Community-acquired infections  Acquired in the home or any place in the community other than a health care facility

Nosocomial infections  Contracted in a hospital or institutional setting  Were not present or incubating in the patient on admission to the facility  More difficult to treat because the causative microorganisms are often drug resistant and the most virulent

Agents used to reduce the risk of nosocomial infections  Antiseptics  Inhibit growth of microorganisms but do not necessarily kill them  Used on living tissue  Disinfectants  Kill organisms  Used on nonliving surfaces

 Living tissue cannot be sterilized  Antiseptics are applied to living tissue ( skin and mucous membranes),  to reduce the risk of infection by reducing the number of microorganisms that can enter the body via an incision or injection site

 Antiseptics may be used for:  Presurgical hand scrubs for members of the surgical team  Preoperative skin preparation  Irrigation of body cavities  Forms  Surgical soaps, ointments, mouthwashes, topical solutions, douches

Disinfectants Used to remove microorganisms from inanimate objects such as tabletops and surgical equipment

 Acetic acid (vinegar)  1% or 5% solution  Benzoic, boric, or lactic acids  Antibacterial, antifungal, bladder irrigation  Otic solution or irrigation solution in various strengths

Isopropyl alcohol or ethanol  Most effective at 60% to 70% concentrations  “Cidal” activity decreases at more than 95% or less than 60%  Used as a skin astringent, cleansing agent, and to disinfect utensils

formaldehyde and glutaraldehyde (Cidex)  Caustic, and may cause burns to skin and mucous membranes  Used mostly as disinfectants  Cidex is used to sterilize surgical equipment

chlorhexidine gluconate (Hibiclens)  Used as a bactericidal skin-cleansing solution (surgical scrub, handwashing agent, and a skin wound cleanser)

Gentian violet, others  Gentian violet is used as a 1% or 2% solution  Topical antiinfective  Antibacterial and antifungal activity

 Dilute sodium hypochlorite (Dakin’s solution)  Antibacterial antiseptic irrigation  5% solution used to disinfect utensils, floors, furniture  0.5% solution used topically on the skin  Household bleach solutions are 5.25%  halazone: chloramine compound  Available in tablet form  Used to sanitize drinking water 1 or 2 tablets in a liter of water can kill water-borne pathogens within 30 to 60 minutes

 thimerosal (Merthiolate)  Organic mercurial agent  Topical antiseptic, primarily antibacterial  Bacteriostatic  Less irritating and less toxic than inorganic mercurials  Ammoniated mercury  Inorganic mercurial agent  Used to treat impetigo, psoriasis, pediculosis, other skin conditions

 Iodine tincture and solution  Kill all forms of microorganisms  Used as a topical antiseptic  povidone-iodine (Betadine)  Comes in various forms Aerosol, topical solution, mouthwash, surgical scrub

 hydrogen peroxide  Bactericidal and virucidal; higher concentrations are sporicidal  Use as wound irrigation solution is controversial may be detrimental to wound healing in that it can destroy newly forming cells as well as bacteria  benzoyl peroxide  potassium permanganate

 cresol, carbolic acid (phenol), Lysol  Used as disinfectants; can burn and blister skin  chloraseptic  used as an oral antiseptic  hexachlorophene  Bacteriostatic skin cleanser and surgical scrub  resorcinol  Used for a variety of skin conditions

 benzalkonium chloride (Zephiran)  Bacteriostatic at low concentrations  Bactericidal and fungicidal at high concentrations  Used as a skin cleanser, antiseptic irrigation solution, and for instrument storage

 Assess for drug and other allergies, or previous sensitivities to antiseptics or other topical agents  If an iodine-based agent is to be used, assess for allergies to iodine or seafood  these allergies are contraindications  Before using antiseptics, assess:  The concentration of the medication  Length of exposure to the skin  Condition of the skin  Size of area affected  Hydration status of the skin

 Before applying a topical agent, ensure correct technique and adequate supplies needed for the procedure  Assess the area to be treated beforehand  Follow specific directions for cleansing the area  Follow manufacturer’s specific guidelines for application  Protect the site as ordered with a dressing if needed  Teach the patient proper technique for application of the medication and dressings as needed

When using these agents on inanimate objects, be sure to protect the patient (and yourself!) from accidental exposure

 Monitor for therapeutic response  Improved healing of the affected area  Decreased symptoms of inflammation or infection  Prevention of infection  Monitor for adverse effects or reactions