Disinfectants are used for processing. Modern disinfectants: types, classification, requirements, purpose. Types of disinfectants and their purpose

Antiseptics and disinfectants

Irina Kuchma, KhMAPO

Antiseptics for the prevention and treatment of local infectious diseases (purulent wounds, burns, bedsores, ulcers, boils, etc.) have been used since ancient times. Hippocrates and Ibn Sina, Paracelsus and Galen used balsamic ointments, wine and apple cider vinegar, lime, formic acid and various alcohols for these purposes.

The term “antiseptics” (anti against, sepsis rotting) was first used by the English scientist I. Pringle in 1750 to designate the anti-putrefactive effect of mineral acids.

The German obstetrician I. F. Semmelweis, the Russian surgeon N. I. Pirogov and the English surgeon J. Lister scientifically substantiated, developed and introduced antiseptic methods for the treatment of purulent diseases and the prevention of sepsis. Semmelweis used bleach to disinfect hands (1847), N. I. Pirogov used solutions of silver nitrate, iodine, and ethyl alcohol to disinfect wounds (1847-1856). A revolution in surgery was made by J. Lister with his work “On a New Method treatment of fractures and ulcers with notes on the causes of suppuration" (1867). Based on the teachings of Louis Pasteur about the microbial origin of purulent and putrefactive processes, Lister, in order to destroy microorganisms, disinfected the air by spraying a solution of carbolic acid in the operating room. The surgeon's hands, instruments and the surgical field were also disinfected with 25% solutions of carbolic acid. This method made it possible to sharply reduce the number of postoperative suppurations and sepsis. According to Lister's definition, antiseptics are measures to destroy, with the help of chemicals, pathogens of purulent diseases in wounds, objects of the external and internal environment that come into contact with the wound.

Currently, drugs that have an antimicrobial effect on microorganisms found on the skin and mucous membranes are considered antiseptic.

Antimicrobial agents that decontaminate environmental objects are called disinfectants.

The appearance of systemic antimicrobial chemotherapy drugs for internal use at the beginning of the 20th century and antibiotics in the 40s created an incredible stir. It seemed that the “golden bullet” had been found that kills a microorganism and does not harm the body’s cells. And as often happens in life, a lack of sense of proportion, a tribute to fashion and distrust of old, proven remedies unreasonably narrowed the scope of use of antiseptics.

The widespread, not always rational, use of antibiotics has led to the spread of nosocomial infections, a sharp increase in wound infections and postoperative complications. Low concentrations of active antimicrobial substances, long courses of antibiotic therapy, etc. have led to the spread of numerous antibiotic-resistant strains of microorganisms.

Compared to antibiotics, antiseptics, as a rule, have a wider spectrum of action (including fungicidal and virucidal), and microbial resistance to them develops more slowly.

The skin and mucous membranes are more resistant to the damaging effects of antiseptic drugs compared to the internal environment of the body, therefore higher concentrations of antiseptic agents can be used to disinfect them.

Infectious diseases of the skin, eyes, nasopharynx, external auditory canal, female genital organs, rectum, etc. in most cases, they can be successfully cured with antiseptic external agents, without the use of antibiotics.

Depending on the purpose, it is customary to distinguish the following categories of antiseptics:

• preventive hygienic hand antisepsis, surgical hand antisepsis, preoperative antisepsis of skin, mucous membranes, wounds; preventive antiseptics for fresh traumatological, surgical, and burn wounds;
• therapeutic destruction and suppression of the population of pathogenic and opportunistic microorganisms during infectious processes in the skin, soft tissues, mucous and serous cavities in order to prevent the generalization of the process.

Disinfection destruction of microorganisms in the external environment: disinfection of patient care items, patient secretions, linen, dishes, medical equipment, instruments; disinfection of wards, operating rooms and other hospital premises, disinfection of the source of infection, air, soil, water supply and sewerage networks, as well as disinfection of premises at medical, pharmaceutical, cosmetic and food industry facilities; public institutions, kindergartens, schools, gyms, etc.

Antiseptics and disinfectants are divided into:

• chemical elements and their inorganic derivatives (iodine, chlorine, bromine, silver, zinc, copper, mercury, etc.), acids, alkalis, peroxides;
• bioorganic compounds (gramicidin, microcide, ectericide, chlorophyllipt, lysozyme, etc.);
• organic substances of abiogenic nature (derivatives of alcohols, phenols, aldehydes, acids, alkalis, surfactants, dyes, derivatives of nitrofuran, quinoxaline, quinoline, etc.).

Main classes of antiseptics and disinfectants

Alcohols and phenols

The antiseptic properties of alcohols have long been used in medical practice. Alcohols lead to denaturation of structural and enzymatic proteins of microbial cells, fungi and viruses. 76% ethanol has the greatest antiseptic activity. The disadvantages of alcohols are: lack of sporicidal effect, ability to fix organic contaminants, rapid decrease in concentration due to evaporation. Modern combination products based on alcohols - sterillium, octeniderm, octenisept, sagrosept - do not have these disadvantages.

Phenols form complex compounds with polysaccharides of the cell wall of microorganisms, disrupting its properties.

Phenol preparations: resorcinol (diatomic phenol); fucorcin, feresol, tricresol, polycresulen (vagotil); thymol. Phenol preparations are not currently widely used in practice. Phenol (carbolic acid) as a disinfectant is prohibited for use due to toxicity and persistent odor.

Aldehydes

Aldehydes are highly active compounds, strong reducing agents, and irreversibly bind proteins and nucleic acids. Preparations containing aldehydes: formaldehyde, lysoform, citral, cimesol, cyminal are used for purulent wounds, phlegmon, 1st and 2nd degree burns, trophic ulcers, for douching in gynecology, cidipol (cyminal + dimexide + polyethylene oxide 400) are used for the treatment of genital organs for the prevention and treatment of syphilis, gonorrhea and trichomoniasis. Formaldehyde (formic acid aldehyde) in the form of a 40% aqueous solution (formalin) has been successfully used for many years to sterilize thermolabile medical supplies (cystoscopes, catheters, laparoscopes, endoscopes, hemodialyzers, etc.) in gas sterilizers using the “cold method”, for disinfection in steam-formalin chambers of things, linen, mattresses, etc., as well as in morgues and forensic stations for processing cadaveric material.

Disinfectants containing aldehydes: Gigasept FF, Deconex 50 FF, Desoform, Lysoformin 3000, Septodor Forte, Sidex are widely used for various types of disinfection and sterilization of medical equipment.

Acids and their derivatives

Disinfectants pervomur, dezoxon-O, odoxon, divosan-forte contain formic and acetic acids. They have a pronounced bactericidal (including sporicidal), fungicidal and virucidal effect. Their disadvantages include a strong odor, the need to work in respirators, and corrosive properties.

Group of halogens and halogen-containing compounds of chlorine, iodine and bromine

In medicine, the bactericidal properties of halogens have long been used, which oxidize a wide variety of microbial cell structures, primarily free sulfhydryl groups (-SH).

Preparations containing chlorine: chloramine B (25% active chlorine), chloramine D (50% active chlorine), chlorsept, sterolova, aquatabs, dichloranthine, chlorantoin, desaktin, septodor, lisoformin special, neochlor, chlorhexidine.

Modern chlorine-containing disinfectants - clorsept, sterolova, neochlor, chlorantoin, etc. - do not have a strong irritating odor or effect on the skin, are highly effective and are used for various types of disinfection. Aquatabs is used primarily for disinfecting water in swimming pools. Aquasept and pantocid are used to disinfect drinking water.

Desam (contains 50% chloramine B and 5% oxalic acid) is used for current and final disinfection.

Iodine preparations: alcoholic iodine solution 5%, iodoform, iodinol (iodine + polyvinyl alcohol) are used for cleaning and disinfecting the skin, surgeon’s hands, treating wounds, trophic and varicose ulcers.

Alcohol solutions of iodine have a pronounced bactericidal and sporicidal effect, but they have a number of disadvantages: they are irritating to the skin and can cause burns and allergic reactions.

In recent years, iodophors—complex compounds of iodine with surfactants or polymers—have become increasingly used. Iodophors do not have an irritating or allergic effect, and retain high bactericidal activity in the presence of organic substances - protein, blood, pus.

Iodophor preparations include: iodonate (an aqueous solution of a surfactant complex with iodine) - widely used to disinfect the surgical field; iodopirone (a mixture of iodopolyvinylpyrrolidone iodine with potassium iodide) in the form of a solution is used to treat surgeon’s hands, purulent wounds, in the form of an ointment for the treatment of phlegmons, abscesses, bedsores, fistulas; suliodopirone (iodopirone + surfactant) for disinfecting the surgical field, the surgeon’s hands, for disinfecting baths in the form of a 50% solution in patients with extensive burns; polyvinylpyrrolidone iodine called “betadine” is produced in the form of an ointment for the treatment of dermatitis and wounds, in the form of suppositories for the treatment of bacterial, fungal and trichomonas vaginosis, in the form of solutions for rinsing the mouth, cleaning and disinfecting the skin. In Ukraine, the drug polyvinylpyrrolidone iodine iodovidone is produced for the complex treatment of wounds and the treatment of the surgical field and the surgeon’s hands.

Oxidizing agents

Oxidizing agents cause destruction of the bacterial cell membrane.

Hydrogen peroxide remains an effective and affordable disinfectant and antiseptic, the main disadvantages of which include the instability of aqueous solutions and short duration of action. 3% and 6% solutions of hydrogen peroxide in combination with detergents are widely used to disinfect premises, furniture, dishes, and honey. products made of metals, polymers, rubber, glass. These solutions are odorless and do not damage furniture or metal. A 3% aqueous solution of hydrogen peroxide is used to treat purulent wounds and mucous membranes for tonsillitis, stomatitis, and gynecological diseases.

Hydroperite (35% aqueous solution of hydrogen peroxide + urea) in dilutions with water is used to wash wounds, gargle and rinse the mouth.

In practice, complex preparations based on hydrogen peroxide are widely used:

• pervomur (a mixture of peroxide and performic acid) is used to treat the surgical field, the surgeon’s hands, and to sterilize products made of polymers, glass, and optical instruments;
• persteril (10% peroxide solution, 40% performic acid solution and 1% sulfuric acid solution) is used for various types of disinfection. In a 1% persteril solution, all naturally occurring microorganisms and their spores die;
• Dezoxon-1 (10% peroxide solution, 15% acetic acid solution + stabilizers) is also used for most types of disinfection.

Potassium permanganate has not lost its effectiveness as an antiseptic. It is used to treat wounds, burns, erosions, gastric lavages, douching and rinsing in gynecological and urological practice.

Derivatives of quinoline and quinoxaline

Dioxidine, dioxicol, quinozol, quinifuril are used to treat purulent-inflammatory diseases of the skin, soft tissues, osteomyelitis, etc.

Nitrofuran derivatives are active against many Gr+ and Gr- microorganisms, Trichomonas, Giardia. Microorganisms slowly develop resistance to them. Furagin, furazolin, nifucin remain effective antiseptics for the treatment of purulent wounds, stomatitis, otitis, douching and rinsing.

Surfactants (detergents)

Currently, surfactants, which include compounds that change the surface tension at the phase boundary, are used more often than other antiseptics to treat wound surfaces, the surgical field, and the surgeon’s hands. These substances carry either a positive electrical charge (cationic surfactants) or a negative electrical charge (anionic surfactants). They disrupt the permeability of the cytoplasmic membrane of microbial cells, inhibit membrane-associated enzymes, and irreversibly disrupt the function of the microbial cell.

This group includes quaternary ammonium compounds (QACs), guanidine derivatives, amine salts, iodophors, and soaps.

Antiseptics of the CHAS group are widely used, have a wide spectrum of action, low toxicity and low allergenic effect, and do not irritate the skin and mucous membranes. These include:

• decamethoxin and medicines based on it: aurisan (ear drops), oftadek (eye drops for the treatment of various conjunctivitis, including chlamydial origin, prevention of blenorrhea in newborns and treatment of contact lenses); palisept ointment (for the treatment of periodontal disease, pustular and fungal skin diseases), amosept (0.5% alcohol solution for disinfecting surgical gloves), dekasan (a broad-spectrum antiseptic), deseptol suppositories (for the treatment of trichomonas, fungal and bacterial diseases of the female genital organs, prostatitis, hemorrhoids), etonium in addition to its bactericidal effect, has the ability to neutralize staphylococcal exotoxin, local anesthetic activity, and stimulates wound healing;
• degmin and degmicide are used to treat surgeon’s hands;
• diramistin has a wide spectrum of action, destroys multidrug-resistant staphylococci and streptococci. Used for external treatment of purulent-inflammatory infections, including for the treatment and prevention of sexually transmitted infections.

Disinfectants from the CHAS group (Mikrobak Forte, Bio-Clean, Hexaquart S, Deconex 51 DR, Blanisol, Septodor) have high bactericidal activity, in addition, good cleaning properties, low toxicity, and no pungent odor. They do not discolor fabrics or cause corrosion. They are used to disinfect rooms, linen, plumbing and medical equipment made of glass, metal and plastic.

The disadvantages of these drugs include low antiviral activity and lack of sporicidal effect. To expand the spectrum of action, alcohols, aldehydes and other components that affect viruses, mycobacterium tuberculosis, and bacterial spores are added to them.

Combined drugs include: Sanifect-128, Septodor-Forte, Terralin, Sentabic, Virkon.

The guanidine derivative chlorhexidine has bactericidal, fungicidal, virucidal activity (including against HIV and hepatitis B virus), and is an effective antiseptic for treating the surgical field, surgeon's hands, and honey. instruments, etc. Based on it, many combined antimicrobial drugs have been created: plivasept and plivasept-N for treating surgeon’s hands, citeal solution (chlorhexidine + hexamidine + chlorocresol) for complex therapy of bacterial, fungal and trichomonas infections of the skin and mucous membranes, Erudril solution (chlorhexidine + chlorobutanol + chloroform) in addition to the bactericidal effect, it has an anti-inflammatory and analgesic effect, sebidine (chlorhexidine + ascorbic acid) is used for oral infections, inflammatory gum diseases, ascorbic acid increases local tissue immunity, protects against periodontopathy.

Metal salts

Metal salts (mercury, silver, copper, zinc, bismuth, lead) irreversibly block the sulfhydryl groups of microbial cell enzymes.

Mercury preparations are now practically not used due to their high toxicity.

Recently, there has been increased interest in silver preparations (silver nitrate: protargol (contains 8% silver), collargol (70% silver), dermazin), which, in addition to a pronounced bactericidal effect, stimulate tissue regeneration and have no side effects.

Copper sulfate and zinc sulfate are used for conjunctivitis, urethritis, vaginitis, and laryngitis.

Bismuth preparations - xeroform, dermatol, etc. - have antiseptic, astringent and drying properties and are included in various ointments and powders.

Preparations of plant and animal origin

The antimicrobial activity of plants is due to the presence in their composition of organic acids, phenols, essential oils, resins, coumarins, and anthraquinones. Many plants have antiseptic properties: celandine, St. John's wort, chamomile, calendula, sage, thyme, leaves of eucalyptus, walnut, birch, lingonberry, plantain, aloe, colanchoe, juniper fruits, etc. Preparations from herbal antiseptics: recutan, rotokan, befungin, vundehil, calendula ointment, altan ointment, essential oils of coniferous trees, thyme, etc. have no side effects, combine antimicrobial properties with anti-inflammatory and regenerating ones.

Beekeeping products (propolis, apilak, etc.), mumiyo have a multifaceted antimicrobial and wound-healing effect.

Dyes

Dyes that have the property of inhibiting the growth of bacteria due to blocking the phosphate groups of nucleoproteins have not lost their relevance: methylene blue, brilliant green, ethacridine (rivanol), etc.

The arsenal of antiseptic and disinfection agents is huge. Unfortunately, the antiseptic agents that our medical and sanitary institutions are equipped with do not meet modern requirements. The “National List of Essential Medicines and Medical Products” includes in the group of antiseptics: preparations of boric acid, iodine, hydrogen peroxide, potassium permanganate, ethanol, brilliant green, chlorhexidine bigluconate, i.e., for the most part, those drugs that have already been used in Lister's time. Until now, many medical institutions use furacillin, which is not only inactive against many microorganisms, but is also an excellent breeding ground for some pathogenic and opportunistic bacteria.

The issues of providing chloractive drugs have been largely resolved. In Ukraine, drugs such as desaktin, neochlor, and chlorantoin are produced. However, there remains an urgent need for the production of modern products based on QACs, aldehydes, and guanidines.

However, in the last decade, the Ukrainian pharmaceutical industry has developed and introduced various modern effective antiseptics and disinfectants: miramistin, decamethoxin, etonium, chlorophyllipt, chlorhexidine, biomoy, vitasept, gembar, dezoxon-O, odoxon. The issues of providing chloractive drugs have been largely resolved.

The trend in the development of disinfection methods in the world is in the direction of expanding the use of complex preparations. Modern combined disinfectants: steradine (iodoplex + surfactant + phosphoric acid), terralin (chlorine + propanol + surfactant), Septodor forte (glutaraldehyde + quaternary ammonium compounds), sagrosept (propanol + lactic acid), decotex, sterillium, etc. low toxicity , are easy to use and have high activity against viruses, microbes and fungi.

Ideally, the rational use of disinfectants, antiseptics and antibiotics should minimize the number of postoperative complications, cases of nosocomial infection and sepsis.

Literature

1. Disinfection. In 3 parts. Part 1. Disinfecting methods and their stagnation / A. M. Zaritsky Zhytomyr: PP “Ruta”, 2001. 384 p.
2. Antiseptics in the prevention and treatment of infections / Paliy G. K. Kyiv: Health, 1997. 195 p.
3. Directory of general practitioners / N. P. Bochkov, V. A. Nasonov, N. R. Paleeva. In 2 volumes. Moscow: Eksmo-Press, 2002.
4. Medical microbiology / Pokrovsky V.I. Moscow: Botar Medicine, 1998. 1183 p.

Healthcare disinfectants are used to kill pathogens.

These are highly active and aggressive chemicals, so they pose a certain danger to humans, hospital facilities and the environment.

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The main thing in the article

The article discusses modern disinfectants based on active chlorine and oxygen, cationic surfactants, aldehydes, alcohols, phenols, acids and alkalis.

Additionally, the features of using disinfectants depending on the chemical group are described.

Many manufacturing companies try to present their products as universal and multifunctional.

However, practice shows that there are still some restrictions on their use - some drugs are more effective in certain situations, others are more aggressive on surfaces, and others can be harmful to human health.

Chloroactive compounds

Compounds based on active chlorine are divided into:

• inorganic (calcium hypochlorite, bleach, etc.);
• organic (chloramines, derivatives of hydantoin and cyanuronic acids);
• chlorinated derivatives of isocyanuronic acid (DCCA, TCCA, etc.);
• hydantoin derivatives (dichlorodimethylhydantoin).

Preparations using active chlorine are active against all forms and types of pathogens - bacteria (including Mycobacterium tuberculosis), viruses, fungi and their spores.

These disinfectants are extremely effective, and therefore are used to destroy pathogens of particularly dangerous infections (for example, anthrax spores).

In addition, chloroactive disinfectants have bleaching and deodorizing properties, and also have a homogenizing effect on the organic substrate.

The disadvantages of chlorine-based products include:

1. Strong unpleasant odor.
2. Irritating effect on the upper respiratory tract and mucous membranes of the eyes.
3. Damaging effect on various materials - metal, some types of fabrics, etc.
4. Low degree of solubility in water (for bleach and calcium chlorite).
5. Low storage stability.

Due to the irritating properties of chloroactive compounds, it is recommended that all work with them be carried out using personal protective equipment - goggles, rubber gloves, respirators.

• treatment of non-residential premises, cesspools, waste collection areas, outbuildings;
• disinfection of biological substances, laboratory glassware, food debris, plumbing fixtures, medical waste, cleaning equipment;
• carrying out general cleaning and final disinfection.

To reduce the harmful effects of chlorine on the human body and give drugs additional properties, composite drugs are created in safer and more hygienic forms - gels, tablets, granules.

List of chloroactive disinfectants for medical institutions

Most often, granules and tablets using the sodium salt of dichloroisocyanuric acid are used in medical institutions:

These drugs have a lower impact on the human body at the time of preparation of the working solution in comparison with conventional products with an active substance - chlorine.

Chloramines and combinations of chlorine with surfactants and other components are also common:

• "Sporox";
• "Domestos";
• "Clorilly";
• preparations of the “Sulfochloranthin” series.

Oxygen-active compounds

The most common preparations based on active oxygen are:

• hydrogen peroxide;
• chlorine dioxide;
• perborates;
• persulfates;
• perphosphates;
• percarbonates;
• Potassium fluoride peroxohydrate.

These compounds have a wide spectrum of antimicrobial activity. However, most of them manifest it only at high concentrations of the active component, even against low-resistant microorganisms.

Preparations that use active oxygen are safe for the environment and humans (due to rapid decomposition into water and oxygen) and do not irritate the respiratory tract. For this reason, their use is permissible for treating objects surrounding the patient (up to maximum permissible concentrations_.

Among the disadvantages are:

• intense irritant effect on the skin and mucous membranes;
• low stability;
• inconvenience of use (most products are in liquid form);
• aggressive effect on treated surfaces.

The introduction of corrosion inhibitors, activators and other additives into the composition of such disinfectants increases their antimicrobial effectiveness, makes them more stable and reduces toxicity and aggressiveness for humans and treated surfaces.

Names of oxygen-active disinfectants

The list of disinfectants for medical institutions, which use active oxygen as an active component, includes the following items:

The first two names are in liquid form, the rest are in solid form.

When active oxygen combines with acids, peracids are obtained, the most common of which is peracetic (PAA). It has a high degree of activity against all forms and types of pathogens.

However, its disadvantages are low stability, aggressiveness towards some materials, a pungent odor and a strong irritant effect on mucous membranes, skin and upper respiratory tract. These effects are eliminated by introducing special additives into the drug formulation.

Preparations containing NAA and hydrogen peroxide-based products have similar qualities. They are used for processing and sterilization of medical devices, including endoscopes and their components. However, it is not advisable to use NAA for disinfecting surfaces.

Cationic surfactants

Cationic surfactants include:

• quaternary ammonium compounds (QAC);
• guanidine derivatives (PHMG-x, PHMG-f);
• tertiary amines.

Advantages of cationic surfactants:

• remain stable for a long time;
• dissolves well in water;
• do not damage surfaces;
• have good cleaning properties.

QAC and guanidine derivatives are active against gram-negative and gram-positive microorganisms, but show weak activity against tubercle bacilli, non-enveloped viruses and spores.

Tertiary amines exhibit high activity against Mycobacterium tuberculosis and various viruses, however, like other cationic surfactants, they do not have a sporicidal effect.

Preparations containing QAC as the main component retain their properties on surfaces from several hours to several months, depending on the type and concentration of the chemical compound.

Cationic surfactants are non-volatile, non-toxic when inhaled, and do not have a strong odor, so rinsing them off the treated objects and ventilating is not required. Their good cleaning properties make it possible to combine disinfection and cleaning, as well as disinfection and pre-sterilization cleaning of medical devices.

KPAV: list of disinfectants

Names of disinfectants for medical institutions based on cationic surfactants:

• "Katamin AB";
• "Dezin";
• "Septabik".

They are used to treat indoor surfaces, plumbing fixtures, dishes, and patient care items.

Combinations of cationic surfactants with alcohols, aldehydes and some other components are more widely used:

These preparations are used for disinfection and pre-sterilization cleaning of medical devices and various materials, including endoscopes and dental instruments.

Aldehydes

Aldehydes include:

• formaldehyde;
• orthophthalic;
• glutaric, etc.

They are active against all forms and types of pathogens and are compatible with most materials. Aldehydes are used for disinfection (including high levels) and sterilization of medical devices, including endoscopes and instruments for them.

Names of disinfectants with aldehydes

The list of aldehyde-based disinfectants for medical institutions includes the following drugs:

1. "Glutaral";
2. "Glutaral N";
3. "Sidex";
4. "Steranios 20%" and others.

Aldehydes have a strong fixing effect, so medical products are washed in running water before being treated with them.

Aldehydes are very toxic and have fixing properties, therefore they are not recommended for treating linen, dishes and indoor surfaces. In addition, they are absorbed by surface materials and then released into the atmosphere over time.

Therefore, after exposure, prolonged ventilation of the room and thorough washing of surfaces and other objects with clean water are required.

More widely used are products containing, in addition to aldehydes, QAS, nonionic surfactants, guanidines and other components:

• "Alaminol";
• "Bianol";
• "Lysoformin 3000";
• "Deconex 50FF".

The combination of various components in these preparations mutually enhances, due to which it is possible to reduce the concentration of the active substance in the working solution. In addition, additives contribute to the appearance of detergent properties in the products and reduce the sorbing and fixing effect.

Alcohols

Most often, ethyl and isopropyl alcohols are used in medical institutions. In high concentrations (60-95%) they are active against bacteria, viruses, fungi and mycobacterium tuberculosis.

However, alcohols are ineffective against spores, and isopropyl alcohol is also ineffective against hydrophilic viruses. 70% alcohols are most effective.

Disadvantages of alcohols:

1. Aggressive to surfaces made of organic glass, rubber, linoleum and surfaces coated with paint or varnish.
2. Organic substances are fixed, as a result of which antimicrobial activity is reduced and subsequent surface cleaning is difficult.
3. They are flammable and easily ignite, as a result of which they are allowed to treat a small surface area (no more than 1/10 of the part).

Due to their pronounced fixing properties, alcohols are used only for treating surfaces without visible contamination.

As a rule, alcohols are used in the form of sprays, in combination with cationic surfactants or other components that enhance the antimicrobial properties of the drug. They are also used as impregnation of antibacterial wipes for treating small surfaces.

Phenols

Phenol preparations include:

• orthophenylphenol;
• orthobenzylparachlorophenol.

They are active against bacteria (including tuberculosis bacillus), fungi, and viruses. Some phenol-containing drugs do not show activity against resistant viruses that do not have an envelope. In addition, phenols are ineffective in killing spores and have no cleaning properties.

Phenol products are poisonous and are not used for treatment in children's institutions and neonatal units in maternity hospitals.

Porous surfaces absorb phenol-containing preparations, resulting in a persistent unpleasant odor. Due to toxicity and the need to wash surfaces for a long time and thoroughly with clean water after disinfection with these disinfectants, they are extremely rarely used in Russian medical institutions.

Acids and alkalis

Preparations based on acids and alkalis have weak antimicrobial properties, but severely damage surface materials, and therefore are used in strict accordance with the manufacturer’s recommendations - most often as part of household chemicals and for treating specific objects.

For example, acids are used to remove limescale from plumbing fixtures, and alkalis are used to remove grease from kitchen equipment. After use, these products must be neutralized, and the object is thoroughly washed to remove its residues.

Use of disinfectants depending on chemical group

The areas of application of disinfectants depending on the chemical group are presented in the table below:

1. Modern disinformation. funds

There is always a threat of the spread of infection, thereby pushing towards the emergence of mass infection of a large number of people with a certain infection. This could lead to a large-scale epidemic. All these negative consequences require urgent intervention from specialists to provide modern disinfectants in medicine. If they are used correctly, the standard availability of doses of disinfectants will be observed, which will ensure complete reliability and safety for the personnel working with them, and for the environment as a whole.

A huge amount of waste material remains after work in medical institutions, and especially in laboratories. Care should be taken when working with collected biological material: blood, urine, feces and other liquids. To carry out disinfection work, it is imperative to adhere to attentiveness and responsibility, approaching this issue with all seriousness. Because research material can pose a catastrophic threat to the spread of a certain infection. To prevent this from happening, this material undergoes special disinfection and is subsequently disposed of.

Modern disinfectants in medicine are used not only for processing raw materials, but also for work sites: premises, objects with which biological material was in direct contact, equipment used during research and instruments. Sterilization of medical instruments is of great importance for maintaining the health of patients. To do this, the method of soaking used medical kits in modern disinfectants for the required time can be used.

Medical waste should be considered a source of massive environmental contamination in healthcare facilities. To ensure the safety of waste management in health care facilities, effective disinfection measures should be carried out at the stages of their collection and disposal.

Medical waste - waste from hospitals and health care institutions - is a complex substrate of heterogeneous quality that poses a serious danger from an epidemiological point of view. In this regard, the issue of disinfection of medical waste in a medical institution poses a certain complexity, since this problem cannot be solved by recommending a single “universal” disinfectant drug.

epidemic disinfection medicine chloroactive

Analyzing the disinfectants offered today on the modern market, we can recommend for these purposes disinfectants from almost any group (halogen-containing, oxygen-containing, surfactants, guanidines, aldehyde-containing, alcohols, phenol-containing).

But, disinfectants should be used with great caution, due to their high toxicity and ability to accumulate in the body of personnel and employees who inevitably come into contact with them. If they are presented in the form of solutions, they must be changed every 2-3 days, since the quality of disinfection decreases and there is a risk of infection transmission. It is important to properly train staff in handling each disinfectant, because in medicine, not just one disinfectant is used, but a whole list of them. Modern disinfectants in medicine have specialized properties designed specifically for the targeted use of individual instruments and materials obtained for analysis.

When disinfecting medical waste with chlorine-active drugs, a certain environmental problem is created. Moreover, this is not only environmental pollution with active chlorine. Healthcare waste is mostly represented by organic matter, which, when combined with active chlorine, forms dioxins - compounds that are extremely dangerous to human health and have mutagenic properties.

Therefore, when searching for an effective disinfectant for medical waste, preference should be given to modern preparations based on a complex of quaternary ammonium compounds, which, when released into the environment, easily and quickly decompose into organic components - ammonia and urea. These disinfectants include, for example, Alaminol, Dezefect, Samarovka, Surfanios, etc.

Preparations based on quaternary ammonium compounds are characterized by high stability of working solutions, low level of toxicity, cleaning effect and the ability to absorb unpleasant odors on treated surfaces. But HATCHES, as chemical compounds, have a relatively narrow microbiological spectrum of action, in particular - lack of activity against parenteral viral infections and polio virus, weak tuberculocidal activity, etc. This problem is solved by introducing additional components into the HAT composition in the form of alcohols and glutaraldehyde, which makes it possible to achieve virucidal activity, as well as expand the spectrum of microbiological activity with a significant decrease in the concentration of ADV.

The disinfectant drug Alaminol, in which the QAC + aldehydes complex acts as an active ingredient, showed the greatest effectiveness in reducing the level of contamination of medical waste (by 9 times).

The obtained result allows us to judge the greatest effectiveness of disinfectants from the group of surface-active compounds in relation to medical waste. Disinfectants existing today - representatives of the class of surfactants and aldehyde-active chemical compounds - can also be recommended for the disinfection of medical waste depending on their hazard class

I. Surfactant group

Alaminol Bianol Vapusan 2000 Veltolen Vex-Side Dezeffect Dulbak DTBL Laina Lizafin Lizafin-special Nika-extra M Nika-dez Samarovka Septustin Stericid Surfanios Triacid

II. Group of aldehyde-containing products

Aldesol Desoform Deconex 50FF Lizafin Lisoformin-3000 Septodor-forte Steranios

As a result of research regarding the disinfection of waste from hospitals and health care institutions, the following was made:

Conclusions

• 1. It is necessary to move away from methods of disinfecting medical waste with chlorine-active disinfectants due to their low efficiency and serious environmental and toxicological hazards.
• 2. To disinfect medical waste, it is necessary to choose disinfectants from the surfactant group.
• 3. The considered method of disinfecting medical waste using modern disinfection means is currently accessible and economical for domestic healthcare, in contrast to methods from the experience of foreign medicine.
• 4. Despite the fact that the proposed drugs have proven to be excellent disinfectants for the disinfection of medical waste, they cannot provide a full range of waste destruction. It is necessary to find new technologies that are economically acceptable for modern healthcare (incineration, recycling, etc.).
• 5. Due to the fact that currently there are no official recommendations for the disinfection of medical waste with modern disinfectants, there is a need to include this section in the Program of Mandatory Testing of New Disinfectants, and for manufacturers or exporters of disinfectants to conduct laboratory and field studies of the microbiological activity of the disinfectant when disinfection of hospital waste.

The processes that arise and occur when chemical disinfectants act on a microbial cell are called the mechanism of action of disinfectants. The state of disinfection or decontamination does not occur immediately. The process of death of microbes occurs gradually, at a speed that depends on many factors, primarily on the fact that among microbes, even of the same species, there are individuals that are very resistant and do not immediately respond to the effects of a disinfectant, and individuals that die almost instantly when exposed to disinfectants. same conditions. In addition, some disinfectants
Particularly effective against gram-negative microorganisms (for example, hypochlorites), others, on the contrary, against gram-positive ones, and still others against both. This property of disinfectants serves as a criterion for their selective action.

Of primary importance in the disinfection process are: 1) the interaction between the disinfectant and the microbial cell, as well as with its environment (organic and inorganic substances); 2) its penetration (diffusion) through the membrane into the cell; 3) the reaction of the disinfectant with the constituent parts of the cell. These phenomena themselves are very complex and depend, on the one hand, on the nature and chemical structure of the disinfectant and its physical state (solid, liquid, gaseous), on the other hand, on the permeability of the microbial cell membrane and the associated phenomena of osmosis, diffusion and other physical and chemical phenomena. The degree of permeability of the membrane, in turn, depends on its structure and on the presence in it of certain compounds that prevent the penetration of foreign substances into the cell. Using modern laboratory research methods, it is possible to study the effects of disinfectants on microbial cells. The study of these issues is also greatly facilitated by the use of electron microscopic research methods, with the help of which one can observe the damaging effect of disinfectants on cells.

It should be noted that many of the issues of the mechanism of action of disinfectants have not been sufficiently studied and are unequally explained by researchers, but many important patterns have been established and are used to guide the practice of disinfection.

As observations have shown, disinfectants have the greatest ability to penetrate into cells when they are in solution. On the contrary, in solid form they almost completely lack the ability to penetrate the microbial cell membrane.

For gaseous disinfectants to penetrate the microbial cell membrane, a small amount of liquid is also required in which a certain amount of these substances could dissolve. A disinfectant that has penetrated into the cell in sufficient quantities comes into contact with various parts of the cell that perform vital functions for microbes (respiration, metabolism, reproduction, etc.). Therefore, the mechanism of action of disinfectants on a microbial cell is judged not only by their death, but also by how the processes of its enzymatic activity in the cell are disrupted and changed (respiration, nutrition, growth abilities, etc.) (V.N. Gladkova).

If the effect of the disinfectant on the cell is weak, then the vital functions of the cell, including the reproductive functions, only freeze - the imaginary death of the cell occurs. When the conditions of the cell's existence change for the better (for example, when poison is neutralized or removed), vital functions begin to appear again and can be restored to normal. Such a reversible effect of a disinfectant on a microbial cell, which does not lead to its complete death, but only to the extinction of vital activity, is called bacteriostatic, and the substance itself is called a bacteriostatic.

If a disinfectant, when acting on a microbial cell, causes irreversible changes in it, leading to its final death, then this action is called bactericidal, and the substance is called a bactericide.

For disinfection purposes, only those disinfectants that have a bactericidal effect (disinfectants) should be used, while strictly observing the concentrations, exposures and other conditions necessary for complete cell death recommended in the instructions.

Disinfectant chemicals that kill spores are called sporicides. The latter, as a rule, have a stronger toxic effect on vegetative forms of microorganisms. If we are talking about the impact on filterable viruses, then the agents that kill them are called virucides. Substances that attack fungi are called fungicides.

Disinfectants that differ from one another in the chemical structure of the molecule of the active substance, penetrating into the cell, have a selective and unequal effect on its constituent parts. Oxidizing agents (chlorine and chlorine-containing preparations, hydrogen peroxide, etc.), interacting with cell proteins, cause an oxidation reaction. Mineral acids and alkalis, acting destructively on the cell with the help of their hydrogen and hydroxyl ions, cause hydrolysis. Salts of heavy metals (mercury, copper, silver, etc.), penetrating into cells, act on proteins, forming albuminates insoluble in water. When phenols penetrate cells, they cause a coagulation reaction of cell proteins. Thus, the mechanism of action on the microbial cell of the listed disinfectants belonging to different groups of chemical compounds is different and varies depending on their type.

Conditions necessary for the effective use of chemical disinfectants. There are certain conditions necessary for disinfection to be effective. The most important of them are the following: 1) the use of chemical disinfectants in the liquid phase, mainly dissolved in water or in the form of emulsions, suspensions; 2) compliance with the required concentrations of disinfectants; 3) ensuring sufficient contact between disinfectants and the object being disinfected; 4) compliance with certain periods of action of disinfectants (exposure).

The need to use disinfectants in the form of aqueous solutions is due to the fact that the smallest particles of liquid containing the active principle are easily and quickly adsorbed by the membrane of the microbial cell and penetrate through it into the latter. This facilitates the interaction between the disinfectant and the microbial cell. Achieving this during disinfection, as we have seen, is one of the most important conditions for the death of a microbial cell. The solubility of disinfectants in solvents other than water (alcohol, ether, benzene, etc.) also favors the progress of the disinfection process. However, products prepared with such solvents are unacceptable for widespread disinfection practice due to damage to objects, fire hazard and high cost. Preference is given to water as a solvent also because disinfectants quickly find access to the cell through the aqueous phase, and this makes aqueous solutions and emulsions more active against the microbial cell. That part of the disinfectant that remains in a solid state during the preparation of aqueous solutions (for example, lumps of chloramine or bleach floating in the liquid) quickly peels off or settles. In this case, it does not participate in the disinfection process, since, remaining in an undissolved state, it does not penetrate the cell membrane and, therefore, cannot act on the internal formations of the cell.

Such solutions and emulsions are usually regarded as incorrectly prepared or, in any case, as containing less than the calculated amount of active substance and, therefore, insufficient to kill the microbial cell. When preparing solutions from a chemical compound that dissolves well in water, it is enough to shake the mixture to obtain a full foam solution. In other cases, in order to speed up dissolution or obtain a good emulsion (for example, when preparing emulsions of cresol drugs, phenol solutions, etc.), it is necessary to preheat the solvent. Sometimes it is necessary to heat a mixture of a disinfectant with water until complete dissolution or at least a slightly cloudy solution is obtained (opalescent solution).

Some water-insoluble disinfectants (for example, black, unrefined carbolic acid) can be used for disinfection only if emulsifiers (alkali, soap) are first added to them, which then makes it possible to prepare aqueous emulsions from them. Therefore, a number of new disinfectants are produced in the form of pastes and soaps.

When preparing disinfectant solutions and emulsions, it is very important to adhere to the following rules:
a) pre-measure or weigh out the required amount of disinfectant in strict accordance with the specified working concentration and volume of the solution being prepared;
b) after adding a disinfectant (solid or liquid) to the water, thoroughly mix the mixture until it is completely dissolved, for which it is recommended to use wooden spatulas;
c) use warm water to dissolve many disinfectants;
d) when using disinfectants that tend to volatilize, keep the solutions prepared immediately before use in a closed container;
e) disinfectant solutions that decompose under the influence of light should be prepared and stored in dark glass containers or in containers protected from light in one way or another.

The next condition for the effective use of disinfectants is the use of solutions, emulsions, suspensions of strictly defined concentrations, i.e., a certain amount of disinfectant or active substance. Gaseous disinfectants must be used in quantities that provide a certain concentration per unit volume of air in the room being disinfected.

The effective concentrations of certain disinfectants are usually determined in the laboratory. Based on the results of laboratory studies, appropriate instructions for the use of certain disinfectants are developed. Compliance with the concentrations specified in the instructions is extremely important for the following reasons: a) pathogens of various infections have different resistance to one or another disinfectant; b) to kill the causative agent of a certain infection, different concentrations of a disinfectant are required depending on the activity of the latter, on the nature and properties of the object being disinfected; c) the vast majority of disinfectants often significantly reduce their activity in response to the presence of organic substances.

To check the concentration of the basic and working solutions used, it is necessary to systematically monitor the correctness of their preparation in the laboratory. Initial disinfectants are also subject to regular testing in order to determine the amount of ADV* in them.

The most important condition for using a chemical disinfection method is to ensure the necessary contact between the disinfectant and pathogenic microbes. For this purpose, it is necessary to use a sufficient amount of disinfecting liquids or gaseous substances during any disinfection procedure (irrigation, immersion, etc.). Thus, when disinfecting the surfaces of objects, floors, walls, doors, etc., contaminated with vegetative forms of infectious agents, it is customary to use a working solution by spraying it coarsely (with a hydraulic remote control or other spraying apparatus), usually at a rate of at least 0.3-0. 5 liters for each square meter of floor area of ​​the disinfected room.

In practice, this amount is spent not only on irrigating the surfaces of the room, but also on irrigating the surfaces of furnishings located in the room. Consequently, per 1 m 2 of disinfected surfaces, due to this fact, the amount of liquid actually falls is significantly less than indicated. When used to disinfect the surfaces of objects in areas of intestinal and respiratory tract infections, for example, a 1% chloramine solution, its consumption can be reduced to 50 ml (depending on contamination) per 1 m2 of the actually disinfected surface, if a hydraulic remote control is not used for irrigation, and a sprayer that produces the smallest particles of liquid (ordinary vacuum cleaners such as “Rocket”, “Uralets”, etc. are practically used for this).

However, when using either a hydraulic remote control or a device for finely dispersed liquid spraying, it is necessary to be guided by the fact that for reliable operation, continuous and uniform wetting or coating of the surfaces to be disinfected must be ensured. When finely spraying with a chloramine solution in very contaminated areas, it is recommended to additionally wash the floor, sinks, toilets and other similarly contaminated surfaces with a rag or brush moistened with a 1-3% chloramine solution.

To destroy more persistent types of pathogenic microbes (anthrax spores, etc.) or microbes protected from the effects of a disinfectant (the presence of organic substances in the disinfected environment), it is necessary to increase the usual rate of liquid consumption (0.3-0.5 l) to 1 -2 liters per 1 m2 of floor area of ​​the room being disinfected.

When disinfecting soil, when it is necessary to disinfect not only the surface, but also the underlying layers, the amount of disinfectant liquid is increased to 5-10 liters per 1 m 2.

When disinfecting soft tissues (mainly linen, handkerchiefs), the disinfection of which is achieved by complete immersion in liquid, it is necessary to consume, depending on the resistance of the infectious agent, at least 4-5 times the volume of liquid to the weight of the tissues being disinfected.

When disinfecting liquid materials, working disinfectant liquids are used in half or equal volume if the material being disinfected does not contain at all or contains very few lumps of organic and inorganic substances (urine, throat rinses, etc.) and is easily mixed with the disinfectant solution. Liquid substrates rich in organic substances, semi-liquid and especially dense, as well as infectious materials in the form of lumps, films, etc. (for example, secretions, pus, blood, solid and liquid food debris), even when vigorously mixed with twice the volume of disinfectant Liquids cannot always be reliably disinfected within the timeframe generally accepted in practice (1-4 hours). This is confirmed by the fact that the period for disinfecting, for example, linen, diapers contaminated with feces, by soaking in a disinfectant solution ends after 24 hours.

The disinfection period is reduced by first removing secretions from them or washing the linen in disinfectant solutions.

To ensure close contact between the disinfectant and the object being disinfected, it is very important to follow certain rules. Thus, in order to completely disinfect the surfaces of objects, they should be thoroughly and evenly washed with disinfectant solutions, irrigated abundantly using special equipment (hydropolettes, automaxes, etc.) with a jet under pressure, or evenly moistened using a device for fine irrigation.

Disinfection of soft and hard things that can be moistened is carried out by completely immersing them in a disinfectant solution with repeated mixing of the disinfected objects and the liquid in which they are immersed (underwear, washcloths, shaving brushes, etc.). If the objects being disinfected cannot be mixed, for example when disinfecting infected dishes, each object should be placed in a vessel (basin, bathtub) so that the disinfectant liquid is in close contact with all surfaces of the objects being disinfected. Small items and objects that cannot be disinfected by immersion are usually thoroughly cleaned with brushes moistened with disinfectant liquids. However, it must be borne in mind that in this way the goal is not always fully achieved, because not all things can be moistened properly.

The last important condition for the successful use of the chemical method of disinfection is compliance with certain periods of action of disinfectants (exposure) necessary for the complete destruction of pathogenic agents on environmental objects.

The duration of the process of interaction between a disinfectant and a microbial cell, in other words, the rate of reaction between the cell and the disinfectant, depends both on the properties of the pathogenic microbe and on the nature of the object being disinfected (wooden, glass surfaces, etc.) and its properties (wettability, porosity, smoothness , absence of cracks, etc.). In practice, it should be assumed that the surfaces of objects are most often disinfected within a period of 30 minutes to 1 hour, and only in some cases within a period of up to 2 hours (if there is dust, dirt, places contaminated with secretions on the surfaces, and if the pathogen is highly persistent). Disinfection of linen requires on average the same amount of time, sometimes less.

With an increase in the concentration of disinfectant solutions used to disinfect objects, the disinfection time is reduced. The exact timing of disinfection with the help of chemical disinfectants of various objects and substrates contaminated with pathogens of various infections is established through laboratory tests.

It is known that with increasing temperature, the course of chemical reactions accelerates. This position is basically correct in relation to the disinfection process. The disinfection process can be accelerated by increasing the temperature of the disinfectant liquids. For these purposes, it is advisable to use hot water for their preparation. At the same time, fat particles and all other contaminants dissolve on objects to be disinfected, which facilitates and accelerates the death of microbes. On the contrary, when the temperature decreases, the process of death of microbes proceeds more slowly, which also must be taken into account when disinfecting certain objects and secretions in the cold, for example, vehicles, outbuildings, etc. in winter, at temperatures below zero. In order to compensate for this delay, it is necessary to increase the exposure time and concentration of disinfectants.

The composition of the environment in which the pathogenic microbes to be destroyed has a very significant influence on the speed of disinfection. It is known that many of them are excreted from the patient’s body along with organic substances that serve as their protection: feces, sputum, pus, blood, mucus, etc. The presence of organic substances and their effect on the effectiveness of disinfection are very important in practical conditions. Many disinfectants interact with organic substances, and a greater or lesser part of them is spent on the coagulation of proteins included in these substances, or on the formation of water-insoluble albuminates with them. In these cases, only the remaining free amount of the disinfectant interacts with the cells of pathogenic microbes, which often turns out to be insufficient to destroy them.

Finally, it is necessary to point out the mechanical protection that organic substances create for pathogenic microorganisms and which the disinfectant in some cases cannot overcome. Thus, in a medium with increased viscosity, due to the presence of mucus and proteins (sputum, etc.), the disinfection process proceeds much slower than in a liquid medium free of these impurities (urine, etc.). Acceleration of the process and its reliability are achieved by mixing the mixture of secretions and disinfectant.

The speed and reliability of the disinfection process is affected not only by the presence of organic substances, the viscosity and density of the disinfected medium, but also by its reaction (pH) - alkaline, acidic or neutral. Thus, chlorine preparations (chloramine, bleach, etc.) act many times weaker in an alkaline environment than in a neutral or acidic environment.

Different types of germs react differently to disinfectants. This phenomenon is explained in some cases by the unequal resistance of different types of microbes to the action of disinfectants, in others it indicates the importance of the selective action of the latter. Some of them can be destructive only for microbes, others only for viruses, others only for fungi; some of them may be active not to one, but to several types of them.

Microbes that cause intestinal infections are of average resistance. The least persistent of the microbes of this group is observed in Vibrio cholerae. Staphylococci and streptococci are much more persistent than pathogens of intestinal infections. The most resistant in the group of vegetative forms are acid-resistant microbes - tuberculosis bacilli (mycobacteria) and leprosy. The greatest resistance is observed in spores formed by certain types of microbes (anthrax bacilli, tetanus bacilli, etc.).

Based on the foregoing, it is possible to determine the basic requirements that disinfectants must satisfy. They must: 1) quickly and completely dissolve in water or mix well with it, forming stable mixtures (emulsions); 2) kill microbes in the smallest possible concentrations and in the shortest possible time;
3) have a bactericidal effect even in the presence of protective organic substances in the disinfected environment;
4) do not lose their bactericidal and other disinfecting properties during storage, for which they must be sufficiently stable during storage.

* ADV is an active substance.

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State Budgetary Educational Institution of Higher Professional Education "Ural State Medical University"

Ministry of Health of the Russian Federation

Faculty of Treatment and Prevention

Department of Nursing

Abstract

Modern disinfectants

Performer: Khareva Ekaterina Aleksandrovna,

student OLD-129 USMU

Scientific supervisor: Luchinin Ivan Yurievich

Ekaterinburg, 2014

1. Introduction

2. Classification of disinfectants

2.1 Halogenated

2.2 Peroxide

2.3 Surfactants

2.4 Guanidine

2.5 Aldehydes, alcohols

2.6 Peracid, alkaline

2.7 Phenolics

3. Use of disinfectants

4. Modern disinfectants (examples)

infectious disinfection disinfection toxin

1. Introduction

Nosocomial infections are one of the most important problems facing any medical institution. Ensuring the prevention of possible complications associated with the activity of pathogenic microorganisms and viruses is the main task for medical workers. The purpose of this work is to expand the knowledge of medical staff about modern disinfectants and their correct use.

Disinfection is a set of measures aimed at destroying pathogens of infectious diseases and destroying toxins in environmental objects. It is performed by using antiseptics and disinfectants, which eliminate the problem of infection even on approach to the human body. There are preventive, current and final disinfection:

· preventive - carried out constantly, regardless of the epidemic situation. This is washing hands and surrounding objects using detergents and cleaning products containing bactericidal additives.

· current - is carried out at the patient’s bedside, in isolation wards of medical centers, and medical institutions. Goal: preventing the spread of infectious diseases beyond the outbreak.

· final - carried out after isolation, hospitalization, recovery or death of the patient to free the epidemic focus from pathogens dispersed by the patient.

Antiseptics are broad-spectrum antimicrobial agents that have a detrimental effect on most microorganisms. They do not have selective activity and are relatively highly toxic to humans, which is why they are used topically.

Disinfectants are analogue preparations used to disinfect external objects (rooms, patient care items, patient excretions, medical instruments, etc.).

It is not possible to draw a line between antiseptics and disinfectants, because many substances are used in lower concentrations as antiseptics, and in higher concentrations for the purpose of disinfection.

It is important that all health care workers know and can apply basic measures to prevent infectious diseases. The peculiarity of nosocomial infections is that they can be caused by pathogens with a relatively low pathogenicity, especially in seriously ill patients with pathological processes.

Nosocomial infections are usually caused by nosocomial strains of opportunistic gram-positive and gram-negative bacteria. They differ from community-acquired strains in their biological characteristics and have multiple drug resistance and higher resistance to adverse environmental factors - the effects of ultraviolet rays and disinfectants. At reduced concentrations of disinfectants, nosocomial strains can persist and multiply in them.

Reservoirs of nosocomial pathogens in the external environment: water, artificial respiration equipment, intravenous fluids, reusable medical products (endoscopes, catheters, probes, etc.). The main reservoir in the human body is the hands; about 50% of nosocomial infections, according to WHO, are transmitted through the hands. The most common transmission mechanism is therapeutic and diagnostic procedures, as well as natural routes: airborne droplets, fecal-oral and household contact. According to the World Health Organization (WHO), the most common infectious diseases today are vaccine-preventable diseases:

· polio, tetanus, measles, diphtheria, whooping cough;

· intestinal infections;

· acute respiratory infections;

· tuberculosis;

· sexually transmitted diseases: syphilis, gonorrhea, chancroid;

· chlamydia, genital herpes, AIDS, etc.;

· malaria.

Most disinfectants that come into direct contact with humans have an alcohol base or alcohol in their composition and are absolutely safe, which is why such disinfectants are the most common in medicine.

To disinfect various premises, disinfectants with a chloride or acid chemical base are used. Use requires protection for the person carrying out disinfection: gloves, shoe covers, gauze masks, special or disposable clothing.

However, modern disinfectants are constantly improving their composition. Their modernization is necessary to ensure that their inherent effect does not weaken and allows them to continue to destroy a wide range of microorganisms and bacteria.

2. Classification of disinfectants

Chemicals used for disinfection belong to the following groups:

· peroxide compounds;

guanidines

aldehydes, alcohols;

· peracids, alkalis;

· phenols, cresols and their derivatives;

· derivatives of metal salts.

All substances have varying degrees of activity, spectra of antimicrobial action, toxicity and influence on the treated objects. As a result, there is a wide range of areas of their application. Along with high antimicrobial activity, modern products have pronounced cleaning and anti-corrosion properties, do not spoil the objects being treated or discolor fabrics, do not have a fixing effect, and can be used repeatedly. Knowledge of the properties and characteristics of disinfectants is necessary for their correct selection and high-quality use.

2.1 Halogenated products

Chloramine B contains active chlorine. Has antiseptic and deodorizing properties. Solutions of chloramine B are used to treat infected wounds (1-2%), to disinfect the skin of hands (0.25-0.5%) and patient care items (1-3%).

Chlorhexidine is used in solutions for treating the surgical field and the surgeon's hands (0.5%), for wound infections, gingivitis, stomatitis, and also for sterilizing instruments.

Preparations containing elemental iodine include Lugol's solution (consists of 1 part iodine, 2 parts potassium iodide, and 17 parts water), used to lubricate the mucous membrane of the pharynx and larynx during inflammatory processes.

Povidone-iodine (betadine) is a complex of iodine with polyvinylpyrrolidone. It has antibacterial, antifungal and antiprotozoal effects associated with the release of free iodine. Used to treat the skin of patients before and after operations. In the form of 0.5-1% solutions, it is used to treat wounds, burns, and infectious skin lesions. Vaginal suppositories are prescribed for acute and chronic vaginitis (trichomoniasis, candidiasis).

2.2 Peroxide compounds

The group of oxidizing disinfectants includes hydrogen peroxide, which has weak antiseptic and deodorizing effects associated with the release of oxygen.

It is widely used for disinfection, sterilization and pre-sterilization cleaning of objects, because it meets many requirements: it does not smell, quickly decomposes in the external environment into non-toxic products (molecular oxygen and water), does not cause allergization. Disadvantages: it is not stable, has a pronounced local irritant and skin-resorptive effect, and has low bactericidal activity. In order to reduce toxicity, increase antimicrobial activity and stability, composite preparations are being created based on hydrogen peroxide. The most convenient for practical use are solid forms of peroxide compounds (sodium peroxycarbonate - persol, carbamide peroxide - Hydroperite, sodium peroxoborate). Compositions based on hydrogen peroxide in solid and liquid form have gained wide recognition (for example, apisin) due to their high efficiency, wide spectrum of action, low toxicity, environmental safety and ease of use.

2.3 Surfactants

Recently, disinfectants from the surfactant group - detergents - have become widespread. Anionic detergents include conventional soaps (sodium or potassium salts of fatty acids). Cationic detergents are mainly used as antiseptics and disinfectants, in particular benzalkonium chloride, cetylpyridinium chloride, miramistin. Detergents cannot be combined with anionic soaps, as this reduces their antimicrobial activity.

Benzalkonium chloride has antibacterial, antiprotozoal and spermicidal effects. Used for treating skin, mucous membranes, wounds, washing the bladder, urethra, and also for the purpose of contraception in women.

Cetylpyridinium chloride in the composition of the drug Cerigel is used to treat hands before operations.

Miramistin is used in the form of a 0.01% solution for the treatment of infected wounds, burns, as an antiseptic in dental practice, in the treatment of infectious diseases of the ENT organs and the genitourinary system. Avoid contact with eyes.

2.4 Guanidine derivatives

From the group of guanidines, the most widely used antiseptics and disinfectants are chlorhexidine bigluconate (Ghibitan) and polyhexamethylene guanidine hypochloride (Polysept).

Gibitan has a wide spectrum of antibacterial action, but virucidal activity is inherent only in its alcohol solutions.

Polysept causes the death of gram-positive and gram-negative microorganisms, many dermatophytes. Its positive quality is its long-lasting effect.

2.5 Aldehyde, alcohol products

From the group of aldehydes, two substances are used in disinfection practice (formaldehyde (FA) and glutaraldehyde (GA). Aldehydes are characterized by bactericidal, virucidal, fungicidal and sporicidal effects, which allows them to be classified as high-level disinfectants. They are found as disinfectants (and antiseptics) application and alcohols. They are used both independently and as solvents that enhance the activity of other disinfectants and have bactericidal and virucidal properties.

Ethyl alcohol 70-95% denatures proteins and has a bactericidal effect. Used to treat patients' skin and surgeon's hands.

Formaldehyde (formalin; contains 36.5-37.5% formaldehyde) acts on bacteria, fungi, and viruses. Formaldehyde solutions of 0.5-1% are used as disinfectants and deodorants for treating the skin of the feet, as well as for disinfecting instruments.

2.6 Peracid, alkaline agents

Preparations from the group of peracids and alkalis are characterized by high antimicrobial activity and a wide spectrum of antimicrobial action. Wofasteril and persteril are known based on peracetic acid (active ingredient content 40% and 20%, respectively). These preparations are recommended for disinfection of medical products made of glass, metal, textiles, rubber, hygienic and surgical treatment of hands.

Dezoxon-1 is a colorless liquid with a specific odor of vinegar, contains 5-8% peracetic acid: highly soluble in water and alcohol. Solutions of the drug corrode products made from low-grade steel. Aqueous solutions quickly lose activity and therefore are used immediately after preparation. It is highly active against all forms of bacteria, viruses and fungi.

Ammonia solution (ammonia) contains 9.5-10.5% ammonia. Has antiseptic and cleaning properties. Used to wash the hands of medical personnel before surgical operations (25 ml per 5 liters of water - 0.5%).

2.7 Phenolic derivatives

Phenolic derivatives are active ingredients found in some household disinfectants. They can also be found in some mouthwashes, disinfectant soaps, and hand sanitizers.

Resorcinol acts on vegetative forms of bacteria and fungi and is used for bacterial and fungal skin lesions in the form of 2-5% solutions and 5-10% ointments.

Lysol (A-sanitary) is a brownish-brown liquid with a pungent odor of phenol. It is a mixture of phenols (50%) and liquid sodium soap. It dissolves well in water (preferably in heated water). Aqueous solutions are transparent or slightly opalescent, soiled, bactericidal against vegetative forms of bacteria (except tuberculosis), and at 5-10% concentration they also have an insecticidal effect. Suitable for current and final disinfection, especially rough disinfection in cases where soiling and odor remaining for some time do not serve as an obstacle.

2.8 Derivatives of metal salts

Salts of Hg, Ag, Zn, Bi and some other metals bind sulfhydryl groups (SH-groups) of microbial enzymes and have a bactericidal effect. At higher concentrations, these compounds exhibit astringent and cauterizing properties against proteins.

Solutions of mercury dichloride (sublimate) are used to disinfect linen and patient care items. Mercury dichloride is highly toxic; easily absorbed through the skin. May cause severe poisoning.

Silver nitrate (lapis) in concentrations up to 2% has an antimicrobial effect, and in higher concentrations it acts as a cauterizing agent.

3. Use of disinfectants

Disinfectants should be used by medical personnel in accordance with the official guidance document. Disinfection of medical instruments can be carried out with hydrogen peroxide followed by washing of the instruments. For products and their parts that are not in direct contact with the patient, wiping should be carried out with a napkin soaked in a disinfectant solution and wrung out to avoid getting inside the product. If the immersion method was used, the product must be rinsed in running water until the odor is completely removed. Each disinfectant solution must be used once, and after disinfection, products made of rubber and polymer materials must be packaged in gauze.

The laundry is boiled for 15 minutes in a 2% solution of sodium bicarbonate (soda) or soaked in a disinfectant solution at the rate of 4 liters per 1 kg of dry laundry (the laundry must be completely immersed in the solution). When finished, the laundry is washed and rinsed.

Tableware is freed from food debris, washed or boiled in a 2% soda solution for 15 minutes or immersed in a disinfectant solution. On average, 2 liters of solution are consumed per set of utensils (cup, saucer, deep and shallow plates, teaspoons and tablespoons, fork and knife).

Toys (plastic, rubber, wood, metal) are washed with a hot 2% soda solution or immersed in a container filled with a disinfectant solution, which is closed, preventing the toys from floating, or they are wiped with a rag previously moistened in a disinfectant solution. Metal toys are treated with non-corrosive solutions.

The premises (floor, walls, doors) and household items are irrigated with a disinfectant solution at the rate of 300 ml/m2 or wiped with a rag soaked in it (the average consumption is 200 ml/m2).

Plumbing installations (toilets, sinks, bathtubs) are irrigated or wiped with a disinfectant solution (500 ml/m2) or wiped with disinfectant powder, followed by rinsing.

Soft toys and upholstered furniture are cleaned with a brush dipped in a disinfectant solution; When treating items with colored upholstery, non-bleaching disinfectant solutions should be used.

Cleaning equipment is boiled in a soda solution or soaked in a disinfectant solution.

The secretions of patients are covered with dry disinfectants or filled with concentrated solutions.

Most disinfectants can have an irritating effect (when diluted and sprayed) on the mucous membranes of the upper respiratory tract and eyes, and some on the skin of the hands. Therefore, when working with them, you should use personal protective measures (robes, headscarves, rubber gloves, goggles, respirators).

4. Modern disinfectants (frequently used)

Dezefect is a disinfectant with a wide spectrum of action. Its use is effective against viruses, fungi, gram-positive and gram-negative bacteria and spores, and additionally has detergent properties. The antimicrobial activity of the drug increases with increasing solution temperature. The cleaning properties of the solution increase with increasing temperature or by adding soda ash to it. Composition: a complex of 2 quaternary ammonium compounds - p-alkyldimethylbenzyl ammonium chloride (4.5%), p-chloride (4.5%) and other components.

Lizafin is a drug for disinfecting indoor surfaces and medical products. Active against gram-negative and gram-positive bacteria (including mycobacterium tuberculosis), fungi of the genus Candida and Trichophyton, viruses (causative agents of viral hepatitis, HIV infections, herpes, rotavirus gastroenteritis, enterovirus infections, polio, influenza and other acute respiratory viral infections). Has cleaning properties. Composition: 30% alkyldimethylbenzylammonium chloride, 0.5% glutaraldehyde, 5% glyoxal, denatured alcohol, synthanol.

Lysoformin is a universal disinfectant for disinfection and sterilization of medical instruments of any composition. Properties: virucidal, bactericidal (including tuberculocidal and sporicidal) and fungicidal, as well as fixative, which requires preliminary removal of organic contaminants from medical instruments. Composition: includes 9.5% glutaraldehyde, 7.5% glyoxal and 9.6% didecyldimethylammonium chloride, auxiliary components; The pH of the concentrate is 3.7-0.6. The activator 10% solution “Lysoformin-3000” contains alkaline ingredients, inert additives and distilled water.

Sidex is a preparation for the disinfection of medical products made using thermolabile materials, as well as for their sterilization. It has bactericidal (including tuberculocidal), virucidal (including against pathogens of parenteral viral hepatitis and HIV infection), fungicidal and sporicidal properties. Composition of the disinfectant "Sidex": liquid component - 2% aqueous solution of glutaraldehyde, powder component - alkaline agent, corrosion inhibitor and dye.

Septodor-Forte is a product used to disinfect room surfaces, plumbing equipment, sanitary transport and laboratory glassware. It has antimicrobial activity against gram-negative and gram-positive bacteria (including mycobacterium tuberculosis, causative agents of especially dangerous infections - plague, cholera, tularemia, glanders, melioidosis, anthrax), viruses, pathogenic fungi of the river Candida and Trichophyton, as well as detergent and sporicidal properties. Composition: 37.5% complex of four quaternary ammonium compounds (QAC) (alkyldimethylbenzylammonium chloride - 15.00%, octyldecyldimethylammonium chloride - 11.25%, dioctyldimethylammonium chloride - 4.50%, didecyldimethylammonium chloride - 6.75%) and 12.5% ​​glutaraldehyde (GA), concentrate pH 5.9.

Alphadez-forte is a drug used for the disinfection of medical products, including surgical and dental instruments, as well as instruments of medical institutions. The product has an antimicrobial effect against gram-negative and gram-positive bacteria (including mycobacterium tuberculosis), viruses, fungi of the genus Candida, Trichophyton, and molds. Composition: benzalkonium chloride and didecyldimethylammonium chloride (QAC) - 12%, glutaraldehyde (GA) - 4%, glyoxal - 8%, auxiliary components isopropyl alcohol, neonol AF 9-10, ethoxylated fatty alcohol and distilled or deionized water up to 100% .

Freebak is a skin antiseptic and quick disinfectant for various objects that are small in area but difficult to handle. The product has antimicrobial activity against gram-negative and gram-positive bacteria, pathogenic fungi (causative agents of dermatophytosis and candidiasis) and parenteral hepatitis viruses B, C, D, HIV infection, influenza, incl. And H5NI, HINI, herpes infection. It contains as active ingredients isopropyl alcohol - 50.0%, hydrogen peroxide - 0.5%, chlorhexidine bigluconate - 0.5%, as well as auxiliary components (glycerin - 0.1%, distilled water).

5. Conclusion

Disinfection, as an event aimed at breaking the mechanism of transmission of infection, is used both for preventive purposes and for epidemic indications, and disinfectants are now a common element of life in a medical institution. Future doctors need to know and understand how various types of disinfection are carried out, because... for some types of infection, disinfection is carried out in the outbreak independently after instructions from a pediatrician or therapist.

Unfortunately, today none of the drugs used immediately has all the necessary properties. In relation to healthcare facilities, depending on the type of devices or the nature of the surfaces being treated, it is necessary to use various disinfection technologies and various disinfectants.

List of references and information sources

1. Prevention of infectious diseases during manipulations / Sanitary rules (SP 3.1.1275-03) came into force on May 1, 2003, approved by the Chief State Sanitary Doctor of the Russian Federation on April 2, 2003 (registered with the Ministry of Justice on April 14, 2003 4417). 2 s.

4. Taits B.M., Zueva L.P. Infection control in health care institutions. SPb.: SPbSMA im. Mechnikova, 1998. 295 p.

5. Problems of modern disinfectology and ways to solve them / Materials of the All-Russian Scientific Conference. - Moscow: ITAR-TASS, 2003. 216 p.

6. Experience in implementing an infection control system in medical institutions. SPb: GOUVPO SPbSMA named after I.I. Mechnikov. 2003. 264 p.

7. http://www.deznet.ru/.

8. http://www.wikipedia.ru/.

9. http://www.ru.wikipedia.org/.

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