Anantiseptic (Greek:ἀντί,romanized: anti,lit.'against'[1] andσηπτικός,sēptikos,'putrefactive'[2]) is anantimicrobial substance or compound that is applied to livingtissue to reduce the possibility ofsepsis,infection, orputrefaction. Antiseptics are generally distinguished fromantibiotics by the latter's ability to safely destroy bacteria within the body, and fromdisinfectants, which destroy microorganisms found on non-living objects.[3]
Antiseptic practices evolved in the 19th century through multiple individuals.Ignaz Semmelweis showed already in 1847-1848 thathand washing prior todelivery reducedpuerperal fever.[5] Despite this, many hospitals continued to practice surgery in unsanitary conditions, with some surgeons taking pride in their bloodstained operating gowns.[6]
Only a decade later the situation started to change, when some French surgeons started to adoptcarbolic acid as an antiseptic, reducing surgical infection rates, followed by their Italian colleagues in the 1860s. In 1867Joseph Lister published seminal paperAntiseptic Principle of the Practice of Surgery, where he explained this reduction in terms ofLouis Pasteur'sgerm theory. Thus he was able to popularize the antisepticsurgical methods in the English-speaking world.[7]
Medieval surgeonsHugh of Lucca, Theoderic of Servia, and his pupilHenri de Mondeville were opponents of Galen's opinion thatpus was important to healing, which had led ancient and medieval surgeons to let pus remain in wounds. They advocated draining and cleaning the wound edges with wine, dressing the wound after suturing, if necessary and leaving the dressing on for ten days, soaking it in warm wine all the while, before changing it. Their theories were bitterly opposed by GalenistGuy de Chauliac and others trained in the classical tradition.[9]
Structure of povidone-iodine complex, the most common antiseptic in use today
Antiseptics can be subdivided into about eight classes of materials. These classes can be subdivided according to their mechanism of action: small molecules that indiscriminately react with organic compounds and kill microorganisms (peroxides, iodine, phenols) and more complex molecules that disrupt the cell walls of the bacteria.[10]
Alcohols, includingethanol and 2-propanol/isopropanol are sometimes referred to assurgical spirit. They are used to disinfect the skin before injections, among other uses.
Diguanides includingchlorhexidine gluconate, a bacteriocidal antiseptic which (with an alcoholic solvent) is considered a safe and effective antiseptic for reducing the risk of infection after clean surgery,[11] including tourniquet-controlled upper limb surgery.[12] It is also used in mouthwashes to treat inflammation of the gums (gingivitis).Polyhexanide (polyhexamethylene biguanide, PHMB) is an antimicrobial compound suitable for clinical use in critically colonized or infected acute and chronic wounds. The physicochemical action on the bacterial envelope prevents or impedes the development of resistant bacterial strains.[13][14][15]
Iodine, especially in the form ofpovidone-iodine, is widely used because it is well tolerated; does not negatively affect wound healing; leaves a deposit of active iodine, thereby creating the so-called "remnant", or persistent effect; and has wide scope of antimicrobial activity. The traditional iodine antiseptic is analcohol solution (calledtincture of iodine) or asLugol's iodine solution. Some studies[16] do not recommend disinfecting minor wounds with iodine because of concern that it may induce scar tissue formation and increase healing time. However, concentrations of 1% iodine or less have not been shown to increase healing time and are not otherwise distinguishable from treatment with saline.[17] Iodine will kill all principal pathogens and, given enough time, evenspores, which are considered to be the most difficult form of microorganisms to be inactivated by disinfectants and antiseptics.
Octenidine dihydrochloride, currently increasingly used in continental Europe, often as a chlorhexidine substitute.
Peroxides, such ashydrogen peroxide andbenzoyl peroxide. Commonly, 3% solutions of hydrogen peroxide have been used in household first aid for scrapes, etc. However, the strong oxidization causes scar formation and increases healing time during fetal development.[18]
Phenols such as phenol itself (as introduced by Lister) andtriclosan,hexachlorophene,chlorocresol, andchloroxylenol. The fact that the more substituted and morelipophylic phenols are less toxic, less irritant and more powerful was gradually discovered in late 19th century.[19] Nowadays comparatively more water-soluble phenols such as chlorocresol are commonly used as preservatives in personal care products while less soluble such as chloroxylenol – as topical antiseptics. Both can be encountered in household disinfectants.
^Millard, Candice (2011).Destiny of the republic: a tale of madness, medicine and the murder of a president. New York: Doubleday.ISBN978-0-385-52626-5.OCLC700205578.
^Ehrhardt, John D.; Nakayama, Don K.; O'Leary, J. Patrick (1 March 2020). "Carbolic Acid before Joseph Lister: Rail Ties, Sewage, Manure, and the Great Stink".The American Surgeon.86 (3):176–183.doi:10.1177/000313482008600324.ISSN1555-9823.PMID32223794.
^Vermeulen, H.; Westerbos, S.J.; Ubbink, D.T. (2010). "Benefit and harm of iodine in wound care: a systematic review".Journal of Hospital Infection.76 (3):191–199.doi:10.1016/j.jhin.2010.04.026.ISSN0195-6701.PMID20619933.
