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 themUsed on living tissue

DisinfectantsKill organismsUsed 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 teamPreoperative 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 irrigation5% solution used to disinfect utensils, floors,

furniture 0.5% solution used topically on the skinHousehold bleach solutions are 5.25%

halazone: chloramine compoundAvailable in tablet formUsed 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 agentTopical antiseptic, primarily antibacterial BacteriostaticLess irritating and less toxic than inorganic

mercurials

Ammoniated mercury

Inorganic mercurial agentUsed to treat impetigo, psoriasis, pediculosis, other skin conditions

Iodine tincture and solution

Kill all forms of microorganisms

Used as a topical antisepticpovidone-iodine (Betadine)Comes in various forms

Aerosol, topical solution, mouthwash, surgical scrub

hydrogen peroxideBactericidal 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 areaDecreased symptoms of inflammation or

infectionPrevention of infection

Monitor for adverse effects or reactions