Alcohol skin preparation

Isopropyl alcohol is prepared from petroleum by hydration of propene With a boil mg point of 82°C isopropyl alcohol evaporates quickly from the skin producing a cool mg effect Often containing dissolved oils and fragrances it is the major component of rubbing alcohol Isopropyl alcohol possesses weak antibacterial properties and is used to maintain medical instruments m a sterile condition and to clean the skin before minor surgery... 

A complication of the use of alcoholic iodine solution has been described in three women undergoing cesarean section, who developed painful, superficial, inflammatory reactions on their buttocks after skin preparation for surgery with 10% iodine in alcohol (59). These lesions were believed to have been caused by pooling of the solution underneath the patients, topical skin damage being exacerbated by heat and occlusive drapes. 

The deltoid is the recommended site for administration. Skin preparation is not necessary, nnless the site is grossly contaminated. Soap and water are effective for cleaning snch sites. Under no circumstances should the vaccinator prepare the skin with alcohol, becanse alcohol can inactivate the vaccinia virus, reducing vaccine... 

Isopropyl alcohol (2-propanol) is also commonly listed in the inactive ingredient guide for topical lotions (2.7 to 78%) and solutions (4 to 50%). Indeed, this alcohol is widely used at around 70% as an antimicrobial agent and has been shown to be effective for preoperative skin preparation (Keblish et al., 2005). However, isopropyl alcohol can also traverse human skin in significant amounts ten healthy adult volunteers applied a commercially available isopropyl alcohol-containing hand rub every 10 min over a 4 h period. Blood levels were recorded in 9 of the 10 volunteers at levels ranging from 0.5 tol.8 mg/1 (Turner et al., 2004). 

Keblish DJ, Zurakowski D, Wilson MG, and Chiodo CP. Preoperative Skin Preparation of the Foot and Ankle Bristles and Alcohol are Better. Bone and Joint Surgery-American Volume, 2005 87A 986-992. 

Example 9.1 In a precatheter-insertion skin preparation evaluation, four anatomical skin sites were used to evaluate two test products, a 70% isopropyl alcohol (IPA) and 70% IPA with 2% chlorhexidine gluconate (CHG). The investigator compared the products at four anatomical sites (abdomen, inguinal, subclavian, and forearm), replicated three times, and sampled for logic microbial reductions both immediately and after a 24 h postpreparation period. The y values are logic reductions from baseline (pretreatment) microbial populations at each of the sites. 

Although all methods were initially comparable, with bacterial reductions of greater than 99%, recolonization of a test site was significantly reduced after 60 minutes when prepared with an alcohol and iodophor drape, compared with the other methods. Jeng and Severin investigated the performance of a povidone-iodine gel alcohol (5% povidone-iodine and 62% ethanol in gel form) as a 30-second, one-time application preoperative skin preparation [20]. The povidone-iodine gel alcohol formulation delivered rapid and persistent antimicrobial activity against a broad spectrum of bacteria, both in vitro and in vivo, and was found to be an effective skin preparation formulation for use in a single-step 30-second application. 

DK Jeng, JE Severin. Povidone iodine gel alcohol a 30-second, one-time application preoperative skin preparation. Am J Infect Control 1998 26 488-494. 

Before surgical procedures are performed, it is standard that the proposed operative site be prepared with an effective antimicrobial to reduce the microbial populations residing on the skin and, thereby, the potential for surgery-associated infection. Povidone iodine and chlorhexidine gluconate (CHG) have been the two most prevalent antimicrobial choices for preoperative patient skin preparation over the years. In efficacy trials using human volunteers whose baseline counts exceed 10 microorganisms/cm on moist skin sites, both antimicrobial products commonly demonstrate at least a 3 logio reduction in resident skin flora within 10 minutes of skin preparation [1]. When a formulation contains at least 60% alcohol, these reductions are observed within seconds. 

What is at the heart of these differences Some chemicals, such as chlorhexidine, are substantive to the skin, that is, the chemical attaches to cells of the stratum corneum. Residual activity of the chemical affects the time and extent of repopulation of the skin after treatment, but the exact mechanism is unknown. Iodophors (or other halogen products) and alcohol are not retained by the skin, but do affect the repopulation by significantly affecting the total count. Other OTC reviewed ingredients, e.g., chlorxylenol (PCMX) and triclosan, have been formulated for skin preparation and are also substantive. These chemicals are absorbed by the skin within approximately 6 hours after application but have activity when present in the skin [66]. Because absorption is a diffusion reaction, the concentration may vary, especially if a second application is made. 

Although alcohols, as topical skin disinfectants, provide excellent immediate antimicrobial activity, they show little persistent activity. Once dried on the skin surfaces, antimicrobial effects of an alcohol have ended. Hence, their value as surgical hand scrub formulations and preoperative skin preparations where... 

Amphoterics can also be used to stabilize emulsions by immobilizing the oil droplets in a network to retard or prevent coalescences (109). Chun (110), in a conference paper presented in 1978, proposed using an amphoteric surfactant (see Figure 15.29) in combination with a fatty amphophile, such as cetyl alcohol, to form a gel network (similar to that of liquid crystal formation) to further improve emulsion stability. A number of commercial skin preparations have used this technique to stabilize treatment lotions. 

Waxes are esters of higher fatty acids and fatty alcohols. Pharmaceutically important examples are the liquid Decyl oleate (unsaturated Cetiol V ), the semisolid Wool fat (Adeps lanae) and the solids Yellow wax (Cera flava). Bees wax, white (Cera alba, white wax) and Cetyl palmitate (Cetaceum). The solid waxes are mainly used to increase the consistency of semisolid skin preparations (see Sect. 12.5.2). Waxy liquid compounds are ethyl oleate, isopropyl myristate and benzyl benzoate. In the first two cases the fatty acid is esterified with a short-chain alcohol. 

It has been shown that rubbing alcohol, chlorhexidine gluconate and acetone are equally efficacious in the prepeel skin preparation... 

CH2Br COOH. White crystalline solid, m.p. 50"C, b.p. 208 C. Soluble in water and alcohol. Prepared by the action of dry bromine on dry ethanoic acid in presence of small amounts of red phosphorus. Produces sores upon the skin used in chemical syntheses. See Reformatski reaction. 

After-Shaves. After-shave preparations serve the same function as and are formulated similarly to skin asttingents. After-shave balms are hydro-alcohoHc or alcohol-free emulsions that supply soothing iagredients, for example, witch ha2el, and em ollients, for example, decyl oleate [3687-46-5] to the skin. Menthol, which provides a cooling sensation, is a common constituent of after-shaves. 

Diethyl pyrocarbonate (DEP) [1609-47-8] M 162.1, b 38-40°/12mm, 160-163 /atm, d 1.119, Op 1.398. Dissolve in Et20, wash with dilute HCl, H2O, dry over Na2S04. filter, evaporate and distil the residue first in vacuo then at atmospheric pressure. It is soluble in alcohols, esters, ketones and hydrocarbon solvents. A 50% w/w soln is usually prepared for general use. Treat with great CAUTION as DEP irritates the eyes, mucous membranes and skin. [Boehm and Mehta Chem Ber 71 1797 1938 Thoma and Rinke Justus Liebigs Ann Chem 624 30 1959.]... 

Because skin exhibits many of the properties of a lipid membrane, dermal penetration can often be enhanced by increasing a molecule s lipophilicity. Preparation of an ester of an alcohol is often used for this purpose since this stratagem simultaneously time covers a hydrophilic group and provides a hydrophobic moiety the ready cleavage of this function by the ubiquitous esterase enzymes assures availability of the parent drug molecule. Thus acylation of the primary alcohol in flucinolone (65) with propionyl chloride affords procinonide (66) the same transform... 

One of the longest known synthetically prepared surfactants are the fatty alcohol sulfates, which were prepared on technical scale before 1940. Along with their ethoxylated counterparts, the fatty alcohol ether sulfates, which appeared on the stage shortly after, their use in toiletries is very popular but they can also be found in products for textile industry and auxiliaries in emulsion polymerization. With the exception of soaps, the mentioned anionic surfactants all have a sulfur-containing functional group. Denying the differences between these, their skin irritancy potential is remarkably high. 

The development of monoalkyl phosphate as a low skin irritating anionic surfactant is accented in a review with 30 references on monoalkyl phosphate salts, including surface-active properties, cutaneous effects, and applications to paste and liquid-type skin cleansers, and also phosphorylation reactions from the viewpoint of industrial production [26]. Amine salts of acrylate ester polymers, which are physiologically acceptable and useful as surfactants, are prepared by transesterification of alkyl acrylate polymers with 4-morpholinethanol or the alkanolamines and fatty alcohols or alkoxylated alkylphenols, and neutralizing with carboxylic or phosphoric acid. The polymer salt was used as an emulsifying agent for oils and waxes [70]. Preparation of pharmaceutical liposomes with surfactants derived from phosphoric acid is described in [279]. Lipid bilayer vesicles comprise an anionic or zwitterionic surfactant which when dispersed in H20 at a temperature above the phase transition temperature is in a micellar phase and a second lipid which is a single-chain fatty acid, fatty acid ester, or fatty alcohol which is in an emulsion phase, and cholesterol or a derivative. 

Decontamination Complete cleansing of the skin with soap and water at the earliest opportunity. If washing is impossible, use the M258A1, M258, or M291 skin decontamination kit. Symptoms may appear as late as 36 h after contact exposure, even if the skin is washed within an hour. In fact, a delay in onset of several hours is typical. Use this time to prepare for the possibility of a widespread outbreak 6-24 h after the attack. Decontaminate bulk quantities of BZ with caustic alcohol solutions. If BZ or other belladonnoids are used as free bases, decontamination will require a solvent, such as 25% ethanol, 0.1 N hydrochloric acid, or 5% acetic acid. 

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