough concentration to avoid damage to the tissue.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Quaternary ammonium cations, also known as quats, are positively charged polyatomic ions of the structure NR4+, R being
an alkyl group or an aryl group.[1] Unlike theammonium ion (NH4+) and the primary, secondary, or tertiary ammonium cations, the
quaternary ammonium cations are permanently charged, independent of the pH of their solution. Quaternary ammonium
salts or quaternary ammonium compounds (called quaternary amines in oilfield parlance) are salts of quaternary ammonium
cations with an anion.

Benzalkonium chloride, also known as BZK, alkyldimethylbenzylammonium chloride and ADBAC, is a cationic surface-acting
agent belonging to the quaternary ammonium group. It has three main categories of use: as a biocide, a cationic surfactant,
and phase transfer agent in the chemical industry. The chemical is anitrogenous mixture of alkylbenzyldimethylammonium chlorides
of various even-numbered[2] alkyl chain lengths.
Applications[edit]
The applications of benzalkonium chloride are extremely wide ranging,[3] from disinfectant formulations, such as being an active
ingredient in Dettol and Lysol brand products, to microbial corrosion inhibition in the oilfield sector, and a multi-surface mould, algae
and moss remover.
It is used in:

Skin antiseptics, such as Bactine, to protect scrapes and cuts

Pharmaceuticals such as throat lozenges[4] & various leave-on skin antiseptics

Hand sanitizers

Preservative in pharmaceuticals and personal care products such as eye, ear and nasal drops, as a preservative

Hygienic towelettes and wet wipes

Cleaners for floor and hard surfaces as a disinfectant

Soak solutions for surgical/dental instruments prior to high-level sterilisation

Spray disinfectants for hard surface sanitisation

Over-the-counter single-application treatments for herpes, cold-sores, and fever blisters, such as RELEEV and Viroxyn

Algaecide for clearing of algae, moss, lichens from paths, roof tiles, swimming pools, masonry and in horticultural
greenhouse disinfection

Hand sanitizers based on benzalkonium chloride are more effective due to better residual activity and less irritant than alcohol gels.
As an antiseptic, it has the advantage of not burning when put on a wound, which is not the case with ethanol-based antiseptics or
hydrogen peroxide.

Phenol, also known as carbolic acid, is an aromatic organic compound with the molecular formula C6H5OH. It is a
white crystalline solid that is volatile. The molecule consists of a phenyl group (-C6H5) bonded to a hydroxyl group (-OH). It is
mildly acidic, but requires careful handling due to its propensity to cause burns.
Phenol was first extracted from coal tar, but today is produced on a large scale (about 7 billion kg/year) from petroleum. It is an
important industrial commodity as a precursor to many materials and useful compounds.[4] Its major uses involve its conversion to
plastics or related materials. Phenol and its chemical derivatives are key for
building polycarbonates, epoxies, Bakelite, nylon, detergents, herbicides such as phenoxy herbicides, and
numerous pharmaceutical drugs.
Although similar to alcohols, phenols have unique distinguishing properties. Unlike in alcohols where the hydroxyl group is bound to
a saturated carbon atom,[5] in phenols the hydroxyl group is attached to an unsaturated ring such as benzene or other arene ring.
[6]

Consequently, phenols have greater acidity than alcohols due to stabilization of the conjugate base through resonance in the

aromatic ring.

Uses[edit]

Phenol is so inexpensive that it attracts many small-scale uses. It once was widely used as an antiseptic,
especially as carbolic soap, from the early 1900s to the 1970s. It is a component of industrial paint strippers used in the aviation
industry for the removal of epoxy, polyurethane and other chemically resistant coatings. [18]
Phenol derivatives are also used in the preparation of cosmetics including sunscreens,[19] hair colorings, and skin
lightening preparations.[20]
Concentrated phenol liquids are commonly used in the surgical treatment of ingrown toenails to prevent a section of the toenail from
growing back. This process is called phenolization.

Chlorhexidine is a cationic polybiguanide (bisbiguanide). It is used primarily as its salts (e.g., the dihydrochloride, diacetate and
digluconate).
It is on the World Health Organization's List of Essential Medicines, a list of the most important medication needed in a basic health
system.[1]
Uses[edit]

Chlorhexidine is used in disinfectants (disinfection of the skin and hands), cosmetics (additive to creams, toothpaste, deodorants,
and antiperspirants), and pharmaceutical products (preservative in eye drops, active substance in wound dressings and antiseptic
mouthwashes). [2]
Antiseptic[edit]
At physiologic pH, chlorhexidine salts dissociate and release the positively charged chlorhexidine cation. The bactericidal effect is a
result of the binding of this cationic molecule to negatively charged bacterial cell walls. At low concentrations of chlorhexidine, this
results in a bacteriostatic effect; at high concentrations, membrane disruption results in cell death.[3]
Chlorhexidine is active against gram-positive and gram-negative organisms, facultative anaerobes, aerobes, and yeast.[3] It is
particularly effective against gram-positive bacteria (in concentrations 1 g/L). Significantly higher concentrations (10 to more than
73 g/mL) are required for gram-negative bacteria and fungi. In the presence of blood or protein the efficacy is reduced by a factor
of 100 to 1000. Chlorhexidine is ineffective against polioviruses and adenoviruses. The effectiveness against herpes viruses has not
yet been established unequivocally. [4]
Chlorhexidine, like other cation-active compounds, remains on the skin. It is frequently combined with alcohols (ethanol and
isopropyl alcohol).

Hydrogen peroxide is a chemical compound with the formula (H

2O
2). It is the simplest peroxide (a compound with an oxygen-oxygen single bond) and in its pure form is a colorless liquid, slightly
more viscous than water. For safety reasons it is normally encountered as an aqueous solution, also colorless. Hydrogen peroxide
is a strong oxidizer and is used as a bleaching agent and disinfectant. Concentrated hydrogen peroxide, or 'high-test peroxide' is
a reactive oxygen species and has been used as a propellant in rocketry.[1]
Organisms naturally produce trace quantities of hydrogen peroxide, most notably by a respiratory burst as part of the immune
response.

Disinfectant[edit]
Hydrogen peroxide is seen as an environmentally benign alternative to chlorine-based bleaches. It can be used for the disinfection
of various surfaces[29] and is generally recognized as safe as an antimicrobial agent by the U.S. FDA.[30] However studies have found
it to be ineffective in certain cases and hospitals and other medical institutions are now being advised to use chlorine-based
bleaches for disinfection.[31]
Historically, hydrogen peroxide was commonly used for disinfecting wounds, partly because of its low cost and ready availability
compared to other antiseptics. It is now thought to slow healing and lead to scarring because it destroys newly formed skin cells.
[32]

Only a very low concentration of H2O2 can induce healing, and only if not repeatedly applied.[33] Surgical use can lead to gas

embolism formation.[34]
It is absorbed by skin upon contact and creates a local capillary embolism that appears as a temporary whitening of the skin.[35]

Boric acid, also called hydrogen borate, boracic acid, orthoboric acid and acidum boricum, is a weak, monobasic Lewis
acid of boron often used as anantiseptic, insecticide, flame retardant, neutron absorber, or precursor to other chemical compounds.
It has the chemical formula H3BO3 (sometimes written B(OH)3), and exists in the form of colorless crystals or a white powder that
dissolves in water. When occurring as a mineral, it is called sassolite.
Uses[edit]
Medical[edit]
Boric acid can be used as an antiseptic for minor burns or cuts and is sometimes used in dressings or salves. Boric acid is applied
in a very dilute solution as an eye wash. Dilute boric acid can be used as a vaginal douche to treat bacterial vaginosis due to
excessive alkalinity.[19] As an antibacterial compound, boric acid can also be used as an acne treatment. It is also used as prevention
of athlete's foot, by inserting powder in the socks or stockings, and in alcohol solution can be used to treat some kinds of otitis
externa (ear infection) in both humans and animals. The preservative in urine sample bottles in the UK is boric acid.
Boric acid solutions used as an eye wash or on abraded skin are known to be toxic, particularly to infants, especially after repeated
use; this is because of its slow elimination rate.[20]