What is the proper use of antiseptics and disinfectants according to infection control guidelines?

From the Guidelines

The proper use of antiseptics and disinfectants according to infection control guidelines involves following the manufacturers' instructions for correct use of cleaning and EPA-registered hospital disinfecting products, avoiding the use of liquid chemical sterilants/high-level disinfectants for environmental surfaces, and using personal protective equipment (PPE) as appropriate. When selecting an antiseptic or disinfectant, it is crucial to identify the specific application and target microorganisms. For skin antisepsis before procedures, chlorhexidine gluconate 2% with 70% alcohol is generally superior to povidone-iodine for preventing surgical site infections, as noted in guidelines 1.

Key Considerations for Antiseptics and Disinfectants

• For environmental disinfection, the choice of disinfectant depends on the surface and the level of microbial kill required, with options including sodium hypochlorite (bleach) for blood spills, quaternary ammonium compounds for general surfaces, and 70% alcohol for small equipment 1.
• The effectiveness of these agents depends on proper concentration, adequate contact time, and compatibility with the material being treated.
• Always follow manufacturer's instructions, as improper use can lead to reduced efficacy, material damage, or increased microbial resistance.

Application and Target Microorganisms

• For skin preparation, the preferred agent for immunization and venipuncture is 70% isopropyl alcohol, while for invasive procedures, a preparation containing 2% chlorhexidine gluconate/70% isopropyl alcohol is preferred for children 2 months and older 1.
• For wound cleansing, options include povidone-iodine 10% solution (diluted 1:10 with saline), chlorhexidine 0.05-0.5%, or hydrogen peroxide 3% (used cautiously due to tissue toxicity).

Safety and Handling

• To prevent contamination, bottles of antiseptics should be dated, not refilled, and discarded if not used within 28 days after opening 1.
• Alcohol pads, chlorhexidine gluconate, and iodine products prepared in single-use packs can help minimize the risk of contamination.

From the FDA Drug Label

Directions Use with care in premature infants or infants under 2 months of age. These products may cause irritation or chemical burns attention to the nails, cuticles, and interdigital spaces a separate nail cleaner may be used rinse thoroughly wash for an additional 3 minutes with 5 ml of product and rinse under running water dry thoroughly Healthcare personnel handwash wet hands with water dispense about 5 ml of product into cupped hands and wash in a vigorous manner for 15 seconds rinse and dry thoroughly Patient preoperative skin preparation apply product liberally to surgical site and swab for at least 2 minutes and dry with a sterile towel repeat procedure for an additional 2 minutes and dry with a sterile towel Skin wound and general skin cleansing thoroughly rinse the area to be cleaned with water apply the minimum amount of product necessary to cover the skin or wound area and wash gently rinse again thoroughly Principal Display Panel – Pouch Label NDC 17518-060-04 Not Made With Natural Rubber Latex Do Not Reuse 3M Skin and Nasal Antiseptic Skin and Nasal Antiseptic (Povidone-Iodine Solution 5% w/w (0.5% available iodine) USP) Patient Preoperative Skin Preparation Non-Sterile Solution Each Pouch Contains: 1 Bottle 0.14 fl oz (4 mL) 4 Sterile Swabs Applicators are sterile if swab pouch is intact REF 192401 Directions First Aid Antiseptic clean the affected area apply a small amount of product on the area 1 to 3 times a day may be covered with a sterile bandage if bandaged, let dry first Oral Debriding Agent (oral rinse): Adults and children 2 years of age & over: mix with an equal amount of water swish around in the mouth over the affected area for at least 1 minute and then spit out use up to 4 times daily after meals and at bedtime or as directed by a dentist or doctor children under 12 years of age should be supervised in the use of this product children under 2 years of age: consult a dentist or doctor

The proper use of antiseptics and disinfectants according to infection control guidelines includes:

• Healthcare personnel handwash: wet hands with water, dispense about 5 ml of product into cupped hands, and wash in a vigorous manner for 15 seconds, then rinse and dry thoroughly 2
• Patient preoperative skin preparation: apply product liberally to surgical site and swab for at least 2 minutes, then dry with a sterile towel, and repeat the procedure for an additional 2 minutes 2
• Skin wound and general skin cleansing: thoroughly rinse the area to be cleaned with water, apply the minimum amount of product necessary to cover the skin or wound area, and wash gently, then rinse again thoroughly 2
• First Aid Antiseptic: clean the affected area, apply a small amount of product on the area 1 to 3 times a day, and may be covered with a sterile bandage if bandaged, let dry first 3

From the Research

Proper Use of Antiseptics and Disinfectants

The proper use of antiseptics and disinfectants is crucial in infection control guidelines. According to the studies, the following points are essential:

• The method of disinfection and sterilization depends on the intended use of the medical device: critical items must be sterilized before use, semicritical items must be high-level disinfected, and noncritical items should receive low-level disinfection 4.
• Cleaning should always precede high-level disinfection and sterilization 4.
• For skin antisepsis, chlorhexidine plus alcohol provides greater protection of peripheral venous catheter-related infectious complications than does povidone iodine plus alcohol 5.
• The use of innovative devices, such as closed integrated catheters and disinfecting caps, can extend the catheter complication-free dwell time 5.

Types of Disinfectants

Different types of disinfectants have varying levels of effectiveness against different microorganisms. For example:

• 2% alkaline glutaraldehyde and 70% ethanol or isopropanol are effective against herpes virus in 1 min 6.
• Hypochlorite solutions (2500 ppm av. Cl2) are effective against herpes virus in 5 min, but povidone-iodine (10%) is slower in action 6.
• Peracetic acid-based disinfectants are effective against C. difficile spores in suspension tests and 4-field tests 7.
• Not all surface disinfectants with a sporicidal claim are effective against C. difficile spores, and preference should be given to products that reliably pass the efficacy criteria of both types of tests 7.

Considerations for Antiseptic Use

The use of antiseptics in wound care is controversial due to their potential toxicity to living human tissue. However:

• Antiseptics have a broad spectrum of activity that makes them effective against a broad range of microorganisms 8.
• The evolution of antibiotic-resistant bacteria has led to renewed interest in antiseptics, and modern antiseptic dressings are being developed 8.
• The decision to use antiseptics should be made on a case-by-case basis, taking into account the complexities of the situation and seeking expert advice when necessary 8.