chapter  7
30 Pages

A Pragmatic Approach to Judicious Selection and Proper Use of Disinfectant and Antiseptic Agents in Healthcare Settings ..................................................................... Vesna Sˇuljagic´

CONTENTS 7.1 Introduction ............................................................................................... 126 7.2 Cleaning...................................................................................................... 126 7.3 Disinfection ................................................................................................ 127

7.3.1 Commonly Used Disinfectants in Healthcare Settings .......... 130 7.3.1.1 Quaternary Ammonium Compounds........................ 130 7.3.1.2 Phenolics.......................................................................... 131 7.3.1.3 Iodophors ........................................................................ 131 7.3.1.4 Chlorine and Chlorine Compounds ........................... 132 7.3.1.5 Alcohols ........................................................................... 132 7.3.1.6 Peracetic Acid................................................................. 133 7.3.1.7 Hydrogen Peroxide ....................................................... 133 7.3.1.8 Aldehydes ....................................................................... 134

7.3.2 Regulatory Framework for Disinfectants.................................. 135 7.4 Antiseptic Agents...................................................................................... 136

7.4.1 Commonly Used Antiseptic Agents in Healthcare Settings.... 137 7.4.1.1 Alcohols ........................................................................... 137 7.4.1.2 Iodine and Iodophors.................................................... 138 7.4.1.3 Chlorhexidine ................................................................. 139 7.4.1.4 Hexachlorophene ........................................................... 139 7.4.1.5 Triclosan .......................................................................... 140 7.4.1.6 Quaternary Ammonium Compounds........................ 140

7.4.2 Regulatory Framework for Antiseptic Agents......................... 140 7.4.3 Hand Hygiene ............................................................................... 141 7.4.4 Antiseptic Shower......................................................................... 142 7.4.5 Skin Preparation of Surgical Sites .............................................. 143 7.4.6 Preparation of Skin or Mucosa during Placement

of Invasive Devices....................................................................... 143

7.5 Special Considerations in Twenty-First Century ................................ 145 7.5.1 Severe Acute Respiratory Syndrome......................................... 145 7.5.2 Avian Influenza............................................................................. 146

7.6 Conclusion ................................................................................................. 147 References ........................................................................................................... 148

In today’s world we are becoming increasingly aware of the problem of nosocomial infections. At any time about 1.4 million people worldwide are suffering from some type (urinary tract infection, surgical site infections, lung infection, bloodstream infection, etc.) of nosocomial infection. About 5%–10% of hospitalized patients in developed countries and much more in developing countries (over 25% patients in some countries) acquire one or more infection during hospitalization [1]. Also, we are aware that approximately one-third of nosocomial infections are preventable and infection control can be very cost-effective. Because of this, infection prevention is important in healthcare settings. We have to protect the patients from infectious agents likely to be acquired during different medical procedures (surgical, invasive, etc.). Also, we have to protect medical staff from infectious agents, because they maintain high level of close interpersonal contact with patients and their blood, body fluids, tissues, mucous membranes, nonintact skin, as an essential part of delivery of care.