2. The Antiseptic Solutions are the anti-infectious drugs that are active against the microorganisms present on the skin and mucous membranes. Their use were forgotten in the period where the antibiotherapy had gained great reputation and use after their discovery. Nowadays, the resistance to antibiotics revealed the importance again of antiseptics and their proper usage.

3. By definition, Antisepsis is the operation with momentary results that allows at the living tissues to eliminate or kill microorganisms and/or inactivate viruses. Results of this operation are limited to microorganisms and/or viruses present at the time of operation.

4. RESISTANCE: Naturally in certain species resistance exists against antiseptics e.g. mycobateria are resistant to quantermary ammonium compounds. As a result of prolonged use of the same antiseptic solution, a layer of microbes arises and becomes resistant to this antiseptic solution.

5. Mode of Action of Antiseptics The most important actions are observed on the cytoplasmic membranes & the respiratory system of microorganisms. Action on viruses is neither still nor well known. Bacterial spores are very resistant to antiseptics.

6. SOME IMPORTANT NOTES There are some bacteriostatic tests that determine the minimal inhibitory concentration (MIC). To know the bacteriostatic activity of an antiseptic is not enough, it is necessary to determine its bactericidal activity. The antiseptic activity depends on:- - Nature of the solvent. - The pH of the solution. - The electrolytes concentration. - The presence or absence of proteins, lipids and other tensioactif substances.

7. PRESERVATION OF ANTISEPTICS 1- Some antiseptics are inactivated by heat of light or may be absorbed by plastics and can be unstable in diluted solutions. 2- The major risk is the contamination by resistant microbes. e.g. of antiseptics evoquing resistance are members of quantermary ammonium compound and phenols e.g. of resistant organisms: Pseudomonas. Some precautions should be taken in hospital wards for the preservation of Antiseptics efficiency

8. PRECAUTION TO USE:- The Antiseptic should be kept in sterile bottle. The cover should be in good state, sterile, tightly closed not cork. Avoid water stagnation at orifice of the bottle. For dilution use always sterile water. The used container should be small so as to avoid as possible using the same container frequently, sometimes it is better to use it once (disposable).

9. GENERAL SIDE EFFECTS OF ANTISEPTIC Principal side effects on skin are: - - Cutaneous irritation - Allergic reactions In case of accidental infection or ingestion (drinking) of a sufficient volume toxic effect are observed.

10. EFFECT OF ANTISEPTICS ON NORMAL FLORA:- On skin and mucous membranes, repeated application leads to diminution of normal flora, which can be replaced by another virulent infectious germs. Formation of resistant layers that substitutes the normal flora.

11. DISTRIBUTION OF NORMAL FLORA Cutaneous Flora Some examples of Flora at different parts of the body

12. Quantitative estimation of Cutaneous Flora, by organisms numbers

13. I. Phenols & Derivatives. II. Chlorehexidine. III.Quanternary Ammonium Compounds. IV.Halogens. V. Alcohols. Principal Groups of Antiseptics Antiseptics consists into 5 main groups which are:

14. Phenols had been used for the first time by Lister in 1867. Actually, rarely used due to their toxicity especially that their activity are mainly against Gram +ve and much less against Gram-ve and very little against mycobacteria. They are strongly inactivated by protein substances e.g. blood serum. etc… I.Phenols & Derivatives

15. Chlorehexidine combines strongly with the spore capsule but cannot penetrate the spore. It acts on spores during their formation and inhibits bacterial growth after germination. However, they can be sporicidal at temp. above >70  C with prolonged contact. II.Chlorehexidine One of the biguanidine derivatives. In aqueous solutions Chlorehexidine is active against most vegetative form of Gram +ve and Gram –ve bacteria. - Activity on Spores

16. Synergistic action can be obtained by the association of Chlorehexidine and Alcohol. But we cannot forget that Chlorehexidine activity is inhibited by organic substances. - Activity on Viruses Different pattern of activities on the different types of viruses. E.g. not active against poliovirus but activity is good in Vitro against viruses as herpes virus. Foaming solution of Chlorehexidine at 4% concentration and Alcoholic solution at 0.5% are active against HIV within 15 seconds.

17. Clinical applications of the Ammonium Quanternary compounds are due to their properties. -as Antiseptics -Foaming agents that can be spread on skin and mucos membrane surfaces. But mostly the actions are very slow on human skin. III. Quanternary Ammonium Compounds It is a large and important group having activity as Antiseptics & Detergents. They are more active against Gram+ve bacteria than the Gram –ve specially the Pseudomonas which are known to be resistant. They can be sporostatic but not sporicidal. Their action against viruses is controversial.

18. Halogens are effective anti-microbial and antiviral agents Some of them like Chloride, Bromide, Fluoride are irritant so they are used as disinfectants rather than Antiseptics. But Iodine is very well tolerated by the skin and mucous membrane can be used as antiseptic. Iodine is bacteriocidal, sporoicidal and antiviral. Due to its rapid action, iodine solutions are used for the antisepsis of hands, surgical field, pre-injection. Iodine antisepsis must not be associated with mercurial antiseptics. IV. Halogens

19. Alcohols are bactericidal and fungicidal, they can be active against some viruses but they are not sporicidal. A solution of 70% Ethyl Alcohol is bactericidal but its activity is less when it is at 95%. Ethanol at a dilution of 70% is active on the cutaneous flora, it can remove 90% of the germs in 30 seconds. Associated with other antiseptics such as Chlorehexidine its power is enhanced. V. Alcohols

20. On the other hand, Antagonistic effect is also observed. That’s why it is necessary to use these associations carefully because as the germicidal effects are added also the toxic effect can always be added. - Association of Antiseptics The synergisitc effect of the association of several antiseptics encouraged their commercial use. e.g. - Chlorehexidine and Aromatic Alchohols - Chlorehexidine and Quaternary ammonium compounds.

21. Utilization of Antiseptics in Medical Practice Antiseptics are used for prevention and treatment of infectious diseases in three cases

22. I. Intact Skin * Antisepsis Before Surgical Intervention The Antisepsis of the skin at the time of the surgical intervention for the surgical team and patient skin. The products mainly used are: -Povidine Iodide -Chlorehexidine in Alcohol. This should be preceded by an antiseptic soap for hands and surgical area.

23. * Antisepsis of the Hands Antisepsis of the hands is implemented in two cases: a)Surgical Hand Wash: Surgeons and nurses must have great care to hand wash by scrubbing using antiseptic soap or ordinary liquid soap followed by the alcoholic antiseptic. b)Hygienic Hand Wash: Its aim is to prevent contamination by hands during caring of patients. The products used must have 2 qualities:- -Safe for the skin as it is an every day use. -Rapid, bactericidal and persistent activity.

24. II. Wounded Skin A. Antisepsis of Wounds For clean wounds the application of an Iodide solution or Alcoholic Chlorehexidine is satisfactory for infected wounds cleaning with a foaming antiseptic is necessary, then application of antiseptic. B. Antisepsis of Burns or Ulcers Wounds of burns are always denuded from skin and the antiseptic used should be irritant to exposed areas and granulation tissue.

25. III. Antisepsis of Mucous Membranes and Peritoneal Tissues In this case, the Antiseptics used are always diluted for the fragility of the tissues. We can say that the antiseptics keep their place beside the antibiotics in prevention and treatment of infectious diseases. Conclusion

26. Antiseptics and disinfectants have the same theoretical base of action. But in practice, these products will be diverged by fabricates to Antiseptics and Disinfectants. We must make a difference between the cleaning action and the disinfecting action.DISINFECTANTS A disinfectant is a product capable of elimination or killing by direct action the undesirable microorganisms on fixed objects.

27. 1) Cleaning It is achieved by water, soaps and tensio-actif detergents. It removes mechanically some of the microorganisms that must be destroyed. We can also call it decontamination. 2) Desinfection It is the process of elimination or killing the germs by a bactericidal effect. This effect is defined by the power of a product during 5 minutes to divide the number of viable bacteria by 10 5. 3) Sterilization It is the destruction and killing of any living microorganisms as well as viruses.

28. The most widely used groups of disinfectants are: - a)Ozone: It is a disinfecting agent specially used in Industry. b)Peracetic Acid: Very powerful oxydant used diluted 1/5 for 30 minutes can kill all microorganisms present. I.The Oxydants :

29. II.Chlorides : The sodium hypochlorite (can be Javel) the disinfectant action is excellent. They can be destructed by organic substance rapidly. The disinfecting results are better if the objects are first decontaminated.

30. III. Aldehydes a)Formaldehyde: The most ancient used product. It is used diluted in water to realize a disinfecting efficacy but corrosive. Now it is not used as before due to its toxicity. b)Glutaraldehyde: Widely used in cold sterilization for thermo-sensible materials at 2% conc. Good rinsing of the device to wash the solution should be done before use.

31. Denaturated alcohols as methyl, or propyl alcohols are used in cleaning or disinfection as it has a short rapid action. IV. Alcohols: VI. Phenols: They had been used in cleaning and desinfection for a long time. They can be bactericidal and active even against bacillus tuberculoses, but weak action on Gram-ve so flourishing of them can results. They are used mixed with tensio-actif anionic substance to prepare disinfecting soaps.