Practical application of antiseptic and disinfectants. What are disinfectants? The role of bactericidal agents

IN medical practice the most relevant and common measure is the disinfection of rooms, surgical instruments and directly individual parts human body. This involves the use of special tools. In this article, we will provide detailed information about what an antiseptic is.

Definition of measures with the use of antimicrobial agents

Methods of sterilization and disinfection play a fundamental role in the performance of various medical manipulations. Knowledge about this constitutes the main sections in training when receiving medical education. To understand what an antiseptic is, you first need to understand what an antiseptic and asepsis are.

Asepsis is a combination preventive measures preventing the emergence of pathogenic microorganisms. Thanks to them, the patient receives reliable protection from the introduction of infectious pathogens into open wounds, as well as organs, tissues and other cavities of the body. Asepsis is mandatory for diagnosis, surgery and microbiological studies.
Antiseptic is a complex suppression or destruction of organisms representing potential danger for the health of the patient, on mucous membranes, damaged skin and cavities.

There are two sources of infection:

Exogenous. The reason for the penetration of microbes is external factors. When pathogens enter from outside medical workers resort to asepsis.
Endogenous. The infection is in the human body. In this case, the main role is given to antiseptics.

Antiseptics

Since we are going to dwell on the means by which the treatment is carried out aimed at the destruction of bacteria, it will be appropriate to learn about the types of antiseptics.

Preventive. It consists in the implementation of the following actions:

Treatment of fresh open wounds.
Hygienic processing of hands.
Disinfection of the operating surface.
Preventive measures in newborns, for example, treatment of an umbilical wound.
Processing the hands of surgeons before surgery.
Antiseptic of mucous membranes and skin infections.

Therapeutic. Antiseptics in medicine are used for their intended purpose. For every kind medical event have their own resources. Here is their list:

Biological (tools developed on the basis of antagonist bacteria and bacteriophages).
Chemical antiseptics (bacteriostatic and bactericidal preparations).
Mechanical antiseptic (use of solutions for primary processing wounds and after removal of infected tissue sites).
Physical method (sorption, drainage, surgical treatment).
Combined.

The type of antiseptic, which is mentioned last, is most often used in medical practice for the reason that one method of treatment is not enough. What is an antiseptic in the aggregate? Let's see how this happens, using the example of treating a fresh wound.

Along with surgical techniques (chemical and mechanical), biological antiseptic. To have a direct effect on the pathogen, tetanus toxoid or antibiotics are administered. After first aid, a physical antiseptic is immediately prescribed, which implies physiotherapy procedures.

The role of bactericidal agents

It is logical that in order to carry out antibacterial treatments, substances capable of defeating harmful bacteria should be found. An antiseptic is a means that prevents decomposition processes and destroys putrefactive microorganisms. Preparations developed for this purpose are classified according to therapeutic actions:

Bacteriostatic inhibit the growth of infectious pathogens.
Germicidal destroy pathogens.
Microbicides contribute to the destruction of viral particles.
Antibacterial agents prevent the growth of bacteria.

The action of antimicrobial agents

Such substances penetrate the walls of bacterial cells, affect their cell membranes. This either inhibits the metabolic processes of microorganisms, or changes the permeability of their cell walls. Antiseptics are designed to inhibit or correct the growth of pathogenic microbes in living tissue areas. Thanks to them, the risk of infection and the development of infection in humans and animals is reduced.

When prescribing an antimicrobial drug, the patient is sampling the causative agent of the disease and checking its sensitivity to the agent. When choosing an external antiseptic, the natural reaction of microbes at the site of application of the antibacterial liquid is recognized.

Belonging of antiseptics to a chemical group

Inorganic substances include alkalis, acids, peroxides. Separate elements are also used here: chlorine, silver, copper, iodine, zinc, bromine, mercury.

The organic group of synthetic substances includes derivatives of phenols and alcohols, quinolines, alkalis, aldegins, acids, nitrofurans and dyes.

Bioorganic antiseptics are products obtained from natural objects. Lichens, fungi and some plants can serve as biological raw materials.

Petroleum products, essential oils, tar and natural salts have also proven to be effective antiseptics.

All of the above chemicals and biological substances act as medicines and can be used at home.

Chemicals popular in medicine

Phenol is the most common agent used to treat the hands of surgeons before surgical intervention. It is included in other antibacterial drugs. The tool is able to defeat viruses and is prescribed for rinsing oral cavity and throat. Phenol in powder form is used to treat navels in babies. In addition, it has an analgesic effect.
metal-containing compounds. Distinctive feature these substances - selective and specific action. On bacteria they have toxic effect, and on the human body - sparing. Because of these properties, they are used to treat sensitive organs. Mercury oxycyanide serves as a disinfectant. Optical instruments are treated with its solution. Wash the eyes and mucous membranes with silver nitrate.
Halides. Alcohol tincture iodine is used as an antiseptic for the skin before surgery and venipuncture. Iodopyrone and iodonate are also widely used. Chloramine is an effective wound antiseptic because it contains active chlorine. A solution of sodium hypochlorite is irrigated and washed with contaminated open foci.
alkalis. From this group, ammonia solution (10%), sodium borate and ammonia for outdoor processing.
Oxidizers. Purulent wounds are washed with hydrogen peroxide during dressing, and lotions and rinses are also made. The solution does not penetrate the tissues, it is used for decomposing cancerous tumors and mucosal bleeding.
Dyes. Brilliant green has a pronounced antimicrobial action. In medicine, an antiseptic is used to combat Pseudomonas aeruginosa and staphylococcus aureus. Zelenka well cleanses purulent skin lesions, abrasions, oral mucosa, superficial wounds.
aldehyde compounds. An aqueous solution of formalin (40%) is used to disinfect medical instruments, gloves, and drains. A weak solution (4%), treat items for patient care. For sterilization optical instruments use dry formaldehyde powder. It is able to destroy bacteria and their spores within 5 hours.
Acids. Solution boric acid prevents the growth and reproduction of many types of bacteria. It is used to treat ulcers, wounds and rinses in the mouth.

The best remedy

During the discussion, we found that doctors and their patients have many drugs at their disposal, each of which has a specific effect on bacteria. It is not possible to say that any of them is the most effective. We will try to highlight several criteria by which the best antiseptic is determined, according to its qualities. Firstly, a worthy remedy has either a good bactericidal effect, aimed at the death of microorganisms, or bacteriostatic, which helps to stop their reproduction. Secondly, it must be environmentally friendly and not side effects on the human body. Thirdly, the drug is considered to be of high quality if it has a wide range positive therapeutic actions. It is also necessary to take into account whether the antiseptic will dissolve in lipids. The antimicrobial activity of the drug should not decrease during the period of body resistance, for example, in the presence of physiological and pathological substrates.

Important factors when choosing a product is the price and a guarantee for the safety of its antibacterial properties.

Preparations

Sprays are very easy to use. Antiseptics of this type do not create unnecessary difficulties when applied. Some preparations are commercially available in large containers that allow the use of a spray bottle. The most common medicines include the following: "Chemetic", "Panthenol", "Eco Breeze", "Octenisept", "BioLong", "Desisprey", "Combi Liquid", "Medonika".

Antiseptics in the form of an ointment are presented the following drugs: "Hexicon", "Rescuer", "Betadine", "Levomikol". As well as ointments: salicylic-zinc, boric, tetracycline and ichthyol.

It is important to know that many external antiseptics contain antibiotics that can provoke allergies. This must be taken into account when choosing a drug.

Natural antiseptics

Many have a disinfecting effect. healing herbs. Good bactericidal properties are distinguished by a series, tangerine oil, aloe vera, knotweed, lime, thyme. They are used in folk medicine and in the development of pharmaceuticals.

Pharmacy tinctures: calendula, chamomile, eucalyptus leaves.
Oils: juniper, frankincense, eucalyptus, lime and tea tree.

A decoction of buckthorn helps in the treatment of boils and eczema. Flax seeds are used for sores in the mouth.

Other applications

It was found that in recent times bacteria have adapted to traditional methods disinfection, and their reproduction has accelerated significantly. To prevent infection by fungi and viral infections, in hairdressing salons use high-quality chemicals. The following is short description some of them.

Antiseptic spray "Bacillon AF" is active against standard viruses. It is used for express processing of surfaces and tools. Use this remedy with caution, as it dries out the skin and causes peeling. Ingredients: ethanol (4.7%), propanol-1 (45%), glutoronic aldehyde (45%), propanol-2 (25%).

"Aerodesin". The alcohol-containing spray is intended for an accelerated processing method. After irrigating objects, the product is left on the surface for about 30 seconds. At long-term use plaque appears on the instruments gray color. Ingredients: didecyldimethylammonium chloride (0.25%), protanol-1 (32.5%), ethanol (18%). According to the instructions, the antiseptics mentioned above are not used for processing medical instruments.

The latest innovation is sprayable hand sanitizers. They can be used in any in public places and on the street. As a rule, they are available in bottles with a dispenser that is easy to carry around.

Widespread use of antiseptics is observed in construction. They protect wooden structures from the appearance of blue, cracks, insects, and serve as the main layer for painting. Antiseptic agents penetrate the wood and form a film on the surface that protects against future damage.

Medicines with antimicrobial activity are divided into 2 groups:

1 - do not have selective antimicrobial action, they have a detrimental effect on most microorganisms (antiseptics and disinfectants).

2 - antimicrobial drugs electoral action(chemotherapeutic agents).

Antiseptics and disinfectants are a group of drugs that are capable of inhibiting the growth, development or death of microorganisms in the patient's environment or on the surface of his body.

Antiseptics -(anti-against; septicas - putrid). This group medicines, which are used to eliminate pathogenic microbes in the wound (skin, mucous membranes) in the gastrointestinal tract and urinary tract. Depending on the concentration, they have a bacteriostatic or bactericidal effect, depending on the concentration.

Disinfectants - serve for disinfection of medical instruments, utensils, premises, equipment, etc. Disinfection – This is a set of measures aimed at preventing infection from entering the wound, into the body as a whole, or to prevent the spread of infection.

It is not always possible to draw a sharp line between antiseptics and disinfectants. many substances in low concentrations are used as antiseptics, and in higher concentrations for disinfection.

Requirements for antiseptics and disinfectants.

Should have a wide spectrum of action;

Should have a small latent period of action;

Must be highly active

Must be chemically resistant;

Availability and low cost;

No local irritating or allergenic effect on tissues;

Minimal absorption from the place of their application;

Low toxicity.

Classification by chemical structure.

1. Inorganic compounds:

· halogens and halogenated compounds

Chloramine B;

Chlorhexine bigluconate;

Alcoholic iodine solution;

Yoddicirin.

· Oxidizers

Potassium permanganate;

hydrogen peroxide.

· Acids and alkalis

Boric acid;

Ammonia solution.

· salt heavy metals

zinc sulfate;

copper sulfate;

Silver nitrate.

organic compounds.

· Aromatic compounds:

· Phenol group

Birch tar;

· Nitrofuran derivatives

Furacillin

· Dyes

Brilliant green;

Ethacridine lact.

· Aliphatic compounds:

· Aldehydes

Formaldehyde

· Alcohols

Ethanol

· Detergents (surfactants)

Zerigel.

Pharmacodynamics.

Antiseptics and disinfectants can have both bacteriostatic and bactericidal effects. The activity of the drug depends on many factors:

From the sensitivity of the pathogen;

From the concentration of the drug;

From exposure time;

From the presence of proteins in the medium.

As a rule, an increase in concentration also increases antimicrobial activity, but ethyl alcohol is an exception - an increase in alcohol concentration to 70% increases antimicrobial activity, but a further increase in concentration in the presence of proteins, on the contrary, reduces activity - this is due to the rapid coagulation of proteins, the formation of a protective film that prevents penetration alcohol into the deep layers of the skin, where microorganisms can be found.

An increase in exposure time increases antimicrobial activity - so sublimate (mercury dichloride) is 40 times more active at an exposure of 30 minutes than at 2.5 minutes.

An increase in temperature by 10 0 C leads to an increase in the activity of phenol by 7 times, sublimate - by 3 times. The presence of proteins reduces the activity of drugs in this group. So, human serum inhibits the activity of phenol by 10%, and sublimate by 90%, because. the process of drug binding to proteins.

Detergents (soaps)- the mechanism of antimicrobial action is associated with their ability to reduce surface tension at the interface between the water and fat phases. As a result, the structure and permeability of the shell of microorganisms, as well as the osmotic balance, nitrogen and phosphorus metabolism, oxidative enzymes are blocked and proteolytic enzymes are activated, lysis and death of the bacterial cell occurs. Widespread use in medical practice as an antiseptic L.S. have cationic detergents - tserigel, rokal. Zerigel consists of cetylperidinium chloride, polyvinyl butyral and ethyl alcohol. When applied to the skin, cerigel forms a film. The antimicrobial activity of the drug is used to treat hands medical staff before surgical operations. Cationic detergents are quite effective against vegetative forms of microorganisms, both gram-positive and gram-negative. Anionic detergents affect only gram-positive microorganisms (green soap, soap alcohol). Of the amphoteric detergents, ampholane is used.

Nitrofuran derivatives- they have a wide spectrum of action, gram-negative and gram-positive strains, as well as protozoa, are sensitive. Preparations - furatsilin, furaplast, lifusol. The mechanism of action is associated with the reduction of the nitro group to the amino group. As hydrogen acceptors, nitrofurans compete with hydrogen acceptors of the microbial cell. As a result, active metabolites are formed that inhibit the activity of enzymes and disrupt the functioning of the respiratory electron transport chain of the microbial cell. Also noted irreversible damage structures of DNA (rupture of helices), which leads to inhibition of growth, reproduction and death of microbes.

Phenol group– the antimicrobial activity of phenol is the standard for determining the activity of other antimicrobial agents. Dilution (1:400 - 1:800) acts bacteriostatically - it violates the permeability of the microbial cell membrane, blocks the activity of dehydrogenases. At a concentration of 1% -5%, it acts bactericidal, tk. causes denaturation of the protein of the cytoplasm of microorganisms have a wide spectrum of action, but does not affect spores and viruses.

Halogen compounds- represented by preparations containing chlorine and iodine. Mechanism bactericidal action chlorine is associated with its interaction with the proteins of the cytoplasm of microorganisms. In a protein molecule, chlorine replaces the hydrogen atom, which is bonded to the nitrogen atom, which leads to a disruption in the formation of hydrogen bonds, as a result of which the secondary structure of the protein is disrupted. In addition, when chlorine interacts with water, atomic oxygen is released, which oxidizes the vital enzymes of microorganisms.

Cl 2 + H 2 O \u003d HCl + HClO \u003d (HCl; O)

Iodine preparations containing free iodine, as well as partially organic iodine compounds are used as active antiseptics. The mechanism of antimicrobial action is protein denaturation as a result of the interaction of iodine with nitro groups of protein molecules. There is a fungicidal effect, it has a local irritant effect and distraction. Preparations: alcohol solution of iodine, ioddicerin, iodovidone. Depending on the dosage form used for burns, wounds, skin ulceration, frostbite, paraproctitis, gynecological diseases.

Metal compounds- their mechanism of action with the blocking of sulfhydryl, carboxyl and amino groups of enzymes and proteins of microorganisms. Metal ions, which are formed during the dissociation of salts, interacting with these functionally active groups of biosubstrates, cause their denaturation. The resulting albuminates can be dense and loose. In the first case, a film is formed, the tissue is compacted and reduced inflammatory process. This is typical of an astringent action. With a deeper penetration of the substance into the tissue, cell irritation occurs and nerve endings, and the extreme manifestation is the cauterizing effect of metal salts. According to the solubility of albuminates in biological media, metals can be arranged in next row: Pb, … Al, Zn, Cu, Ag, … Hg. Antimicrobial activity also increases in the same sequence. As antiseptics, metal salts on the right side of the series are of the greatest interest.

Oxidizers- hydrogen peroxide and potassium permanganate have an antiseptic and deodorizing effect. The principle of action of both drugs is the release of oxygen.

1) H 2 O 2 \u003d 2H + O 2 (molecular oxygen is formed);

2) 2KMnO 4 + H 2 O = 2KOH + 2MnO 2 + 3O 2 (atomic oxygen is formed).

The antimicrobial activity of molecular oxygen is much lower than that of atomic oxygen, so H 2 O 2 is used mainly for mechanical wound cleansing, because foam and bubbles form. Used to treat mucous membranes and burn surfaces.

KMnO 4 along with antimicrobial activity has deodorant and astringent action due to the formation of manganese oxide. The drug is used for rinsing, douching, irrigation of wounds, treatment of burn surfaces, gastric lavage.

Aldehydes and alcohols- represented by ethyl alcohol and formaldehyde. Both drugs cause protein denaturation, tissue dehydration, tissue thickening, narrowing of the sweat and excretory ducts. sebaceous glands, which complicates the penetration of ethanol into the deeper layers of the skin and prevents the death of microbes there. For antimicrobial action, 70% ethyl alcohol is used, and for leather tanning - 90%.

Formaldehyde is used to treat the skin with sweating as a disinfectant.

Acids and alkalis cause denaturation of microbial proteins. Go through cell walls in an undissociated form, and their dissociation takes place inside the microbial cell, where they cause the denaturation of protein components.

Dyes - act mainly on pyogenic gram-positive cocci and fungi (Candida). Dye cations displace the hydrogen proton from biologically active compounds of microorganisms and form difficult-to-dissociate complexes with carboxyl groups of amino acids, excluding them from metabolic processes.

Brilliant green - effectively suppresses the causative agent of diphtheria, in the presence of organic compounds of phenolic acids, the activity decreases. Used to treat purulent wounds, with skin lesions, blepharitis.

Ethacritide lactate - effective in streptococcal infections, in the presence of organic compounds, the phenol coefficient does not decrease. Used for washing cavities, in the form of tampons, in eye drops, for skin diseases.

Methylene blue - has antimicrobial and antifungal action. It is an acceptor and donor of hydrogen proton. It converts hemoglobin to methemoglobin, which actively combines with cyanides, and therefore is used as a first aid for poisoning with cyanide compounds.

Phytoncides and essential oils(mint essential oil, calendula tincture, chlorophyllipt) - used to irrigate the throat and nasopharynx. Menthol is irritant.

What is the difference between antiseptic and disinfectant?

Both antiseptics and disinfectants are cleaning agents. They are widely used not only in hospitals and other medical institutions but also at home. Although the terms used to describe them are used interchangeably, it is important to know that there is a difference between them. This article compares antiseptics and disinfectants.

Should be remembered

The overuse of antibacterial products such as antiseptics and disinfectants is known to lead to the emergence of multidrug-resistant strains of bacteria. If similar products are used not for certain medical purposes, but for domestic purposes, proper observance of the rules of personal and home hygiene is always preferable (use ordinary soap, warm water and a simple cleaning agent).

What are antiseptics?

Antiseptics are chemicals designed to be applied to living tissue, such as the skin, to kill or inhibit the growth of pathogens. They help reduce possible risk infections, sepsis or other diseases. Moreover, antiseptics are used to cleanse the skin before it is incised for surgical purposes. These substances are also used to treat cuts or scrapes to kill germs that may have already entered the wound. They can also serve as antibacterial agent where hand washing is not possible. Antiseptics are commonly found in mouthwash products, medicated creams etc. Some examples of antiseptics include rubbing alcohol, iodine, boric acid, and hydrogen peroxide.

What are disinfectants?

Disinfectants are chemicals intended to be applied to inanimate objects or surfaces to kill or control the growth of microorganisms present thereon. Disinfectants can be toxic and should never be applied to living tissue or skin. They are widely used in cleaning houses, bathrooms, kitchens and operating rooms, washing countertops, floors, etc. Some popular disinfectants include various alcohols, household bleach, aldehydes and oxidizers. There are many other disinfectants such as iodine, silver, etc., the use of which is subject to applicability. Ultraviolet light is also considered a disinfectant and is used when wetting surfaces is unacceptable. It is also useful in cases where frequent disinfection is required. In general, disinfectants should sterilize surfaces, but it is noted that sometimes microorganisms develop resistance to them, and their use can only exacerbate the situation. This often necessitates the use of much more concentrated varieties.

Note: As you can see, iodine, as well as some other chemicals, is used both as an antiseptic and as a disinfectant. Assigning it to the group of antiseptics or disinfectants depends on the concentration in which it is used. Thus, a weak solution of iodine can be used as an antiseptic, and a more concentrated one can be used as a disinfectant.

Mode of action

It is known that both these types of antimicrobial agents act in a similar way. They destroy bacteria and other microorganisms by penetrating their cell walls, damaging cell membranes, interfering with their metabolism, or changing the permeability of their cell walls.

Differences

Antiseptics	Disinfectants
Place of application
Applied to living tissues such as skin.	Applied to inanimate objects or surfaces.
Action
Inhibit or control the growth of pathogens on living tissues. Thus, they reduce the risk of developing infections and other diseases that develop in humans or animals.	Destroy microorganisms that are present on various surfaces and inanimate objects. Thus, objects that can serve as a means of transmitting microbes are disinfected.
Toxicity
Less toxic and aggressive Safe for application to living tissues, do not cause their damage.	Very toxic and aggressive Application to living tissues is unacceptable, they can cause serious damage.
Interactions
On interacting with others medical means not reported. However, it should not be used in conjunction with other topical creams, ointments or solutions.	May react with other common household chemicals. Disinfectants such as bleach can react with ammonia or vinegar to form toxic gases.
Concentration
low concentration Used over weak solutions chemical substances. They have relatively little effect.	High concentration More concentrated solutions of chemicals are used. They have a relatively strong effect.
Application
Widely used in the production of mouth rinses, hand and eye washes, creams against fungal infections, as first aid products, etc.	Widely used in the manufacture of medical and household cleaners for kitchens, bathrooms, hospital rooms and floors and other surfaces where germs may be present.

When considering the above comparison table it becomes clear that the key difference between these two types of antimicrobial agents is the place of their application. This point must be kept in mind, as disinfectants mistakenly used on living tissues or skin can have a detrimental effect on them.

Antiseptics and disinfectants

Irina Kuchma, KhMAPE

Antiseptics for the prevention and treatment of local infectious diseases (purulent wounds, burns, bedsores, ulcers, boils, etc.) have been used since ancient times. Hippocrates and Ibn Sina, Paracelsus and Galen used balsamic ointments, wine and Apple vinegar, lime, formic acid and various alcohols.

The term "antiseptic" (anti against, sepsis rotting) was first used by the English scientist I. Pringle in 1750 to refer to the anti-putrefactive effect of mineral acids.

Scientifically substantiated, developed and implemented antiseptic methods for the treatment purulent diseases and the prevention of sepsis, the German obstetrician I.F. Semmelweis, the Russian surgeon N.I. Pirogov and the English surgeon J. Lister. Semmelweis used bleach to disinfect hands (1847), N. I. Pirogov used solutions of silver nitrate, iodine, ethyl alcohol (18471856) to disinfect wounds. J. Lister made a revolution in surgery with his work “On a new method treatment of fractures and abscesses with comments on the causes of suppuration "(1867). Based on the teachings of Louis Pasteur on microbial origin purulent and putrefactive processes, Lister, in order to destroy microorganisms, disinfected the air by spraying a solution of carbolic acid in the operating room. The surgeon's hands, instruments and operating field were also disinfected with 25% solutions of carbolic acid. This method has drastically reduced the number postoperative suppuration and sepsis. According to Lister's definition, antiseptics are measures to destroy, with the help of chemicals, pathogens of purulent diseases in wounds, objects of the external and internal environment that is in contact with the wound.

Currently, antiseptic drugs are considered to have an antimicrobial effect on microorganisms that are on the skin and mucous membranes.

Antimicrobial agents that decontaminate environmental objects are called disinfectants.

The emergence at the beginning of the 20th century of systemic antimicrobial chemotherapy drugs for internal use and in the 40s antibiotics made an incredible stir. It seemed that the "golden bullet" that kills the microorganism and does not harm the cells of the body has been found. And as it often happens in life, the lack of a sense of proportion, a tribute to fashion and distrust of the old tested means unreasonably narrowed the scope of application of antiseptics.

Widespread, not always rational use of antibiotics has led to the spread of nosocomial infection, a sharp increase in wound infection and postoperative complications. Low concentrations of active antimicrobial substances, long courses of antibiotic therapy, etc. have led to the spread of numerous antibiotic-resistant strains of microorganisms.

Compared to antibiotics, antiseptics, as a rule, have a wider spectrum of action (including fungicidal and virucidal), and resistance of microorganisms to them develops more slowly.

The skin and mucous membranes are more resistant to the damaging effect of antiseptic drugs in comparison with internal environment organism, so for their disinfection it is possible to use more than high concentrations antiseptic agents.

Infectious diseases of the skin, eyes, nasopharynx, external ear canal, female genital organs, rectum, etc. in most cases, they are successfully cured with antiseptic external agents, without the use of antibiotics.

Depending on the purpose, it is customary to distinguish the following categories of antiseptics:

preventive hygienic hand antisepsis, surgical hand antisepsis, preoperative antisepsis of the skin, mucous membranes, wounds; preventive antisepsis of fresh traumatological, operational, burn wounds;
therapeutic destruction and suppression of populations of pathogenic and conditionally pathogenic microorganisms with infectious processes in the skin, soft tissues, mucous and serous cavities in order to prevent the generalization of the process.

Disinfection destruction of microorganisms during external environment: disinfection of patient care items, discharges of patients, linen, dishes, medical equipment, tools; disinfection of wards, operating rooms and other hospital premises, disinfection of the source of infection, air, soil, water and sewer networks, as well as disinfection of premises at medical, pharmaceutical, cosmetic and Food Industry; public institutions, kindergartens, schools, gyms, etc.

Antiseptics and disinfectants are divided into:

chemical elements and their inorganic derivatives (iodine, chlorine, bromine, silver, zinc, copper, mercury, etc.), acids, alkalis, peroxides;
bioorganic compounds (gramicidin, microcide, ectericide, chlorophyllipt, lysozyme, etc.);
organic substances of abiogenic nature (derivatives of alcohols, phenols, aldehydes, acids, alkalis, surface-active substances (surfactants), dyes, derivatives of nitrofuran, quinoxaline, quinoline, etc.).

The main classes of antiseptics and disinfectants

Alcohols and phenols

The antiseptic properties of alcohols have long been used in medical practice. Alcohols lead to denaturation of structural and enzymatic proteins of microbial cells, fungi and viruses. The greatest antiseptic activity has 76% ethanol. The disadvantages of alcohols are: the absence of a sporicidal effect, the ability to fix organic contaminants, a rapid decrease in concentration due to evaporation. These shortcomings are deprived of modern combined products based on alcohols sterillium, octeniderm, octenisept, sagrosept.

Phenols form complex compounds with polysaccharides of the cell wall of microorganisms, violating its properties.

Phenol preparations: resorcinol (dihydric phenol); fucorcin, ferezol, tricresol, polycresulen (vagotil); thymol. Phenol preparations are not currently widely used in practice. Phenol (carbolic acid) as a disinfectant is prohibited for use due to toxicity and persistent odor.

Aldehydes

Aldehydes highly active compounds, strong reducing agents, irreversibly bind proteins and nucleic acids. Preparations containing aldehydes: formaldehyde, lysoform, citral, cimesol, ciminal are used for purulent wounds, phlegmon, burns of 12 degrees, trophic ulcers, for douching in gynecology, cidipol (ciminal + dimexide + polyethylene oxide 400) are used for the treatment of genital organs for the prevention and treatment of syphilis, gonorrhea and trichomoniasis. Formaldehyde (formaldehyde) in the form of a 40% aqueous solution (formalin) has been successfully used for many years to sterilize heat-labile objects. medical purpose(cystoscopes, catheters, laparoscopes, endoscopes, hemodiagnosers, etc.) in gas sterilizers by the “cold method”, for disinfection in steam-formalin chambers of things, linen, mattresses, etc., as well as in morgues and forensic stations for processing cadaveric material.

Disinfectants containing aldehydes: gigasept FF, deconex 50 FF, desoform, lysoformin 3000, septodor forte, sideks are widely used for various kinds disinfection and sterilization of medical equipment.

Acids and their derivatives

Disinfectants Pervomur, Deoxon-O, Odoxon, Divosan-Forte contain formic and acetic acids. They have a pronounced bactericidal (including sporicidal), fungicidal and virucidal action. Their disadvantages include strong smell, the need to work in respirators, as well as corrosive properties.

Group of halogens and halogenated compounds of chlorine, iodine and bromine

In medicine, the bactericidal properties of halogens have long been used, which oxidize the most various structures microbial cells, primarily free sulfhydryl groups (-SH).

Preparations containing chlorine: chloramine B (25% active chlorine), chloramine D (50% active chlorine), chlorsept, sterin, aquatabs, dichloranthin, chlorantoin, deactin, septodor, lysoformin special, neochlor, chlorhexidine.

Modern chlorine-containing disinfectants clorcept, sterin, neochlor, chlorantoin, etc. do not have a strong irritating odor and effect on the skin, are highly effective and are used for various types of disinfection. Aquatabs is mainly used for water disinfection in swimming pools. Aquasept and pantocide are used to disinfect drinking water.

Dezam (contains 50% chloramine B and 5% oxalic acid) is used for current and final disinfection.

Iodine preparations: alcohol iodine solution 5%, iodoform, iodinol (iodine + polyvinyl alcohol) are used to clean and disinfect the skin, surgeon's hands, treat wounds, trophic and varicose ulcers.

Alcoholic solutions of iodine have a pronounced bactericidal and sporicidal effect, but they have a number of disadvantages: they irritate the skin, can cause burns and allergic reactions.

IN last years More and more wide application find iodophors complex compounds of iodine with surfactants or polymers. Iodophors do not have an irritating and allergic effect, retain high bactericidal activity in the presence of organic matter protein, blood, pus.

Iodophor preparations include: iodonate ( water solution complex of surfactants with iodine) are widely used for disinfection operating field; iodopyrone (a mixture of iodopolyvinylpyrrolidone iodine with potassium iodide) in the form of a solution is used to treat the surgeon's hands, purulent wounds, in the form of an ointment for the treatment of cellulitis, abscesses, bedsores, fistulas; sulidopyrone (iodopirone + surfactant) for disinfection of the surgical field, surgeon's hands, for disinfecting baths in the form of a 50% solution in patients with extensive burns; polyvinylpyrrolidone iodine under the name "betadine" is produced in the form of an ointment for the treatment of dermatitis and wounds, in the form of suppositories for the treatment of bacterial, fungal and trichomonas vaginosis, in the form of solutions for rinsing the mouth, cleaning and disinfecting the skin. Ukraine produces the drug polyvinylpyrrolidone iodine iodovidone for complex treatment wounds and processing of the surgical field and hands of the surgeon.

Oxidizers

Oxidizers cause destruction cell membrane bacteria.

Hydrogen peroxide remains an effective and affordable disinfectant and antiseptic agent, the main disadvantages of which include the instability of aqueous solutions and the short duration of action. 3% and 6% solutions of hydrogen peroxide in combination with detergents are widely used for disinfection of premises, furniture, utensils, honey. products made of metals, polymers, rubber, glass. These solutions are odorless and do not damage furniture and metal. A 3% aqueous solution of hydrogen peroxide is used to treat purulent wounds, mucous membranes with tonsillitis, stomatitis, gynecological diseases.

Hydroperite (35% aqueous solution of hydrogen peroxide + urea) in dilutions with water is used for washing wounds, gargling and rinsing the mouth.

In practice, complex preparations based on hydrogen peroxide are widely used:

pervomur (a mixture of peroxide and performic acid) is used to treat the surgical field, the surgeon's hands, to sterilize products made of polymers, glass, optical instruments;
persteril (10% peroxide solution, 40% solution of performic acid and 1% solution of sulfuric acid) are used for various types of disinfection. In 1% persteril solution, all naturally occurring microorganisms and their spores die;
deoxon-1 (10% peroxide solution, 15% solution acetic acid+ stabilizers) is also used for most types of disinfection.

Has not lost its effectiveness as an antiseptic potassium permanganate. It is used to treat wounds, burns, erosions, gastric lavages, douches and washes in gynecological and urological practice.

Quinoline and quinoxaline derivatives

Dioxidine, dioxycol, chinosol, quinifuril are used to treat purulent-inflammatory diseases of the skin, soft tissues, osteomyelitis, etc.

Nitrofuran derivatives are active against many Gr+ and Gr- microorganisms, Trichomonas, Giardia. To them, the resistance of microorganisms is slowly developing. Furagin, furazolin, nifucin remain effective antiseptics for the treatment of purulent wounds, stomatitis, otitis, douching and washing.

Surfactants (detergents)

Currently for processing wound surfaces, surgical field, surgeon's hands, more often than other antiseptics, surfactants are used, which include compounds that change surface tension at the phase boundary. These substances carry either a positive electric charge(cationic surfactants), or negative (anionic surfactants). They break permeability cytoplasmic membrane microbial cells, inhibit membrane-bound enzymes, irreversibly impair the function of the microbial cell.

This group includes quaternary ammonium compounds (QAC), guanidine derivatives, amine salts, iodophors, soaps.

QAC antiseptics are widely used, have a wide spectrum of action, low toxicity and low allergenic effect, do not irritate the skin and mucous membranes. These include:

decamethoxin and medicines based on it: aurisan (ear drops), oftadek ( eye drops for the treatment of various conjunctivitis, including chlamydial nature, prevention of blennorrhea in newborns and treatment of contact lenses); palisept ointment (for the treatment of periodontal disease, pustular and fungal skin diseases), amosept (0.5% alcohol solution for the disinfection of surgical gloves), decasan (broad antiseptic), deseptol suppositories (for the treatment of trichomonas, fungal and bacterial diseases female genital organs, prostatitis, hemorrhoids), ethonium in addition to bactericidal action, has the ability to neutralize staphylococcal exotoxin, local anesthetic activity, stimulates wound healing;
degmin and degmicide are used to treat the surgeon's hands;
diramistin has a wide spectrum of action, destroys multiresistant staphylococci and streptococci. It is used for external treatment of purulent-inflammatory infections, including for the treatment and prevention of sexually transmitted infections.

Disinfectants from the QAC group (Mikrobak Forte, Bio-Clean, Hexaquart C, Deconex 51 DR, Blanisol, Septodor) have high bactericidal activity, in addition, good detergent properties, low toxicity, no pungent odor. They do not discolor fabrics, do not cause corrosion. They are used for disinfection of premises, linen, plumbing and medical equipment made of glass, metal and plastic.

The disadvantages of these drugs include low antiviral activity and the absence of a sporicidal effect. To expand the spectrum of action, alcohols, aldehydes and other components that act on viruses, Mycobacterium tuberculosis, and bacterial spores are added to them.

TO combined preparations include: sanitary-128, septodor-forte, terralin, sentabik, virkon.

The guanidine derivative chlorhexidine has bactericidal, fungicidal, virucidal activity (including against HIV and hepatitis B virus), is an effective antiseptic for treating the surgical field, surgeon's hands, honey. tools, etc. Based on it, many combined antimicrobials: plivasept and plivasept-N for the treatment of the surgeon's hands, citeal solution (chlorhexidine + hexamidine + chlorcresol) for the complex therapy of bacterial, fungal and trichomonas infections of the skin and mucous membranes, erudril solution (chlorhexidine + chlorbutanol + chloroform) in addition to bactericidal anti-inflammatory and analgesic effect, sebidine (chlorhexidine + ascorbic acid) used for oral infections, inflammatory gum disease, ascorbic acid increases local immunity tissues, protects against periodontal disease.

metal salts

Metal salts (mercury, silver, copper, zinc, bismuth, lead) irreversibly block sulfhydryl groups of microbial cell enzymes.

Mercury preparations are practically not used now because of their high toxicity.

Recently, interest has increased in silver preparations (silver nitrate: protargol (contains 8% silver), collargol (70% silver), dermazin), which, in addition to a pronounced bactericidal effect, stimulate tissue regeneration, have no side effects.

Copper sulfate, zinc sulfate is used for conjunctivitis, urethritis, vaginitis, laryngitis.

Bismuth preparations xeroform, dermatol, etc. have antiseptic, astringent and drying properties, are part of various ointments and powder.

Preparations of plant and animal origin

The antimicrobial activity of plants is due to the presence in their composition of organic acids, phenols, essential oils, resins, coumarins, anthraquinones. antiseptic properties many plants possess: celandine, St. vundehil, calendula ointment, altan ointment, essential oils coniferous trees, thyme, etc. have no side effects, combine antimicrobial properties with anti-inflammatory and regenerating.

Beekeeping products (propolis, apilac, etc.), mumiyo have a multilateral antimicrobial and wound healing effect.

Dyes

Dyes that have the property of inhibiting the growth of bacteria due to the blocking of phosphate groups of nucleoproteins have not lost their relevance: methylene blue, brilliant green, ethacridine (rivanol), etc.

The arsenal of antiseptic and disinfectants is huge. Unfortunately, the antiseptics that our medical and sanitary institutions are equipped with do not meet modern requirements. In the "National List of Essential Medicines and Medical Products" the group of antiseptics includes: boric acid preparations, iodine, hydrogen peroxide, potassium permanganate, ethanol, brilliant green, chlorhexidine bigluconate, i.e., for the most part, those drugs that have been used yet during Lister's time. Until now, many medical institutions use furacillin, which is not only not active against many microorganisms, but is also an excellent breeding ground for some pathogenic and opportunistic bacteria.

The issues of providing chlorine-active preparations have been largely resolved. In Ukraine, drugs such as deactin, neochlor, chlorantoin are produced. However, there is an urgent need to produce modern means based on QAC, aldehydes, guanidines.

However, in the last decade of Ukrainian pharmaceutical industry various modern effective antiseptic and disinfectants have been developed and introduced: miramistin, decamethoxin, aethonium, chlorphyllipt, chlorhexidine, biomoy, vitasept, gembar, deoxon-O, odoxon. The issues of providing chlorine-active preparations have been largely resolved.

The trend in the development of disinfection methods in the world is in the direction of expanding the use of complex preparations. Modern combined disinfectants: steradin (iodoplex + surfactant + phosphoric acid), terralin (chlorine + propanol + surfactant), septodor forte (glutaraldehyde + quaternary ammonium compounds), sagrosept (propanol + lactic acid), decotex, sterillium, etc. , easy to use and have high activity against viruses, microbes and fungi.

Ideally rational use disinfectants, antiseptics and antibiotics should minimize the number of postoperative complications, cases of nosocomial infection and sepsis.

Literature

Disinfection. In 3 parts. Part 1. Disinfection and disinfection / A. M. Zaritsky Zhytomyr: PP "Ruta", 2001. 384 p.
Antiseptics in the prevention and treatment of infections / Paliy G. K. Kyiv: Health, 1997. 195 p.
Reference book of a general practitioner / N. P. Bochkov, V. A. Nasonov, N. R. Paleeva. In 2 volumes. Moscow: Eksmo-Press, 2002.
Medical microbiology / Pokrovsky V.I. Moscow: Botar Meditsina, 1998. 1183 p.

ANTISEPTIC AND DISINFECTANTS

Disinfectants- are designed to destroy the pathogen in the external environment, are used to disinfect rooms, patient clothes, care items, secretions, medical instruments.

Antiseptics- are used to destroy the pathogen on the surface of the human body (skin, mucous membranes, wound surfaces).

Features of antiseptics and disinfectants:

the mechanism of action is mainly related to protein coagulation

nature of action bactericidal

wide antimicrobial spectrum, no selectivity for certain microflora

habituation of the microflora does not occur

toxicity is high, so the main application is local (rarely with resorptive purposes)

a) Chlorine preparations

In aqueous solutions, they form hypochlorous acid (HClO), which decomposes in an acidic and neutral environment to form atomic oxygen and chlorine. Oxygen oxidizes and coagulates the proteins of the microbial cell, and chlorine replaces H + in the amino group, forming a chlorinated protein, which leads to disruption of the formation of H-bonds between polypeptide chains and disruption of the secondary structure of the protein. In an alkaline environment, hypochlorous acid dissociates to form a hypochlorite ion (ClO -), which also has the properties of an oxidizing agent, but its antimicrobial activity is lower than that of atomic O and Cl. Therefore, with an increase in pH, the effect of chlorine-containing antiseptics decreases. The antimicrobial activity of drugs is determined by the presence of active chlorine.

Chloramine B- a good antiseptic with a deodorizing effect. Contains 25-28% active chlorine. Does not irritate the skin. Used:

0.5 - 1% solution - treatment of hands, infected wounds

2-3% - processing of care items, patient secretions

5% - treatment of secretions of a tuberculosis patient

b) Iodine preparations

Elemental iodine has a powerful bactericidal activity, it coagulates proteins, providing a powerful regenerating effect.

Pharmacological effects of iodine:

antiseptic

antisyphilitic

antifungal

expectorant

anti-sclerotic (improves lipid metabolism)

antithyroid

absorbable

Alcohol solution of iodine used in the treatment of abrasions, scratches.

Iodinol applied externally in chronic tosillitis, purulent otitis media, trophic ulcers.

Biguanides.

Chlorhexidine acts on bacteria, fungi of the genus Candida, Trichomonas. Does not work on disputes. Used in solutions for the treatment of the hands of the surgeon and the operating field - 0.5% alcohol solution; with gingivitis, stomatitis, wound infections, gynecological practice- 0.05% aqueous solution; for washing Bladder- 0.02% aqueous solution.

Oxidizers:

Hydrogen peroxide- upon contact with tissues, it decomposes in two ways:

1. H 2 O 2 peroxidase H 2 O + O (antimicrobial action (oxidation))

2. H 2 O 2 catalase H 2 + O 2 (mechanical cleansing of wounds)

As an antiseptic, the drug is not very active, the cleansing effect is mainly expressed due to foaming. It is used to treat contaminated and purulent wounds, to rinse the mouth with stomatitis, tonsillitis. It has a hemostatic effect (due to the activation of thromboplastin and mechanical blockage of small vessels; it is dangerous to wash the cavities (uterus, bladder) due to the possibility of embolism). Preparations: diluted hydrogen peroxide solution (3%), perhydrol (concentrated solution).

Potassium permanganate- as an antiseptic, it is more active than hydrogen peroxide, because. when it decomposes, atomic oxygen is released. It also has deodorizing properties. Solutions of the drug

(0.01-0.1%) is used for washing wounds, rinsing the mouth and throat, for douching, washing the urethra. It oxidizes alkaloids and some toxins, therefore it is used for gastric lavage in case of alkaloid poisoning and food poisoning. Due to manganese oxide, it has an astringent and cauterizing effect, which is used to treat ulcers and burns (2-5% solution).

Metal compounds: these are general cellular poisons, they bind thiol groups (SH-groups) of enzymes and form albuminates with proteins. If the albuminate is dense, the action is astringent and bacteriostatic, if it is loose, the action is cauterizing and bactericidal.

According to the degree of solubility of albuminates, metals are arranged as follows:

Schmideberg series

AlPb ZnCuAghg

Solubility

Antimicrobial action

Silver nitrate- low concentrations (up to 2%) have an antimicrobial effect, in higher concentrations (5-10%) it acts as a cauterizing agent. Used in small concentrations infectious diseases eyes (trachoma, conjunctivitis), and in higher ones - in the treatment of skin ulcers, erosions, cracks, as well as to remove excess granulations, warts.

Protargol, collargol- organic preparations of silver.

zinc sulfate And copper sulfate as an antiseptic and astringents used in solutions of 0.1-0.25% for conjunctivitis, laryngitis, urethritis.

Mercury dichloride(mercuric chloride) in solutions of 1:1000 is used to disinfect linen, patient care items. Highly toxic.

Mercury oxide yellow- less toxic, used as an antiseptic for conjunctivitis, blepharitis.

Acids and alkalis: interact with proteins, the nature of the action depends on the concentration of the substance.

Weak acids have a reversible astringent effect (form gels in the surface layers). Strong acids deeply denature proteins, have a cauterizing effect, dehydrate tissues (dry necrosis - coagulation).

Weak alkalis soften the epidermis, dissolve mucus, reduce its viscosity. Strong alkalis cause tissue necrosis with their liquefaction (colliquation necrosis), penetrate deeply into tissues (deep burns).

Boric acid in the form of a 2% solution is used in eye practice, 3% - for dermatitis, pyoderma.

Ammonia solution(ammonia) has antiseptic and detergent properties. It is used for washing hands of medical personnel, for processing premises.

Aldehydes and alcohols:

Formaldehyde- used in the form of a 40% solution (formalin). Acts on bacteria, fungi, viruses. Coagulates proteins, has a powerful antimicrobial effect. It has a tanning effect, takes away water from the surface layers of fabrics. It is used for the treatment of hands, disinfection of instruments, with excessive sweating (0.5 - 1% solution), for the preservation of tissues, histological preparations, formalin vapor - for disinfection of clothing.

Ethanol 70-95% denatures proteins and has a bactericidal effect. At a concentration of 70%, it is used to treat the surgeon's hands and the patient's skin. At this concentration, ethyl alcohol has a deeper antiseptic effect on the skin (penetrates into the ducts of the sebaceous and sweat glands). In concentrations of 90-95%, they are used for disinfection - disinfection surgical instruments.

Detergents: These are cationic soaps, substances with high surface activity. They accumulate on the cell membrane of a microorganism, change the surface tension, increase permeability, which leads to swelling and death of the microorganism.

Cetylpyridinium chloride in the preparation "Zerigel" used for hand treatment.

Aromatic antiseptics:

Phenol(carbolic acid) - the oldest antiseptic, a standard for assessing the antiseptic activity of other drugs (phenol coefficient).

Phenol in small doses has a bacteriostatic effect, in large doses it has a bactericidal effect. It causes deep denaturation of the cytoplasmic protein of the microbial cell. It acts mainly on vegetative forms of bacteria, fungi and little on spores. When interacting with proteins, it does not form a strong bond and can react with several protein molecules, i.e. the presence of proteins does not reduce the antiseptic activity of phenol, so it is rational to use it to treat the patient's secretions. It is used in the form of 1-3% solutions for disinfection of linen, care items, tools. It has a pronounced irritating, local anesthetic effect; at a concentration of 2% and above - cauterizing effect. Possible poisoning by absorption through the skin.

Birch tar contains phenol and its derivatives. It has antiseptic, insecticidal, keratoplastic and keratolytic effects. It is used to treat a number of skin diseases and scabies.

Dyes: methylene blue, brilliant green, ethacridine lactate. They mainly affect the gram-positive flora, violate the enzymatic properties of microorganisms.

brilliant green- the most active dye, used in the form of 1-2% aqueous or alcoholic solutions to lubricate the skin with pyoderma and the edges of the eyelids with blepharitis.

methylene blue- as an antiseptic inferior to other dyes. It is used for cystitis, urethritis - 0.02%, ulcerative stomatitis - 0.5-1% aqueous solution, for pyoderma, burns - 1-3% alcohol solution. It is used to study the functional abilities of the kidneys. It is interesting in toxicological terms - it has powerful redox properties, can play the role of an H + acceptor and donor, and is used as an antidote for cyanide and nitrite poisoning (intravenous 1% aqueous solution).

Ethacridine(rivanol) is used in solutions of 0.05-0.1% for the treatment of wounds, washing cavities during purulent processes. For the treatment of skin diseases, a 3% ointment is used.

Nitrofurans.

Used as an antiseptic furatsilin effective against Gram-positive and Gram-negative bacteria. An aqueous solution of furacilin 0.02% is used for rinsing the mouth and throat with stomatitis, tonsillitis, for washing purulent wounds.