Antiseptics & Disinfectants

-:Introduction:- Antimicrobial:- the substances derived from natural or synthetic sources that kills or inhibit the growth of microorganism such as bacteria, fungi, protozoas

Germicides:- a group of drugs that are able to inhibit the growth, development or leads to death of microorganisms in the environment surrounding the patient or on the surface of the body.  Specially agents which inhibits or kills microbes on contact  They have low margin of safety  Non-systemic use  Non selective Antimicrobial agents 2 GermicidesGermicides

ANTISEPTICS DISINFECTANTS

ANTISEPTICS:-ANTISEPTICS:- (Anti=(Anti= against; septicas – emitting a fetid smell) Chemical substances which are used to destroy, inhibit pathogenic bacteria (not the spores) on animate (living) surface such as skin, eye, mucous membranes(as in mouth washes). 1879- Lister- Father of ‘Antiseptic surgery’ They falls under “ Drug Control Agency of the Government” DISINFECTANTS • Chemical substances or germicides which are use to destroy or inhibit the growth of pathogenic vegetative bacteria (not their spores) on inanimate(non-living) surface such as glassware's or surgical instruments. e.g.- Formaldehyde, phenol, ethyl alcohol, soaps.

 They falls under “Control of Environmental protection agency of the Government”

 They process “concentration dependent killing”  Antiseptics & Disinfectant are often added to easily available every day utilities like soaps,toothpastes,mouth wash, after saving lotion. 4 -:Some ancillary terms:- 1.Sterilization:- Definition:- freeing an article, a surface or a medium by removing or killing all micro-organisms including vegetative bacteria, Spores, fungi & viruses

 usually sterilization is affected by autoclaving at 15lb pressure of stream at 120oC for atleast 30 min [It is the ultimate goal of any infection control protocol] Other methods also include- o Infra-red(IR)-radiation, o Ultraviolet(UV)-radiation o γ-radiation 2. Decontamination:- Marketed destruction of viable pathogenic organisms to a level that will allow a healthy person’s natural defenses to prevent any infection. e.g.- Decontamination of water

3.Sanitisation:- reduction In microbial load from an inanimate surface to a level set forth by public health Department of Environmental Agency  These levels are considered acceptable for the health of the population 4. Pasteurisation:- Process of heating milk or other liquids or semisolids for about 30 min at 60-80oC which kills the non- sporulating microorganism and prevents the growth of food-borne pathogens for a specific period of time.

5.Preservation:- To preserve the efficacy & to prevent the deterioration of the drug formulation up to its expiry period. A Preservatives may protect the drug from oxidation. e.g.-Benzyl Alcohol(2%),Benzoic Acid & its salts (0.2%)

7 -:-:IDEALIDEAL Antiseptics/DisinfectantAntiseptics/Disinfectant:-:- • HighHigh Efficacy:Efficacy: – BroadBroad spectrumspectrum // sporicidalsporicidal // killkill allall formsforms – RapidRapid onsetonset // longlong durationduration actionaction – Cidal not static – Active in presence of blood, pus,exudates and excreta – No Resistance • NonNon Toxic:Toxic: – Non-irritating to tissues,should not delay healing. – Non absorbable / No hypersensitivity – ChemicallyChemically stable.stable.

8 IDEALIDEAL ANTISEPTICSANTISEPTICS :: • Added Advantage:- – Non-staining with agreeable color and odour – Could be added to soaps – Non corrosive.

9 MECHANISM OF ACTION:

1. Oxidation of Bacterial protoplasm. e.g.- KMn04, H202, Halogens 2.Denaturation of Bacterial Proteins & Enzyme e.g.-Phenols, Chlorhexidine, Alcohol, Aldehyde 3.Detergent like action increasing permeability of bacterial membrane e.g.- Soaps,Cetrimide

10 FACTORSFACTORS MODIFYINGMODIFYING ACTIONACTION • TEMPERATURE AND pH.

• PERIOD OF CONTACT WITH MICROBES.

• NATURE OF MICROBES INVOLVED.

• SIZE OF INNOCULUM

• PRESENCE OF BLOOD,PUS,OR ORGANIC MATTER.

11 General Uses of Antiseptics/ Disinfectants • Asepsis before injections:- • Surgical Uses:- – Asepsis before surgery – Scrubbing – Sterilization of the surgical instruments • Cuts, wounds & Lacerations • Disinfection of Hospital premises • Water purification & domestic disinfection

12 CLASSIFICATIONCLASSIFICATION :-:-‘PHAARMA GOD’ • PHENOL DERIVATIVES:- Phenol,Cresol,Hexylresorcinol,HexachlorophenePhenol,Cresol,Hexylresorcinol,Hexachlorophene • HALOGENS:-Iodine,Iodine, Iodophores,Iodophores, Chlorine,Chlorine, ChlorophoresChlorophores • ALCOHOLS:-ethanol:-ethanol ,, Isopropanol.Isopropanol. • ALDEHYDES:-:- Formaldehyde,Formaldehyde, GlutaraldehydeGlutaraldehyde • SUSURRFACEFACE ACTIVEACTIVE AGENTS:-AGENTS:- • QUATERNARY AMMONIUM (CATIONIC):- Cetrimide, Benzalkonium chloride, Dequalinium chloride. BIGUANIDE:- Chlorhexidine • SOAPS:- OF sodium & Potassium

13 • MMETALLICETALLIC SALTSSALTS:-:- Silver nitrate, Silver sulfadiazine, Mild silver protein, Zinc sulfate, Calamine, Zinc oxide. • AACIDSCIDS:-:- Boric acid, Acetic acid • GGASESASES:-:- EthyleneEthylene oxideoxide

• OOXIDIZINGXIDIZING AGENTSAGENTS:-:- KMnoKMno4,,Hydrogen peroxide, Benzoyl peroxide

• DDYESYES:- GENTIAN VIOLET, METHYLENE BLUE BRILIANT GREEN, ACRIFLAVIN AND PROFLAVIN

• MMISCELLANEOUSISCELLANEOUS:-:- NITROFURAZONENITROFURAZONE 14

PHENOLPHENOL DERIVATIVESDERIVATIVES:: • PHENOL (CARBOLIC ACID):- • One of the earliest used Antiseptics & still the standard for comparing other germicides. • Weak agents Static at- 0.2% Bactericidal at >1%, • Poor action bacterial spore • ProtoplasmicProtoplasmic poisonpoison MOA:- Denatured bacterial protein (irritant/toxic(irritant/toxic toto tissues)tissues) -Mild-Mild LALA action-action- useuse asas AntipruriticAntipruritic PreparationPreparation USESUSES:: DisinfectantDisinfectant ofof Urine,faecesUrine,faeces pus,sputum,antipruriticpus,sputum,antipruritic preparationpreparation mouthmouth wash.wash.

SideSide effecteffect:-Buccal,:-Buccal, esophageal,esophageal, gastricgastric burns,burns, scars/stricturesscars/strictures

15 CRESOL (METHYL PHENOL):- • X3X3 potentpotent thanthan PhenolPhenol // lessless damagedamage toto tissuestissues • USES:-USES:- DisinfectingDisinfecting ofof utensils,utensils, Excreta,Excreta, forfor washingwashing hands,hands, irrigationirrigation ofof rootroot canals.canals. CHLOROXYLENOL(DETTOL):- • Non-corrosive,Non-corrosive, Non-irritatingNon-irritating toto intactintact skin,skin, NoNo stain,stain,  4.8%4.8% commercialcommercial useuse “Dettol”(9%“Dettol”(9% terpinol+13%terpinol+13% Alcohol)Alcohol)  6.25%-6.25%- InstrumentsInstruments  CreamCream && Soap,Soap,  LubricatingLubricating obstetricobstetric creamcream (1.4%(1.4% ).). • USESUSES:-:- SurgicalSurgical AntisepticsAntiseptics ,, skinskin cream,cream, mouthmouth wash,wash, soaps,soaps, woundswounds && cutscuts • HEXACHLOROPHENE: • POTENTPOTENT CHLORINATEDCHLORINATED PHENOLPHENOL • Odourless,Odourless, nonnon staining,staining, nonnon irritantirritant (+soaps)(+soaps) • SustainedSustained actionaction • Good-Good- Gm+ve/Gm+ve/ Poor-Poor- Gm-veGm-ve && sporesspores • USESUSES:- ANTISEPTICSANTISEPTICS FORFOR SURGICALSURGICAL SCRUB,SCRUB, TOILETTOILET PRODUCTSPRODUCTS && DEODRANTS,DEODRANTS, SkinSkin infectionsinfections (Furunculosis/(Furunculosis/ Carbuncle),Carbuncle), babybaby bathbath productsproducts (<2%).(<2%). • Side effect:- NeurotoxicityNeurotoxicity (Neonates)->2%-(Neonates)->2%- BAN.BAN.

17 Phenol Derivatives (contd.) • Triclosan:-uses- Liquid soaps, Dentifrices, mouth wash • Thymol:- – Antiseptic / mild LA effect – Uses- cough drops / Dentifrices / Acne / mouth wash • Resorcinol- less potent than Phenol • Uses- Antiseptic (ringworm, acne, ), keratolytic & antipruritic effect (Seborrhoeic dermatitis, Eczema, Psoriasis • Hexylresorcinol- mouthwash

18 Contains are menthol, thymol, methyl salicylate, and eucalyptol

19 OXIDIZINGOXIDIZING AGENTS:-AGENTS:- • POTASSIUM PERMAGNATE:- • HIGHLYHIGHLY WATERWATER SOLUBLE.SOLUBLE. • NascentNascent [O]-OXIDIZES[O]-OXIDIZES BACTERIALBACTERIAL PROTOPLASMPROTOPLASM.. USESUSES:-:- 1:4000-1:10,0001:4000-1:10,000 SOLNSOLN ((CONDY’SCONDY’S LOTIONLOTION)-)- – Antiseptic(Mouthwash/GARGLING/DOUCHING,Antiseptic(Mouthwash/GARGLING/DOUCHING, IRRIGATINGIRRIGATING CAVITIES/CAVITIES/ wounds/wounds/ AtheletesAtheletes footfoot (1%)(1%) – DomesticDomestic use-DISINFECTIONuse-DISINFECTION OFOF utensils/utensils/ vegetables/vegetables/ fruits/fruits/ purificationpurification ofof WATERWATER (ponds/(ponds/ wells)wells) – GASTRICGASTRIC LAVAGELAVAGE (in(in alkaloidalalkaloidal poisoning)poisoning) – StypticStyptic (5%)(5%) • SideSide effecteffect:-:- BURNS,BLISTERINGBURNS,BLISTERING /stain/stain // RustingRusting // sensitvesensitve toto light.light.

20 OXIDIZINGOXIDIZING AGENTS:AGENTS:

HH2OO2 –– Adv.- – Non-toxic/ colorless/ odourless – Effective against anaerobic bacteria • Demerits- – Weak antiseptic – To be kept in dark bottles • Uses- – Dental use- Mouthwash (3%)- dilute with water- stomatitis/ cavity preparation

– Bleaching agent (for teeth stains)- 30% H2O2 + glycerine+ pumice – Surgical use (3-6%)- wound cleaning / slough remove – Removal of ear wax – Deodorant – Styptic (25-30%) • BENZOYL PEROXIDE:-

• LiberateLiberate 002,killsAnerobic,microaerophilic,killsAnerobic,microaerophilic bacteriabacteria KeratolyticKeratolytic && comedolyticcomedolytic properties-properties-(To remove warts and other lesions in which the epidermis produces excess skin) • USESUSES:-:-ACNEACNE (2.5-10%(2.5-10% cream),cream), ANTISEPTICSANTISEPTICS.. ADVERSEADVERSE EFFECTSEFFECTS:-:- Burning, stinging sensation, localized erythmia, dryness of skin, SCALING EDEMA.

22 HALOGENS:HALOGENS:- Chlorine & Cl- IODINE & I- releasing releasing agents: agents: • Rapid action • Rapid action • Broad spectrum • Broad spectrum • readily inactivated by • Not readily inactivated organic matter by organic matter • MICROBICIDALMICROBICIDAL • MICROBICIDALMICROBICIDAL AGENT,AGENT, AGENT,AGENT, IODINATESIODINATES CHLORINATESCHLORINATES ANDAND ANDAND OXIDIZESOXIDIZES OXIDIZESOXIDIZES MICROBIALMICROBIAL MICROBIALMICROBIAL PROTOPLASMPROTOPLASM PROTOPLASMPROTOPLASM HALOGENS:HALOGENS:- • IODINE: USES:USES: ((1:20,0001:20,000 ,, SOLNSOLN KILLKILL VEGETATIVEVEGETATIVE FORM-FORM- ANTISEPTICANTISEPTIC USES)USES) 1.TINCTURE1.TINCTURE IODINEIODINE (2.5%(2.5% ININ ALCOHOL)ALCOHOL) 2.MANDL’S2.MANDL’S THROATTHROAT PAINTPAINT (1.25%(1.25% ININ POTPOT .IODIDE).IODIDE) FORFOR SORESORE THROAT.THROAT. 3.COUNTER3.COUNTER IRRITANTIRRITANT 4.4. WATERWATER PURIFICATIONPURIFICATION. ADRsADRs: CORROSIVE,BURNS,BLISTERS,CORROSIVE,BURNS,BLISTERS, RASHES,RASHES, stain,stain, irritant,irritant, lessless durationduration ofof actionaction • ToTo bebe keptkept inin darkdark coloredcolored bottles.bottles.

24 IODOPHORES:- • SOLUBLESOLUBLE COMPLEXCOMPLEX OFOF IODINE.IODINE. • SlowSlow RELEASERELEASE ofof FREEFREE IODINEIODINE • NON-IRRITATING,NONTOXIC,NonNON-IRRITATING,NONTOXIC,Non stainingstaining • USES:-USES:- POVIDONEPOVIDONE IODINEIODINE (POLYVINYL(POLYVINYL PYRROLIDONEPYRROLIDONE Iodine)-Iodine)- – FORFOR BOILS,FURUNCULOSIS,BURNS,OTITISBOILS,FURUNCULOSIS,BURNS,OTITIS EXTERNA,EXTERNA, ULCER,VAGINITIS,SURGICALULCER,VAGINITIS,SURGICAL SCRUBBING,DISINFECTIONSCRUBBING,DISINFECTION OFOF ENDOSCOPICENDOSCOPIC INSTRUMENTS,INSTRUMENTS, TineaTinea infectionsinfections (5%-(5%- cream,cream, solution,solution, OintmentOintment – DentalDental uses-uses- MouthMouth wash/wash/ GargleGargle (2%)(2%) – AnalgesicAnalgesic (Iodine(Iodine (4%)(4%) creams-creams- analgesics}analgesics}

25 • CHLORINE:- • HIGHLYHIGHLY REACTIVEREACTIVE • POTENTPOTENT GERMICIDEGERMICIDE • USESUSES:: DISINFECTIONDISINFECTION OFOF URBANURBAN WATERWATER SUPPLIESSUPPLIES

(Cl(Cl2 gas-gas- 0.2-0.2- 0.4ppm)0.4ppm) • CHLOROPHORES:- • COMPOUNDCOMPOUND RELEASESRELEASES hypochlorous.hypochlorous. • TYPES:-TYPES:-1.CHLORONATED LIME (BLEACHING POWDER) • USES:USES: • DisinfectionDisinfection ofof drinkingdrinking water,water, • SwimmingSwimming poolpool • SanitizerSanitizer • ToothTooth stainsstains removalremoval 26 2.SODIUM HYPOCHLORITE SOLN:- USESUSES:(4-6%):(4-6%) DISINFECTANTDISINFECTANT ININ DAIRIESDAIRIES FORFOR MILKMILK CANS,CANS, LabLab disinfectant,disinfectant, BiohazardBiohazard SpillSpill management,management, EQUIPMENTS,ANTISEPTIC,ROOTEQUIPMENTS,ANTISEPTIC,ROOT CANALCANAL THERAPY,THERAPY, alsoalso usedused asas BleachingBleaching agentagent inin dentistrydentistry • 3.DAKIN SOLN: DILUTEDILUTE SOD.SOD. HYPOCHLORITEHYPOCHLORITE BUFFEREDBUFFERED WITHWITH BORICBORIC ACIDACID.. • 4.EUSOL: (chlorinatedchlorinated limelime 1.25%+Boric1.25%+Boric acid).acid). • USESUSES:-:- DissolvingDissolving pus,pus, BloodBlood clots,clots, NecroticNecrotic matter,matter, CleanClean infectedinfected wound,wound,

27 -:QUATERNARY AMMONIUM (CATIONIC ANTISEPTICS):- • Detergents,CidalDetergents,Cidal toto bacteria,bacteria, FungalFungal &viruses,&viruses, nonnon irritating,irritating, mildmild keratolytickeratolytic.. • USESUSES:-:- Sanitizer,Sanitizer, AntisepticsAntiseptics,, DisinfectantDisinfectant forfor surgicalsurgical instrument,instrument, glovesgloves.. • CETRIMIDE:- • soapysoapy powderpowder withwith faintfaint ,fishy,fishy odorsodors • woundwound clearingclearing fromfrom dirtdirt ,skin,skin disinfectant,disinfectant, • Anti-plaqueAnti-plaque agentagent,, • AsAs antiseptics,antiseptics, SurgicalSurgical instruments,instruments, utensilutensil

28 • CetylCetyl pyridiniumpyridinium Chloride-Chloride- mouthmouth wash,wash, antiplaqueantiplaque agentagent,, LozengesLozenges • BenzalkoniumBenzalkonium Chloride-Chloride- storagestorage ofof sterilesterile surgicalsurgical instrumentsinstruments • SOAPSSOAPS:-:- • AnionicAnionic detergents,detergents, weakweak AntisepticsAntiseptics • Sod.Sod. OrOr Pot.Pot. SaltsSalts ofof largelarge chainchain fattyfatty acidsacids • EmulsifyingEmulsifying agents.agents. • AffectiveAffective against-gm+Veagainst-gm+Ve • USEDUSED FORFOR CLEANSINGCLEANSING ACTIONACTION • SodiumSodium LaurylLauryl sulphatesulphate.

29 -:CHLOROHEXIDINE:- • Cationic biguanide which highly Powerful, on-irritating, colorless, odorless antiseptics • Spectrum of activity:- Active against gm+ve bacteria Moderately active against –gm-ve bacteria

MOA:- Disrupt bacterial membrane. • Effective in the presence of pus, blood, organic matter. • Exhibits residual activity after repeated use • Savlon liquid antiseptics:- Chlorhexidine gluconate 1.5% + cetrimide 3% exhibits enhanced efficacy • Formulation available:- lotion, Cream,

Washes, Aqueous solution 30 (Savlon is a combination of Chlorhexidine gluconate & cetrimide)

31 USES:-  Bath, Neonatal bath, surgical scrub,  Dental use-  mouthwash including candidiasis (0.1-0.2% mouth wash)  Aqueous solution In mouth wash-↓dental plaque accumulation  Obstetrics (1% cream) & skin antiseptics & clearing of wounds(0.05% aqueous solution)  Preoperative clearing of skin(0.5% solution in 70% alcohol)  Anti-plaque agent(prevent periodic disease)  In catheterisation & cystoscopy- gel (0.25% chlorhexidine+xylocaine)  Disinfection of hydrophilic contact lenses-0.002-0.005% chlorhexidine

Side effects:- Yellow brown stain, Altered taste, mucosal soreness -:ALCOHOLS:--:ALCOHOLS:- MOA- ppts bacterial proteins /cidal • ETHANOL:ETHANOL: • EFFECTIVE ANTISEPTIC on skin (not on muc. Membrane) / rapid action • CLEANSING AGENT AT 40-90% CONC. • ADRs: BURNING SENSATION,INJURY, irritant on Muc. membranes. • Uses- wounds/ cuts, degerming of skin before injections (Isopropyl alcohol)

33 ALDEHYDES:ALDEHYDES:

• MOA- DENATURES BACTERIAL PROTEINS. • PROTOPLASMIC POISON. • FORMALDEHYDE (Formalin): slow antiseptic, broad spectrum, sporicidal • USES: Disinfection of surgical instruments (2-8%), Preservation of dead tissue samples (4% aqueous Solution), fumigation, urinary antiseptic (Methenamine) • ADRs: ECZEMATOID REACTIONS, irritates,No oral use.

34 ALDEHYDES:ALDEHYDES: • GLUTARALDEHYDE:  Sterilizing agents  Less irritating  Less pungent ,  Broad spectrum ,not inactivated by Bio fluids,  Activated at alkaline pH. • USES: 1. Cold sterilization- Disinfection of surgical instruments , Endoscopes (to be kept for 12 hrs) 2. Hospital disinfectant of premises / OTs

35 Acids:-Acids:- • BORIC ACID:- • Bacteriostatic & Weak antiseptics , • Non irritating • USES:- • Irritating eyes (4%), • Mouth washes • Boroglycerin paint (30%)- stomatitis ,Glossitis 2.CUTS AND ABRASION (10%), 3.PRICKLY HEAT POWDERS,EAR DROPS,IRRIGATING BLADDER. • ADRs:- vomiting ,Abdominal pain Diarrhoea, visual

& kidney damage 36 • ACETICACETIC ACIDACID:-:- Oldest antiseptic, BACTERICIDALBACTERICIDAL –– FORFOR BURNBURN DRESSING(>5%),DRESSING(>5%), effectiveeffective againstagainst PseudomonasPseudomonas..

• SalicylicSalicylic acid-acid- Bacteriostatic,Bacteriostatic, KeratolyticKeratolytic ((>25%),25%), FungicidalFungicidal (3%-(3%- WhitfieldWhitfield Oint.)Oint.)

• BenzoicBenzoic acid-acid- FungistaticFungistatic (6%-(6%- WhitfieldWhitfield Oint.)Oint.)

37 METALLIC SALTS:- Mercury compounds:- • Bacterioststics & Poor antiseptics • Low TI • INACTIVATES SH-ENZYMES. • 1.AMMONIUM MERCURY: • 5-10% ointments, dermatophytosis • Anal purities

38 • 2.PHENYL2.PHENYL MERCURICMERCURIC NITRATENITRATE:: USES: IN TINEA REMEDIES,ANORECTAL PREPARATIONS, OTIC, OCULAR PREPARATIONS & PRESERVATIVES.

MERBROMIN (Mercurochrome): • BRIGHT RED, ORGANIC MERCURIAL. • NON-IRRITATING & LESS TOXIC. • USES: 1-2% FOR EYES AND SKIN antiseptic.

39 SILVERSILVER COMOUNDSCOMOUNDS:: • ASTRINGENT & CAUSTIC. • REACT WITH -SH,-COOH,-PO4,-NH2 PROTEINS. • SILVERSILVER NITRATENITRATE (slow(slow AgAg release)release) • RAPIDILY KILLS MICROBES. • USES: Opthalmia Neonatarum (1% soln.) SOLN., APTHOUS ULCER • Demerits: black discoloration of tissues SILVER SULFADIAZINE: • No black discoloration. • USES: AS OINTMENT IN BURNS / effective in Pseudomonas inf.. 40 ZINCZINC SALTSSALTS:: • ASTRINGENT & MILD ANTISEPTICS.

• 1.ZINC SULFATE: WATER SOLUBLE. • USES: EYE & EAR DROPS, Mouth wash, EYE WASH, FOR ACNE AND IMPETIGO, Lotiocalamine (Zno + Calamine), Anti Perspirants.

41 DYES:DYES: • Complex organic substances derived from coal tar • Gentian violet (crystal violet): • Rosaniline dye. • Active against staphylococci,gram +ve bacteria, fungi. • Uses: alcoholic soln (0.5%) for furunculosis, bed sores, chronic ulcers,infective eczema, thrush, ringworm. • Demerits- poor efficacy against Gm-ve & in the presence of pus, blue stain on skin

Briliant green :-rosaniline dye.

42 • Acridine Dyes: Acriflavin and Proflavin: • Orange-yellow acridine dyes • Active against gram + ve bacteria &gonococci. • Sensitive to light & lose efficacy • Effective in alk. pH • Non irritant. • Uses: chronic ulcers,wounds, burn dressings, Triple dye lotion-gentian violet 0.25%+briliant green 0.25%+ acriflavin 0.1% for burns. Dressing in umbilical stump in neonates. • Demerits- to be stored in amber coloured bottles

43 FURANFURAN DERIVATIVES:DERIVATIVES:

• Nitrofurozone: • Cidal for gram +ve & gram –ve,aerobic &anaerobic bacteria.

• Inhibits enzymes for carbohydrates metabolism.

• Use- Efficacious in burns,skin grafting.

44 Chronic Toxicity- Skeletal Fluorosis