An antiseptic is a chemical substance that stops or slows the growth of microorganisms on external surfaces of the body and helps prevent infections.

Antiseptics are different from antibiotics, which destroy microorganisms inside the body, and from disinfectants, which destroy microorganisms found on inanimate (non-living) objects. Antiseptics can be referred to as skin disinfectants.

Now, what is antiseptic and how does it differ from disinfectant in terms of their uses and effectiveness?

What are the uses of antiseptics?

When the skin or mucous membranes are damaged or ruptured, an antiseptic can be used to clean the area and reduce the possibility of infection by normally occurring microorganisms. Antiseptics kill, inhibit, or reduce the number of microorganisms by mechanical removal or chemical activity.

Antiseptics are often used for:

• Hand washing- chlorhexidine gluconate and povidone-iodine solutions are frequently used in hand rubs at hospitals and other healthcare settings. Alcohol in more than 60% concentrations will kill pathogens such as the SARS-CoV-19 virus.
• Skin disinfection before surgery- antiseptics are used to clean the skin before an operation (to lower the chance of surgical site infections) or a procedure like an intravenous (IV) cannulation.
• Mucous membrane disinfection- antiseptic irrigations can be instilled into the urethra, bladder, or vagina to clean the cavity before a medical procedure, such as catheterisation.
• Treating and preventing infected skin- antiseptics can be used to clean contaminated wounds, cuts, burns, abrasions, and bites, including in some skin conditions such as acne and atopic dermatitis (eczema).
• Treating oral infections- throat and mouth infections can be treated with antiseptic throat lozenges, gargles, and mouthwashes.

Depending on the concentration, many substances can be used as both antiseptic and disinfectant. For instance, hydrogen peroxide 6% solution is used to clean wounds, whereas more powerful solutions (>30 percent) are used in industries as bleach and oxidising agents.

Types of antiseptics

Many different types of antiseptics are available, each with its own distinctive properties and uses. The most commonly used antiseptics are:

1. Chlorhexidine: The antiseptic is frequently used in hospitals and other healthcare environments to cleanse and disinfect the skin before surgical procedures. It can also be used for wound care and to prevent the spread of infections.
2. Povidone-iodine: This antiseptic is commonly used to clean the skin and disinfect wounds. It is also used for surgical hand washing and sterilizing medical equipment.
3. Hydrogen peroxide: This antiseptic is commonly used to clean and disinfect wounds. It is also used for ear cleaning and as a mouthwash.
4. Alcohol: Ethanol or isopropyl alcohol are frequently used as antiseptics to clean the skin and medical devices.
5. Benzalkonium chloride: This antiseptic is commonly used in hand sanitizers and as a disinfectant for medical equipment.

What are the advantages and disadvantages of antiseptics?

Benefits of Antiseptics:

1. Prevention of Infections: One of the main benefits of antiseptics is their ability to prevent infections. By killing or preventing the growth of microorganisms, antiseptics can help in preventing the spread of infectious diseases.
2. Promote Healing: Antiseptics help in healing by preventing infections and allowing your body to focus on repairing damaged tissue. This will help wounds to recover faster and reduce the risk of complications.
3. Sterilizing Medical Equipment: Antiseptics are commonly used to sterilize medical equipment, which is crucial to prevent the spread of diseases in healthcare settings.
4. Disinfecting surfaces: Antiseptics can also be used to disinfect surfaces, which can help to prevent the spread of infectious diseases in public places.
5. Treating Skin Conditions: Antiseptics can be used to treat various skin issues, such as acne, eczema, and psoriasis.

Disadvantages of Antiseptics:

1. Skin irritation: Some antiseptics may cause allergic reactions or skin irritation in some people. This can lead to itching, discomfort, and other signs that may require medical attention.
2. Resistance: Excessive use of antiseptics can lead to the development of antimicrobial resistance and make it harder to treat infections in the future. This is an issue in healthcare settings where antibiotic-resistant bacteria can pose a major risk for patients.
3. Toxicity: Some antiseptics, like chlorhexidine and iodine, are toxic when used incorrectly or in large doses. The result could be symptoms like nausea, vomiting, or even organ damage.
4. Slow healing: While antiseptics can promote healing by preventing infections, but some studies have suggested that they may also delay healing in some cases. It is believed due to the fact that antiseptics can damage harm healthy cells along with the microorganisms they target.
5. Cost: Antiseptics are expensive, especially when used on a regular basis. This can be a significant barrier to their use in some healthcare settings and for those who can’t afford them.

Antiseptic safety and efficacy

The effectiveness and safety of antiseptics have proven difficult to establish.

In September 2016, the US Food and Drug Administration (FDA) issued an official rule stating that over-the-counter consumer antiseptic wash products containing any of the 19 ingredients listed could not be advertised. This included triclosan and triclocarban. The rationale cited is:

• Insufficient evidence to show that antibacterial wash is more efficient than plain water and soap at preventing illness.
• Prolonged household use of antibacterial products such as antibacterial soaps may contribute to the development of antibiotic resistance.

In December 2017, the FDA also ruled that 24 ingredients in antiseptic products (including triclosan) were generally not recognized as safe and efficient (often due to insufficient data). These required regulatory approval for marketing from December 2018 as new drugs. A decision was delayed on the remaining six substances (benzalkonium chloride, benzethonium chloride, chloroxylenol, ethyl alcohol, isopropyl alcohol, and povidone-iodine).

It is crucial to remember that antiseptics may hinder wound healing by killing skin cells involved in the healing process, like fibroblasts. Using antiseptics regularly to clean up wounds is not recommended anymore. Necrotic tissue and pus can also inactivate some antiseptics and reduce their effectiveness.

Antiseptics must also be differentiated from antibiotics. Antiseptics can only eliminate microorganisms on the surface of the tissue, while antibiotics may be required if there is an infection within the tissues.

What are the side effects and risks of antiseptics?

People using antiseptics need to do so correctly. Strong antiseptics should be diluted before being applied to the skin, as concentrated products may cause chemical burns or severe irritant contact dermatitis. Prolonged contact with dilute antiseptics can also cause erosive contact dermatitis, as described with chlorhexidine-impregnated dressings.

Antiseptic products shouldn’t be used for more than one week for acute wounds. If the wound is not improving within 10 to 14 days, it should also be referred for medical review.

Other reasons to stop using an antiseptic and to seek medical attention include:

• The affected area hasn’t healed or improved.
• There’s a large wound, deep cut, burn, or abrasion embedded with particles that won’t wash away
• Injury due to a human or animal bite.

People with allergies of any kind should consult a doctor or pharmacist before using an over-the-counter antiseptic product. Some antiseptics can irritate the skin and cause allergic contact dermatitis.

Conclusion

Antiseptics are a crucial tool in preventing infections and promoting healing. They are frequently used in medical settings and to treat wounds. While they are generally safe to use, it is crucial to read the instructions carefully and use them as directed. By understanding the benefits and uses of antiseptics, we can help to prevent infections and promote healing.