Surgical antiseptics

Abstract

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.

Absorption and tolerability of aqueous chlorhexidine gluconate used for skin antisepsis prior to catheter insertion in preterm neonates

“…We observed that most infants with detectable serum chlorhexidine concentrations had their highest measured concentrations 2 to 3 days after exposure. Chlorhexidine is a cationic biguanide that strongly binds to protein in the outermost layer of the skin, which contributes to its effectiveness as an antimicrobial agent (16). Hexachlorophene, another antimicrobial agent that leaves a residue on the skin, has also been shown to have delayed absorption in neonates (17).…”

Safety of chlorhexidine gluconate used for skin antisepsis in the preterm infant

“…Chlorhexidine more strongly binds to protein in the outermost layer of the skin, withstanding removal by alcohol and immediately decreasing organisms on the skin after one application. 18 Although numerous studies have assessed CHG absorption in term infants with no reports of neurotoxicity, residual concerns have limited its use in some hospitalized neonates, especially low birth weight preterm infants. 19 This population with increased vulnerability to infection may benefit from the antiseptic effects of CHG.…”

Fundamentos básicos para a cirurgia e cuidados perioperatórios

“…O álcool iodado a 1 ou 2% é germicida de largo espectro, mesmo para esporulados; apesar de eficaz e barato não possui efeito residual e pode provocar reação dermatológica de hipersensibilidade em alguns pacientes. Os derivados da clorhexidina têm atividade antibacteriana duradoura, ação residual e raramente provocam reação alérgica 7 , mas podem custar mais que os iodofóricos.…”