Properties of common antiseptics

Antiseptics vary from one country to another, and a wide variety of products are commercially available throughout the world. This section notes the most common types of antiseptics and provides the trade names of the most commonly available commercial products. In general, these have been studied the most extensively and, thus, their effectiveness is known.

You may be using or have access to different commercial products than the ones discussed here. In some cases, the labeling of commercial products may be confusing or may contradict what is presented here.

Iodophors:

• Antimicrobial spectrum: Effective against a broad range of microorganisms.
• Advantages: Less irritating to the skin than iodine; can be used on mucous membranes.
• Disadvantages: Effectiveness is moderately reduced by blood or other organic material.
• Usage: Recommended for surgical scrub and client prep, and is the best antiseptic for use in the genital area, vagina, and cervix. Iodophors are effective 1-2 minutes after application; for optimal effectiveness, wait several minutes after application. Most preparations should be used full strength; do not dilute them.
• Comments: Iodophors are distinctly different from iodine. Iodophors are sudsy; pure iodine is not. If you receive any antiseptic solution from your facility's pharmacy or central supply that is labeled simply "iodine" or "iodophor," ask the pharmacist or person in charge of supplies what the solution contains. For example, if you receive a brown liquid in a bottle, put a small amount in your hand and rub in. If it seems more sudsy than usual, it is an iodophor, not iodine.

Chlorhexidine gluconate (e.g. Hibitane, Hibiclens, Hibiscrub), chlorhexidine gluconate with cetrimide (e.g. Savlon)

• Antimicrobial spectrum: Effective against a broad range of microorganisms, but has a minimal effect on tuberculosis and fungi.
• Advantages: Has a good, persistent effect; remains effective for at least 6 hours after being applied. Effectiveness is not reduced by blood or other organic material.
• Disadvantages: On rare occasions, products containing chlorhexidine have been reported to cause irritation, especially when used in the genital area. Effectiveness can be reduced by hard water, hand creams, and natural soaps.
• Usage: Recommended for surgical scrub and skin prep. Preparations without cetrimide are preferable to those with cetrimide. While products containing chlorhexidine are ideal for surgical handscrub and skin prep in general, they may not be the best antiseptics to use in the genital area, vagina, and cervix because of the small potential for irritating these areas. Iodophors are a better choice for use in these areas. However, if an iodophor is not available, a product containing chlorhexidine is the best alternative.
• Comments: The concentration of chlorhexidine in products with the name Savlon may vary from one country to another. Savlon products containing at least 4% chlorhexidine are appropriate for use as antiseptics. Savlon products containing less than 4% chlorhexidine in an alcohol base are also adequate, but should not be used on mucous membranes.

Iodine, tincture of iodine (iodine and alcohol)

• Antimicrobial spectrum: Effective against a broad range of microorganisms.
• Advantages: Fast-acting.
• Disadvantages: Can cause skin irritation. Effectiveness is markedly reduced by blood or other organic material.
• Usage: Too irritating for routine use in surgical scrub or for use on mucous membranes. Because of the potential to cause skin irritation, when used for preprocedure skin preparation, iodine must be allowed to dry and then removed from the skin with alcohol.
• Comments: If you receive any antiseptic solution from your facility's pharmacy or central supply that is labeled simply "iodine," ask the pharmacist or person in charge of supplies what the solution contains. For example, if you receive a brown liquid in a bottle, put a small amount in your hand and rub it in. If it seems more sudsy than usual, it is an iodophor, not iodine.

Alcohol (60-90% ethyl or isopropyl)

• Antimicrobial spectrum: Effective against a broad range of microorganisms.
• Advantages: Kills microorganisms most rapidly. Most effective in reducing microorganisms. Effectiveness is only moderately reduced by blood or other organic material.
• Disadvantages: Has a drying effect on skin. Cannot be used on mucous membranes.
• Usage: Cannot be used when skin is dirty; wash the area before applying. It must dry completely to be effective.
• Comments: The 60-70% strength is most effective because alcohol must be diluted for optimal killing of microorganisms; it is less drying to skin; and it is less expensive.

Para-chloro-meta-xylenol, PCMX, chloroxylenol (e.g., Dettol)

• Antimicrobial spectrum: Fairly effective against most microorganisms.
• Advantages: Has a persistent effect over several hours. Activity is only minimally reduced by blood or other organic material.
• Disadvantages: Less effective than chlorhexidine and iodophors.
• Comments: Not recommended for routine use. PCMX is available in both antiseptic and disinfectant preparations. Antiseptic PCMX preparations containing alcohol should not be used on mucous membranes. Disinfectant preparations should not be used as antiseptics.

Hexachlorophene (e.g., pHisoHex)

• Antimicrobial spectrum: Poor effectiveness against most microorganisms.
• Advantages: Has a good, persistent effect with repeated use; remains effective for at least 6 hours after being applied. Effectiveness is not reduced by blood or other organic material.
• Disadvantages: Potentially toxic to the nervous system. Occasional use is not effective in reducing the number of microorganisms on hands. If use of hexachlorophene is discontinued after long-term use, rebound increase in growth of bacteria will occur (bacteria whose growth was being inhibited by its use will grow and multiply), causing large-scale contamination.
• Comments: Contraindicated for routine use on irritated or broken skin or mucous membranes. Not recommended for use in surgical scrub or client prep due to its limited antimicrobial effectiveness.

Antiseptics are designed to be used for reducing or destroying microorganisms on the skin or mucous membranes. Never use antiseptics to disinfect objects or instruments, and never leave instruments soaking in an antiseptic solution.

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