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Community-acquired infections
Acquired in the home or any place in the community other than a health care facility
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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
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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
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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
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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
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Disinfectants Used to remove microorganisms from inanimate objects such as tabletops and surgical equipment
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Acetic acid (vinegar)1% or 5% solution
Benzoic, boric, or lactic acids
Antibacterial, antifungal, bladder irrigation
Otic solution or irrigation solution in various strengths
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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
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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
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chlorhexidine gluconate (Hibiclens)
Used as a bactericidal skin-cleansing solution (surgical scrub, handwashing agent, and a skin wound cleanser)
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Gentian violet, others
Gentian violet is used as a 1% or 2% solution Topical antiinfective Antibacterial and antifungal activity
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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
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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
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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
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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
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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
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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
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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
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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
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When using these agents on inanimate objects, be sure to protect the patient (and yourself!) from accidental exposure
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Monitor for therapeutic response Improved healing of the affected areaDecreased symptoms of inflammation or
infectionPrevention of infection
Monitor for adverse effects or reactions