Disinfectants chlorhexidine

For skin disinfection, chlorhexidine has been formulated as a 0.5% w/v solution in 70% v/v ethanol and, in conjunction with detergents, as a 4% w/v surgical scrub. Chlorhexidine salts may also be used in topical antiseptic creams, mouthwashes, dental gels, and in urology for catheter sterilization and bladder irrigation. 

Chlorhexidine salts are widely used in pharmaceutical formulations in Europe and Japan for their antimicrobial properties. Although mainly used as disinfectants, chlorhexidine salts are also used as antimicrobial preservatives. 

Ethanol and 2-propanol have also found use ia disinfecting clinical thermometers, and as preservatives to prevent microbial deterioration of cosmetics and mediciaals. They are sometimes combiaed with other disiafectants, namely formaldehyde (69), phenoHcs (70), chlorhexidine (71), hypochlorite (72), and phenols (70). 

Flood with a phenolic disinfectant any biologically contaminated area for 30 to 60 min and then clean up with water and allow to dry. After cleaning up wash hands with a suitable skin disinfectant (such as 0.5% Chlorhexidine in 70% methylated spirit)... 

As is apparent from the above information, there is no ideal disinfectant, antiseptic or preservative. All chemical agents have their limitations either in terms of their antimicrobial activity, resistance to organic matter, stability, incompatibility, irritancy, toxicity or corrosivity. To overcome the limitations of an individual agent, formulations consisting of combinations of agents are available. For example, ethanol has been combined with chlorhexidine and iodine to produce more active preparations. The combination of chlorhexidine and cetrimide is also considered to improve activity. QACs and phenols have been combined with glutaraldehyde so that the same effect can be achieved with lower, less irritant concentrations of glutaraldehyde. Some... 

The most widely used and effective disinfectant solutions are based on iodine (iodophor) with concentrations ranging between 0.05% and 0.1%, but sometimes higher concentrations are recommended. Other agents such as chlorhexidine or chlorine dioxide, peroxide, sodium chloride and lactic acid may also be effective (Wilson et al., 1997) but are not common. Recent trials show positive effects of aloe vera-based dipping agents (Leon et al., 2004). One problem of iodine containing products is their low pH value (<4.0), which is necessary for their antimicrobial activity (Hansen and Hamann, 2003). 

Surface disinfectants Compounds containing phenolics, chlorhexidine (not effective against bacteria spores), quaternary ammonium salts (additional activity if bis-n-tributyltin oxide present), hypochlorites such as household bleach, alcohols such as 70-95% ethanol and isopropyl (not effective against bacteria spores), potassium peroxymonosulfate, hydrogen peroxide, iodine/iodophores, and triclosan. 

Wound disinfection can be achieved with hydrogen peroxide (0.3%-l% solution short, foaming action on contact with blood and thus wound cleansing) or with potassium permanganate (0.0015% solution, slightly astringent), as well as PVP iodine, chlorhexidine, and biguanidines. 

Chlorhexamed, Merfen Chlorhexidine" digluconate (C34) Degussa, gsk, Novartis Disinfectant... 

Phenols Disrupt cell membranes, denature proteins, and inactivate enzymes phenol is not impaired by organic matter Phenol is used to disinfect surfaces and destroy cultures amylphenol destroys vegetative organisms and inactivates viruses on skin and objects chlorhexidine gluconate is effective as surgical scrub... 

Ethyl alcohol or isopropyl alcohol in an aqueous solution (between 70 and 92%) is an inexpensive and easily accessible disinfectant, which is rapidly acting and bactericidal as well as germicidal to most viruses, fungi, and other pathogens.13 However, its residual activity is limited and it should be used in conjunction with a longer-acting disinfectant (i.e., chlorhexidine) for optimal antimicrobial... 

Triclosan cannot only be applied as an emulsion, but it also has demonstrated antibacterial and antiinflammatory efficacy in eczema therapy when used as an antiseptic wash.28,30 Likewise, 10% povidone-iodine solution as a disinfectant showed excellent antibacterial activity together with improvement of clinical severity.79 As a 1% solution, chlorhexidine digluconate has shown superior effectiveness to triclosan in vitro, but may be only suitable for therapeutic use in intertriginous areas or as part of wet wrap dressings in the treatment of AD when used as an alcoholic solution.26,80... 

Use of contact lenses increases the risk of corneal infection. The most common pathogens that cause eye infection are Pseudomonas aeruginosa, Serratia marcescens, Staphylococcus aureus, S. epidermidis, and S. pneumoniae. Fungi rarely cause eye infections. Commonly used disinfectants are benzalkonium chloride and chlorhexidine. 

The need of skin disinfectants before injection is controversial.110 It is generally thought that the use of antiseptics may be ineffective and unnecessary.111112 Aseptic conditions are required for the use of catheters to minimize the infection. Povidone iodine and chlorhexidine are commonly used for the catheters. 

Chlorhexidine is available as lotions, creams, washes for disinfection and cleansing of skin and wounds, and as oral gels and mouthwashes. It also has... 

Microbial degradation of biocides has been described by Hugo [72] who points out that soil organisms are able to break down substances such as phenols added as fumigants. He also reviewed the utilization by bacteria of aromatic compounds (including the preservatives cresol, phenol, benzoic acid and esters of 4-hydroxybenzoic acid). Several types of preservatives and disinfectants, such as the QACs (e.g. cetrimide, cetylpyridinium chloride, benzalkonium chloride), chlorhexidine and phenylethanol can also be inactivated. Significantly, this only occurs at concentrations well below inhibitory or in-use concentrations [33] and thus cannot be responsible for insusceptibility. A further comment about chlorhexidine is given below. 

An association between antibiotic resistance and chlorhexidine and QAC resistance in Providencia stuartii and Proteus has been observed, but no evidence of a plasmid link obtained [25, 73, 287,288]. Chlorhexidine hypersensitivity has been noted in ciprofloxacin-resistant variants of Ps. aeruginosa [289] and vancomycin- and gentamicin-resistant strains of E. faecium retained sensitivity to the /usbiguanide [289, 290] and to other biocides [270-272], Anderson et al. [272] studied the inactivation kinetics of VRE and vancomycin-sensitive enterococci (VSE) exposed to environmental disinfectants at concentrations well below (extended dilutions) the recommended use-dilutions and found no differences in susceptibility of VRE and VSE. This type of approach is much more relevant than the widespread usage of MICs to measure responses to biocides. 

Stray-Pedersen, B., Bergan, T., Hafstad, A., Normann, E., Grogaard, J., and Vangdal, M. (1999), Vaginal disinfection with chlorhexidine during childbirth, Int. J. Antimicrob. Agents, 12,245-251. 

A wide range of substances that are toxic to the cornea may produce epithelial insult known as toxic keratitis. This terminology is generally reserved for mild superficial corneal irritation after contact with a harmful substance. Solutions foreign to the eye that commonly cause toxic keratitis include shampoos, lotions, and chlorinated pool water. Toxic corneal reactions have been reported from tonometer tips contaminated with 70% isopropyl alcohol or hydrogen peroxide that was not fully removed after disinfection of the probe. Irreversible corneal scarring has resulted from inadvertent ocular contamination with chlorhexidine gluconate, a skin cleanser used preop-eratively. The mistaken use of nonophthalmic products for eyedrops may result in various forms of corneal trauma. 

Occupational asthma caused by chlorhexidine alcohol disinfectant spray was well documented in three nurses (11). 

Reversible hyposmia occurred after Hardy s operation for pituitary adenomas following preoperative disinfection of the nasal cavity with chlorhexidine (12). The olfactory... 

The middle ear should be carefully protected against chlorhexidine solutions in preoperative skin disinfection in otolaryngology. Severe sensorineural deafness occurred in 14 of 97 patients who underwent myringoplasty (13). The only common factor in all these patients was the preoperative skin disinfection of the ear with 0.5% chlorhexidine in a 70% alcoholic solution. 

Chlorhexidine disinfectant was accidentally used to irrigate the eyes of four patients despite immediate treatment, corneal burns occurred in all (18). 

Epithelial and stromal edema of the cornea and a diffuse bullous keratopathy developed in a 39-year-old woman 2 weeks after a preoperative disinfection of the face with an alcoholic chlorhexidine solution. This led to penetrating keratoplasty 10 months later (20). 

Sclerosing peritoneal disease occurred in peritoneal dialysis patients in whom the tubing connection had been disinfected with chlorhexidine (32-34) 214 cases were... 

Anaphylaxis occurred in four surgical patients after the use of chlorhexidine as a skin disinfectant. All four had a history of minor symptoms, such as rashes or faints, in connection with previous surgery or invasive procedures (45). 

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