Types of antiseptics, methods of application. Modern antiseptics in the prevention of healthcare-associated infections Modern antiseptics

Antiseptics and disinfectants

Irina Kuchma, KhMAPO

Antiseptic agents for the prevention and treatment of local infectious diseases ( festering 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 cider vinegar, lime, formic acid and various alcohols for this purpose.

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

The German obstetrician I.F. Semmelweis, the Russian surgeon N.I. Pirogov and the English surgeon J. Lister scientifically substantiated, developed and introduced antiseptic methods for the treatment of purulent diseases and the prevention of sepsis. Semmelweis used bleach to disinfect hands (1847), N. I. Pirogov used solutions of silver nitrate, iodine, ethyl alcohol (1847–1856) 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 the microbial origin of purulent and putrefactive processes, Lister, in order to destroy microorganisms, disinfected the air by spraying a solution of carbolic acid into the operating room. The surgeon's hands, instruments, and surgical field were also disinfected with 2–5% solutions of carbolic acid. This method has dramatically reduced the number of 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 considered antiseptic medicines, which have an antimicrobial effect on microorganisms located on the skin and mucous membranes.

Antimicrobial agents that decontaminate environmental objects are called disinfectants.

The emergence of systemic antimicrobial chemotherapeutic agents for internal use in the early 20th century and antibiotics in the 1940s created 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 is often the case in life, the lack of a sense of proportion, a tribute to fashion and distrust of the old tried and tested means unreasonably narrowed the scope of antiseptics.

The widespread, not always rational use of antibiotics has led to the spread of nosocomial infections, a sharp increase in wound infections 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 preparations in comparison with the internal environment of the body, therefore, higher concentrations of antiseptic agents can be used to disinfect them.

Infectious diseases of the skin, eyes, nasopharynx, external auditory 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:

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

Disinfection - the destruction of microorganisms in the external environment: disinfection of patient care items, discharge 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 industries; 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 are highly active compounds, strong reducing agents that irreversibly bind proteins and nucleic acids. Preparations containing aldehydes: formaldehyde, lysoform, citral, cimesol, ciminal - are used for purulent wounds, phlegmon, burns of 1-2 degrees, trophic ulcers ah, for douching in gynecology, cidipol (ciminal + dimexide + polyethylene oxide 400) is used to treat the genital organs in order to prevent and treat 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 medical items (cystoscopes, catheters, laparoscopes, endoscopes, hemodiaanalyzers, etc.) in gas sterilizers using 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 types of 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 a strong odor, 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 a wide variety of microbial cell structures, primarily free sulfhydryl groups (-SH).

Preparations containing chlorine: chloramine B (25% available chlorine), chloramine D (50% available 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) - 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 recent years, iodophors, complex compounds of iodine with surfactants or polymers, have been increasingly used. Iodophors do not have an irritating and allergic effect, retain high bactericidal activity in the presence of organic substances - protein, blood, pus.

Iodophor preparations include: iodonate (an aqueous solution of a surfactant complex with iodine) - widely used for disinfection of the surgical 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 - to treat phlegmon, abscesses, bedsores, fistulas; sulidopyrone (iodopirone + surfactant) - for disinfection of the surgical field, the 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. In Ukraine, the drug polyvinylpyrrolidone iodine - iodovidone - is produced for complex treatment wounds and processing of the surgical field and hands of the surgeon.

Oxidizers

Oxidizing agents cause destruction of the bacterial cell membrane.

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% performic acid solution and 1% sulfuric acid solution) is used for various types of disinfection. In 1% persteril solution, all naturally occurring microorganisms and their spores die;
• deoxon-1 (10% peroxide solution, 15% acetic acid solution + 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 the treatment of wound surfaces, the surgical field, the 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 a negative one (anionic surfactants). They disrupt the permeability of the cytoplasmic membrane of microbial cells, inhibit enzymes associated with the membrane, and irreversibly disrupt 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 disinfecting surgical gloves), dekasan (broad antiseptic), deseptol suppositories (for the treatment of trichomonas, fungal and bacterial diseases of the 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 - 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 cleaning properties, low toxicity, and the absence of a strong 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.

Combined preparations include: Sanifect-128, Septodor-Forte, Terralin, Sentabik, Virkon.

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 antimicrobial preparations have been created: plivasept and plivasept-N - for treating the hands of a surgeon, citeal solution (chlorhexidine + hexamidine + chlorcresol) - for complex therapy bacterial, fungal and trichomonas infections of the skin and mucous membranes, erudril solution (chlorhexidine + chlorobutanol + chloroform) - in addition to bactericidal, it has an anti-inflammatory and analgesic effect, sebidine (chlorhexidine + ascorbic acid) - is used for infections of the oral cavity, inflammatory diseases gums, ascorbic acid increases local tissue immunity, 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 powders.

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. Many plants have antiseptic properties: celandine, St. John's wort, chamomile, calendula, sage, thyme, eucalyptus, walnut, birch, lingonberry, plantain, aloe, kolanchoe, juniper fruits, etc. Preparations from plant antiseptics: recutan, rotokan, befungin, vundehil, calendula ointment, altan ointment, essential oils coniferous trees, thyme, etc. - do not have side effects, combine antimicrobial properties with anti-inflammatory and regenerating properties.

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, antiseptics, with which our medical and sanitary institutions are equipped, 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. - low toxicity , easy to use and have high activity against viruses, microbes and fungi.

Ideally, the prudent use of disinfectants, antiseptics, and antibiotics should minimize postoperative complications, nosocomial infections, and sepsis.

Literature

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

Detailed instructions for different types medical antiseptics for wound treatment: what are antiseptics, how do they work and how to choose the right drug for different types of damage

Summer has come - the time for outdoor activities, cottages and gardens. The time of abrasions and wounds, and hence the high demand for antiseptics. More than 250 trade names of antiseptic agents in the form of ointments, solutions, sprays and powders are registered in Russia. Let's see which drugs are antiseptics in medicine, how they differ from each other and which of them can be recommended for each home first aid kit.

First of all, we note that the pharmacist independently selects a remedy only for external use, and the choice of an antiseptic for the mucous membranes of the nasopharynx, gastrointestinal tract, respiratory and urinary tract, as well as for the genitals remains with the doctor. Also recall that many antiseptics should not be applied to injured skin. Here are two main points to consider when selling and talking to a client. The mechanism of action of antiseptics may be different, depending on the main active ingredient.

Classification of antiseptics

All these substances have different degrees of activity, antimicrobial spectrum and toxicity. To understand how to choose the right antiseptic, it is necessary to be guided by all these characteristics in accordance with the goal: primary wound treatment, treatment of festering wounds, or treatment of damaged mucous or intact skin / mucous membranes. When choosing which antiseptic to treat a particular wound, it is imperative to focus on the instructions in order to avoid side effects, as well as determine the dosage required in a particular case. Let us consider in more detail the most popular antiseptics.

Ethanol

At a concentration of 40 to 70%, it shows its disinfecting properties, above 70% - tanning. It is commercially available in the form of alcohol-containing wipes and alcohol solutions. It is not applied to mucous membranes, as it causes a chemical burn. Only the edges of a pre-washed wound are treated with ethyl alcohol. It is not recommended for use in children, since even with external application it can be absorbed into the systemic circulation and inhibit the respiratory center.

Hydrogen peroxide

For the treatment of wounds, only a 3% solution is used (a higher concentration can cause a chemical burn). It is also used as a hemostatic agent. Hydrogen peroxide is an excellent tool for primary wound treatment (washing), as it has a great cleansing ability - with the resulting foam, dirt particles and damaged cells are mechanically removed. It is possible to treat wounds both on the surface of the skin and on the mucous membranes. Hydrogen peroxide is generally not used on healing wounds, as it lengthens the full healing period. Also, it is not used for deep wounds and is not injected into body cavities. When stored in the light, it loses its active properties. Opened packaging is stored for about a month, closed - 2 years.

Iodine/povidone-iodine

It is used in an alcohol solution (the so-called "tincture of iodine") or in Lugol's solution. Only the edges of the wound are treated with iodine so as not to cause soft tissue burns. The great advantage of iodine is its broad spectrum of antimicrobial activity: it kills all major pathogens and, with prolonged exposure, even spores, the most resistant forms of microorganisms. The use of large amounts of iodine is contraindicated in case of hypersensitivity to it, hyperfunction thyroid gland, formations of the thyroid gland, dermatitis, kidney disease. Application to mucous membranes is not desirable, especially in children.

Chlorhexidine bigluconate

Belongs to the group of halides. Typically used at a concentration of 0.5-4.0%. At lower concentrations, the bactericidal activity of chlorhexidine decreases, therefore, as an antiseptic in this case, it is used only in an alcohol solution. Chlorhexidine has bacteriostatic, fungicidal, antiviral properties. However, 1% chlorhexidine against fungi and Mycobacterium tuberculosis has a weaker effect compared to povidone-iodine. The drug can be used for the primary treatment of injured skin areas, as well as to accelerate the healing of purulent wounds and to treat damaged mucous membranes. In most cases, it is well tolerated. There are no age restrictions on the use - a good option for an antiseptic for children. It is not recommended to use together with iodine preparations (often skin irritation).

Benzyldimethyl-myristoylamino-propylammonium

It is used as a solution for washing wounds or as an ointment for application to purulent wounds. It is active against viruses, bacteria, fungi, protozoa, but it has practically no effect on human cell membranes, unlike chlorhexidine. It has an antiseptic, immunostimulating and wound healing effect. The immunostimulatory effect is associated with the ability of the drug to increase the activity of phagocytes and macrophages. The positive effect on wound healing is due to the fact that active substance absorbs pus and fluid released during inflammation of wounds. At the same time, the agent does not irritate healthy tissues and does not interfere with the growth of new tissues. The main indication for use is the prevention of suppuration and the treatment of purulent wounds. Application to mucous membranes is possible. It is possible to use for the treatment of wounds in children older than 3 years.

Potassium permanganate (potassium permanganate)

Currently, it is used mainly in a hospital setting. In a pharmacy, an antiseptic is sold in the form of a powder for preparing a solution. Potassium permanganate is used to wash the wounds of the skin and mucous membranes. Suitable for primary treatment and for the treatment of festering wounds (it has cleansing properties due to active oxygen), especially when there is a risk of anaerobic microorganisms entering the wound. Before washing the wound, you need to prepare a fresh solution each time.

Brilliant green solution

Everyone's favorite green. Available in the form of alcohol solutions and pencils. It has a moderate antiseptic effect, effective against gram-positive bacteria. Only the edges of wounds are treated with a solution, without going into damaged tissues. Has a drying effect. It is applied before the period when fresh granulation tissue begins to appear in the wound, since prolonged use prevents adequate tightening of the wound edges. Can be used as a baby antiseptic.

Fukortsin

Coloring antiseptic. A combination of fuchsin, boric acid, phenol, acetone, resorcinol and ethanol. Indications for the use of fucorcin are fungal and pustular skin diseases, abrasions, cracks, etc. It is applied to the edges of wounds. It has a less drying effect than brilliant green and iodine. In the treatment of wounds, it is used much less frequently. It is undesirable to use in children because of the boric acid and phenol that make up the composition, which have a large number of side effects. When applied to the skin, boric acid easily penetrates into the bloodstream (especially in children) and enters internal organs and tissues accumulating there. Therefore, prolonged use can cause intoxication. This property forced to sharply limit the use of boric acid, especially in childhood. Phenol also has the ability to easily penetrate the skin and lead to intoxication of internal organs.

Octenidine (octenidine dihydrochloride)

Cationic surfactant with antimicrobial activity against gram-positive and gram-negative bacteria, viruses, as well as against yeast-like fungi and dermatophytes (fungi that feed on keratin and cause dermatomycosis). It is similar in its action to quaternary ammonium compounds (QAC). The damaged surface is completely processed. Can be used on mucous membranes. The antiseptic has no age restrictions, it is used for children. It is currently the drug of choice in Europe as an antiseptic due to its wide spectrum of action and maximum speed achieving an effect.

Table 1.
Comparative characteristics basic antiseptics

In every first aid kit

So, what remedies can a pharmacy worker recommend to a buyer for a home first aid kit? First of all, these are benzyldimethyl-myristoylamino-propylammonium and octenidine, as the most versatile and safe means. These drugs are the drugs of choice and should be recommended first. Also quite versatile is chlorhexidine, which is used on intact tissues and for the treatment of wounds, including mucous membranes. As for solutions of brilliant green and iodine, it is necessary to inform the buyer that these antiseptics are only suitable for treating wound edges and should not be used on mucous membranes. Thus, among the entire list of antiseptics on the pharmaceutical market, a fairly small number of drugs have universal application possibilities.

Sources

1. Kharkevich D. A. Pharmacology. M. Geotar Medicine. 2010.
2. Blatun L. A. Miramistin in a comprehensive program to combat hospital infection in a surgical hospital // Miramistin: application in surgery, traumatology and combustiology: collection of works / ed. Yu. S. Krivosheina. M., 2006.
3. Carolin Fromm-Dornieden, Gorovtsov A. V., Nadine Schöfer, Ewa K. Stuermer. Comparison of the rate of growth suppression of E. COLI, STAPHYLOCOCCUSAUREUS and PSEUDOMONASAERUGINOSA by modern antiseptics for the purpose of their use for infected wounds // Basic Research. - 2013. - № 10–2.

For citation: Cherkashin M.A. Local antiseptics in surgical practice // BC. 2007. No. 22. S. 1648-1650

Prevention and treatment surgical infections is currently one of the most difficult tasks. The wide prevalence and availability of antimicrobial chemotherapy agents contributes to the growth of resistant forms of microorganisms. Nosocomial infections are becoming increasingly important. Sometimes a dramatic situation develops - after a seemingly small intervention, rather severe and unpleasant wound complications develop, often requiring surgical assistance. In 30% of surgical patients in the postoperative period, infectious complications of various localization develop (the area of ​​the surgical incision, the respiratory organs, the organs of the urinary system). An important problem is the reinfection of wound surfaces with hospital strains from the hands of medical personnel, bed linen, suture and dressing material in intensive care units, in groups of patients with handicapped movement (after violations cerebral circulation) . Among other things, the period of inpatient treatment is lengthened, which reduces both the patient's ability to work and his quality of life, not to mention pharmacoeconomic indicators. So, according to E.A. Oganesyan et al. (2003), A.A. Belozer et al. (2003), the length of stay of patients in the hospital is increased by 15-18 days.

One of the important aspects of solving this problem is the impact on the pathogen. The leading role in this, undoubtedly, belongs to the means of antimicrobial chemotherapy.
Rational antibiotic therapy is the cornerstone in the treatment of any infectious process. Especially when it comes to nosocomial pathogens.
But we should not forget about the second part of the treatment strategy. Local treatment also plays an important role.
Topical preparations include topical antiseptics and topical forms of antibiotics.
Currently, a huge number of antiseptic products are used in domestic healthcare. At the same time, it is no secret to anyone that many drugs are obsolete due to the fact that:
pathogenic microorganisms developed resistance mechanisms;
for many years of use, the medical staff developed allergic reactions;
there is an inconvenience on the part of logistics - heavy, voluminous and fragile containers;
many preparations need to be prepared "on demand" because there are no long-term storage dosage forms.
For example, many antiseptics intended for the treatment of the surgical field, the surgeon's hands, the skin before injections, the introduction of vascular catheters, elbows before vascular puncture, do not always provide reliable sterility. Recent studies show that hospital strains of microorganisms are resistant to traditional antiseptics (furatsilin, chlorhexidine aqueous solution, potassium permanganate solution). In a solution of furacilin Ps. aeruginosa persists at 106 cfu/ml.
The most widely used in the treatment of wound infections are chemical antiseptics.
Means of chemical antiseptics in our country are usually classified as follows:
I. Halogen group:
1. Chloramine B
2. Iodine alcohol solution 5-10%
3. Iodine preparations: iodonate 1% solution, iodinol 1% solution, iodopyrone 1% solution
II. Oxidizers:
1. Solution of hydrogen peroxide
2. Perhydrol, contains about 30% hydrogen peroxide, is used to prepare a solution of pervomur
3. Potassium permanganate
III. Acids:
1. Boric acid
2. Formic acid
3. Hydrochloric acid
IV. Aldehydes:
1. Formaldehyde
2. Lysoform
3. Formalin
V. Phenols:
1. Carbolic acid
2. Ichthyol
VI. Alcohols
VII. Hypertonic solutions:
1. Hypertonic solution - 10% solution of sodium chloride
2. 30% solution of urea
3. 40% r-r glucose
VIII. Dyes:
1. Methylene blue 1-3% alcohol solution
2. Brilliant green (brilliant green)
3. Rivanol
IX. Heavy metal salts:
1. Silver nitrate
2. Sublimate (mercury dichloride)
3. Silver salts: collargol and protargol
X. Detergents:
1. Chlorhexidine bigluconate
2. Zerigel
3. Rokkal - 10% and 1% aqueous solution
XI. Nitrofuran derivatives:
1. Furacillin - for the treatment of wounds, instruments, washing cavities
2. Furadonin, furazolidone
3. Furagin
In practical surgery, traumatology, military field surgery, drugs that can be used directly in the wound play an important role. Based on this, rather stringent requirements should be imposed on such antiseptics:
non-toxicity
hypoallergenicity
high bactericidal activity
ease of use in any conditions (preferably ready-made dosage form in convenient packaging).
Traditionally, for the treatment of wound surfaces, antiseptics from the group of halides (iodine alcohol solution), oxidizing agents (hydrogen peroxide), dyes (brilliant green) are used.
Currently, there are a number of drugs created on the basis of high technologies. Silver-based preparations, various long-term wound dressings, wet wound healing media, etc. are very promising.
One of the modern local antiseptics is polyvinylpyrrolidone iodine (Vokadin and others).
What are its merits?
Polyvinylpyrrolidone itself is a biologically inert polymer molecule.
Polyvinylpyrrolidone binds halides to form galexes, which have a strong disinfecting effect. The complex of PVP with iodine was first obtained by Shelansky, who showed that polyvinylpyrrolidone forms an odorless reddish-brown complex with iodine in an aqueous solution. In combination with polyvinylpyrrolidone, iodine loses its ability to burn tissues, but retains high bactericidal activity, which made it possible to expand the scope of iodine as an antiseptic. Thanks to the polymer molecule, iodine penetrates deep into the wound into inflamed tissues, under the scab, etc.
The drug has a wide spectrum of antimicrobial action: bactericidal, fungicidal, selective virucidal, tuberculocidal, protocidal.
Contraindications to the use of polyvinylpyrrolidone-iodine are:
sensitivity to iodine
hyperthyroidism
thyroid adenoma
dermatitis
kidney failure
The drug can be used both for treating the surgeon's hands before operations (there is a form of Vokadin in the form of soap), for treating the surgical field, and for local treatment of wounds (1% solution for local application and 5% topical ointment) and to prevent infection before surgery or diagnostic procedures in the vagina ( vaginal suppositories and tablets).
Polyvinylpyrrolidone iodine can be used in all phases of the wound process.
A huge problem in almost all hospitals (not only surgical, but also neurological, therapeutic) are bedsores that form in patients with limited mobility. Traditional methods of preventing the formation of bedsores by treating problem areas of the skin (sacrum, shoulder blades, heels and other areas) with a solution of potassium permanganate today can be considered as an ineffective method that contributes to the involvement of deep anatomical structures. A solution of potassium permanganate is not active against the main pathogens of nosocomial infection. The resulting dense scab as a result of daily skin treatments with this antiseptic creates ideal greenhouse conditions for the development of deep phlegmon. However, when using a solution or water-soluble ointment polyvinylpyrrolidone-iodine, favorable conditions for the reproduction of microorganisms are not created, since due to PVP, an iodine conductor, the drug penetrates well under the scab.
A serious problem of modern health care both in our country and in the whole world is the treatment of severe forms of venous insufficiency accompanied by trophic disorders.
It is now generally accepted that venous trophic ulcers occur in 2% of the adult population of industrialized countries.
In our country, the insufficient development of the system of public phlebological care leads to the fact that often patients turn to a specialist with a long-term trophic ulcer. Many patients prefer to self-treat for a long time using various systemic and local remedies, which in no way improves their condition.
In general, there is such a situation that patients most often seek qualified help for purulent inflammation.
Wound infection plays a large role in stimulating local autoimmune processes, thus turning on the "negative Feedback" And chronic inflammation exists for a long time, creating, in turn, the conditions for the persistence of infection.
A feature of the treatment of venous ulcers is the impossibility and senselessness of using most topical forms of antibiotics, because in an acidic environment, they break down very quickly and do not provide the proper therapeutic effect. In this regard, local antiseptics and antibiotics that work at low pH values ​​should be used. In the exudation phase, antiseptics are one of the important components of treatment, since it is necessary to achieve maximum cleansing of the ulcer from necrotic tissues and suppress the infection. It would be logical to use a solution of PVP-iodine (this allows you to wash the wound). In the repair phase, one of the goals of treatment is the prevention of reinfection, and here also antiseptics cannot be dispensed with. In this phase, it is possible to use the ointment form of the drug.
In the outpatient practice of polyclinic surgeons, a large place is occupied by the treatment of purulent-destructive processes in the soft tissues of the hand and foot (panaritium, paronychia, phlegmon). The most important condition for successful treatment is the drainage of the focus, the evacuation of purulent discharge, systemic antibiotic therapy and, of course, local treatment which is unthinkable without the use of antiseptics. In such cases, polyvinylpyrrolidone-iodine is indispensable, since the polymer molecule allows iodine to penetrate into inflamed tissues.
Thus, the polyvinylpyrrolidone–iodine complex is a highly effective, safe, and convenient local antiseptic agent. Vokadin can be widely used in surgical practice for the treatment of various wounds, surgical infections, burns, bedsores, and trophic ulcers. Iodophors must be included in the medical kit when stockpiling supplies for disaster medicine teams, military medical service.

Literature

1. Blatun L.A. Modern iodophors - effective drugs for the prevention and treatment of infectious complications. Consilium medicum. 2005, volume 7 #1.
2. Oganesyan E.A., Pavlov S.I., Petkova V.A. Epidemiological surveillance of nosocomial infections in the Kaluga region. Sat: Contemporary Issues epidemiology, diagnosis and prevention of nosocomial infections. St. Petersburg, 2003; from. 61–63.
3. Belozer A.A., Smirnov O.A., Petkova V.A. Infection control for nosocomial infections in the emergency room medical care. Modern problems of epidemiology, diagnosis and prevention of nosocomial infections. St. Petersburg, 2003; from. 75–77.
4. Novikova N.F., Mordovtsev V.N., Parenkova T.V. New possibilities for the treatment of trophic ulcers, skin and soft tissue wounds, bedsores and fistulas. – Consilium provisorum, 2001, v.1, N4. - P.30.
5. Phlebology. A Guide for Physicians under. ed. V.S. Saveliev. M., Medicine. 2001.
6. Lode H. Catheter-associated infections in the ICU. Proceedings of the International Conference "Nosocomial Infections in Intensive Care Units". 1998; from. 15–16.

Antiseptics for the treatment of wounds are in every home first aid kit. But do people always choose the right way to treat a wound? After all, it is not without reason that there are several different solutions, each of which should be used to treat certain wounds and sores. Today we will find out why we need an antiseptic? Consider the 9 most popular and inexpensive tools and understand their differences.

What is an antiseptic?

Let us immediately turn to the Greek translation of the term: anti - against, septikos - putrid. And an antiseptic is really called any remedy that is able to fight bacteria caused by decomposition processes, and also serves as a prevention of their reproduction.

Antiseptics have been known since ancient times. The embalming of corpses was carried out with means that prevented the processes of decay, otherwise some of the finds would not have survived to their contemporaries. But antiseptics began to be popularized only from the middle of the 19th century, when the first trials of surgical operations using carbolic acid began.

By the way! Antiseptics are not used for wound healing, but for their disinfection, i.e. to kill infection and prevent inflammation.

Antiseptics are now used not only in medicine, but also in other areas. For example, in the woodworking industry for impregnation of wood in order to avoid the development of putrefactive processes. Logs for a bath, which will constantly be in a humid environment, definitely need pretreatment antiseptic impregnations. So, what are antiseptics?

9 best antiseptics

Carbolic acid, which was first used as a body antiseptic, is not used today due to its danger. In fact, it is a harmful phenol, which in large quantities can cause poisoning. But over 150 years, many different antiseptics have been invented that meet all the necessary requirements, namely:

All these requirements are met to varying degrees by at least 9 antiseptics, which are considered the most effective and affordable.

The antiseptic effect of ethyl alcohol does not last long. As soon as the alcohol evaporates (30-40 seconds), the action stops. But usually it is enough to destroy the most active microbes. Ethanol is primarily treated for small, fresh wounds and cuts, but should not be used continuously. Alcohol dries out the skin and, if used frequently, can cause microtrauma. The cost of one bottle of ethanol (100 ml) is small: about 30 rubles.

Aqueous solution of Furacilin

Furacilin is a broad spectrum antimicrobial agent. It is used more often in the form of an aqueous solution, although it is possible to prepare it with alcohol. An aqueous solution of Furacilin is good to use for the treatment of wounds and sores on the mucous membrane: in the oral cavity, nose, vagina. But it also works great as a skin antiseptic (ulcers, burns).

Furacilin is sold in the form of ready-made solutions (60-70 rubles per 100 ml), tablets that need to be ground into powder before dissolving (80-90 rubles for 10 pcs.), As well as effervescent self-dissolving tablets (110-120 rubles for 10 pcs. ).

It is a so-called antiseptic-antioxidant, which, upon contact with the skin, releases oxygen. This is indicated by the bubbles that appear when peroxide is applied to the wound. The more bubbles, the more pollution. Treatment of the wound with hydrogen peroxide is very effective on postoperative sutures, as the resulting foam automatically washes away dirt without requiring wiping the wound.

Despite the apparent aggressiveness of hydrogen peroxide, it is a fairly mild antiseptic that can also be used for mucous membranes. For example, they can moisten a cotton swab and insert it into the nostril to stop bleeding and treat the damaged vessel. At the same time, it is an excellent drying agent. The cost of a bottle of peroxide (10 ml) is approximately 40 rubles.

Potassium permanganate solution

It has an antimicrobial and disinfectant effect due to the oxidizing ability of manganese. Potassium permanganate is used to treat wounds, sores, burns. But it is important to prepare a weak solution, because a highly concentrated one can cause a chemical burn to the skin.

At home, it is not recommended to use potassium permanganate precisely because of ignorance of the exact concentration for certain wounds and non-compliance with the technique of its preparation. But pink water is suitable, for example, for wetting a dried bandage. In a pharmacy, potassium permanganate is sold in the form of burgundy crystals and is called Potassium permanganate. The cost of a five-gram vial is 60-70 rubles.

Good old antiseptic, which is in almost every home. For the treatment of wounds, a 5% solution is used, although in some cases it is necessary to dilute it to a less concentrated one. Iodine is good for treating fresh cuts and shallow wounds.

It is not recommended to use iodine solution for the treatment of wounds received more than 5 days ago, as well as acne, bedsores and thermal burns. Also, iodine should be used with caution in people suffering from endocrine diseases. 10 ml of iodine costs only 10-15 rubles.

Or simply brilliant green, which is so disliked in the USA, believing that it is toxic. But in Russia, this antiseptic is the most popular. Perhaps there is no person who would never come across a brilliant green. It has an excellent antimicrobial effect, but it does not damage tissues and does not cause burns, such as iodine. The content of ethyl alcohol in brilliant green makes the antiseptic even more effective in use for both fresh and old wounds.

A solution of brilliant green is able to fight not only gram-positive and gram-negative bacteria, but also dangerous Staphylococcus aureus and diphtheria bacillus. Another plus of brilliant green: the ability to stimulate tissue regeneration. And this is the cheapest antiseptic: the cost of a bottle (10 ml) is 10 rubles. Against the background of all the pluses, only one minus is distinguished: a rich green color that is washed off for a very long time. And in order not to stain yourself and everything around with brilliant green, you can use not a standard bottle, but a special pencil. It costs 50-60 rubles.

Otherwise, it is called "red brilliant green", although its properties are somewhat different from those of a solution of brilliant green. Fukortsin also contains ethyl alcohol, as well as boric acid and phenol. Therefore, it must be used with caution.

Fukortsin is used to disinfect wounds, prevent their suppuration and stop the process that has already begun. Suitable for the treatment of purulent and fungal skin diseases. It is used for abrasions, erosive wounds, acne on the face. The cost of a bottle of Fukortsin (25 ml) is approximately 40 rubles.

Chlorhexidine bigluconate

An antiseptic that is rarely found in a home first aid kit because it is not universal. Chlorhexidine bigluconate (or as it is called more simply - Chlorhexidine) is prescribed by a doctor, and in a certain concentration.

For example, 0.05% is used to rinse the throat and rinse the nose, and a more concentrated solution is needed to treat wounds on the skin: from 0.1 to 0.5%. Chlorhexidine is good for festering wounds and burns. It is suitable for the prevention of sexually transmitted diseases (genital organs can be treated with a 0.1% solution).

Important! For open wounds and mucous membranes, an aqueous solution of Chlorhexidine is used. Alcohol is also used by surgeons for rubbing hands before operations, processing tools and instruments.

Depending on the concentration of Chlorhexidine, it is able to fight certain types of bacteria and infections. The cost of a bottle of an aqueous solution of 0.05% costs less than 10 rubles per 100 ml. Alcohol will cost 10-15 rubles more.

A universal antiseptic that appeared relatively recently and immediately became popular. Its basis is a complex monohydrate. Those who have tried Miramistin once rarely return to other means. It has a very wide spectrum of action, it perfectly fights infections of the throat, nose, and genital tract, and is suitable for suture treatment. Another plus is that it is absolutely tasteless and does not sting, even if you treat severe and deep wounds.

The minus of Miramistin is its price. This is the most expensive antiseptic presented earlier. A bottle of 150 ml costs 340-350 rubles. But it is economically used, thanks to the spray nozzle.

There are also antiseptic ointments that also work effectively ( Ichthyol ointment, Vishnevsky ointment, Tetracycline, Erythromycin, Levomekol, etc.) and antibacterial powders for wounds (Gentaksan, Baneocin, Streptocid, Xeroform, Galagran).

How to properly treat an open wound

Antiseptic treatment requires any, even a minor wound. The cat scratched, the burr came off, they were damaged during shaving - it is necessary to treat the wound in order to avoid its infection and the development of gangrene. There are cases when a negligent attitude towards oneself led to serious consequences, and, for example, an infection got into the body due to a squeezed and untreated pimple.

Having received a wound (any damage to the skin that provoked bleeding), you must immediately exclude any contact with it. Then take an antiseptic and apply it to the wound with a piece of cotton wool or a bandage, or simply by spraying it. Then, if the damage is serious, you should consult a doctor. If it’s not serious, you can stick a patch on top or bandage it.

Attention! Before treating a deep wound with an antiseptic, you need to stop heavy bleeding. This is done with a pressure bandage or pulling the vessel with a tourniquet according to all the rules of first aid.

It turns out that out of the nine antiseptics listed, it is optimal to use Miramistin, brilliant green or hydrogen peroxide. These are the three most versatile tools that meet the maximum number of requirements. They perfectly disinfect wounds, do not cause pain in the victim, do not cause irritation and toxic poisoning of the body.