Chapter 19: Chemical

disinfectants, antiseptics and

preservatives
Disinfectants, antiseptics and
preservatives
-destroy or inhibit the growth of
microorganism
-biocide
Biocidal product
-encompasses active substances
and preparations containing one
or more active substances
-intended to destroy, deter, render
harmless, prevent the action of,
exert a controlling effect on any
harmless organism by chemical or
biological means
Disinfectant and disinfection
Disinfection
-process of removing
microorganisms, including
pathogens, from the surfaces of
inanimate objects
High-level disinfection
-indicates destruction of all
microorganisms but not
necessarily bacterial spores
-have good sporicidal activity
-liquid chemical sterilants or
chemosterilants that indicate a
complete kill or sterilization
Intermediate-level disinfection
-indicates destruction of all
vegetative bacteria including
Mycobacterium tuberculosis
Low-level disinfection
-can destroy most vegetative
bacteria, fungi and viruses
-will not include spores and some
of the more resistant
microorganisms
Antiseptic and antisepsis
Antisepsis
-destruction or inhibition of
microorganisms on living tissues

-applied to skin and mucous

membranes
-must not be toxic or irritating for
these tissues
-mostly used to reduce the
microbial population on the skin
before surgery or on the hands to
help prevent spread of infection by
this route
-lower concentrations of agents
used for disinfection
Preservative and preservation
Preservatives
-included in pharmaceutical and
many other types of formulation
-prevent microbial spoilage
-minimize the risk to the consumer
of acquiring an infection
-limit proliferation of
microorganisms
-should kill any microbial
contaminants
-not toxic
-employed at very low
concentrations
-consequently levels of
antimicrobial action also tend to
be of a lower order than for
disinfectants or antiseptics
Economic aspects
-concerns about bacterial and other
pathogenic threats
FACTORS AFFECTING CHOICE OF
ANTIMICROBIAL AGENT
1. Properties of the chemical
agent
Chemical reaction and rate and extent
-influenced by concentration of
agent, temperature, pH and
formulation
Tissue toxicity
-determine if a chemical can be
used as an antiseptic or
preservative

-limits the range of agents for

these applications
-necessitates the use of lower
concentrations of the agent
2. Microbial challenge
-types of microorganism present
and levels of microbial
contamination (the bioburden)
*Bioburden is high
-long exposure times and/or
higher concentrations of
antimicrobial may be required
-merit attention because of
resistance to disinfection or
significance in cross-infection or
nosocomial infection
a. Vegetative bacteria
-at in-use concentrations,
chemicals used for disinfection
should be capable of killing
bacteria and other organisms
expected in that environment
within a defined contact period
-problems may occur when
heavily soiled articles or diluted
or degraded disinfectant
solutions are employed
b. Mycobacterium tuberculosis
-resistant to many bactericides
-resistance is either:
Intrinsic
-due to reduced cellular
permeability
Acquired
-due to mutation or the
acquisition of plasmids
-the greatest risk of acquiring
infection is from the
undiagnosed patient
c. Bacterial spores
-exhibit significantly resistance to
even the most active chemical
disinfectant treatment
-majority of disinfectants have no
useful sporicidal action in a
pharmaceutical context

-Bacillus and Clostridium

-aldehydes, halogens and
peroxygen displays very good
activity and used as an
alternative to physical methods
for sterilization of heat-sensitive
equipment
-Clostridium difficile is a
problematic contaminant in
hospital environments, resulting
in high levels of morbidity and
mortality.
(Antibacterial activity of some
disinfectants and antiseptics
is summarized in Tale 19.2 on
page 316 of our book)
d. Fungi
-vegetative fungal form is often
as sensitive as vegetative
bacteria to chemical
antimicrobial agents
-fungal spores may be resistant,
but this resistance is of lesser
magnitude than that exhibited
by bacterial spores
-ethanol (70%) is rapid and
reliable against Candida species
e. Viruses
-susceptibility depends on
whether the viruses posses a
lipid envelope
-non-lipid viruses are frequently
more resistant to disinfectants
-responsible for many nosocomial
infections
-Ebola and Marburg
>cause haemorrhagic fevers
>highly infectious
>safe destruction by
disinfectants is of paramount
importance
-Hepatitis A
>enterivirus
>one of the most resistant
viruses
-HIV

>inactivated by mostchemicals
at in-use concentration
>disinfect: use a high-level
disinfectants
-Influenza A virus
>susceptible to a large number
of disinfectant products when
they are used I hard, non-porous
surfaces
f. Protozoa
-Acanthamoeba
>can cause acanthamoeba
keratitis with associated corneal
scarring and loss of vision in
wearers of soft contact lenses.
-Chlorine-generating systems in
use are generally inadequate
-Hydrogen peroxide-based
disinfection is considered
completely reliable and
consistent in producing
acanthamoebicidal effects
g. Prions
-most resistant
-not microorganism
-no cellular structure nor do they
contain nucleic acids
-cause spongiform
encephalopathies
-risk of infectivity is highest in
brain, spinal cord and eye
tisssues
3. Intended application`
-medical preparation
>ingredients used may antagonize
preservative activity
-disinfection of instruments
>chemicals used must not
adversely affect the instruments
4. Environmental factors
-organic matter can have a drastic
effect on antimicrobial capacity
either by adsorption or chemical
inactivation thus reducing the
concentration of active agent in
solution

-dried organic deposits may inhibit

penetration of the chemical agent
(SUMMARIZED FORM OF THE
EFFECTS ON ACTIVITY BY
THESE FACTORS CAN BE SEEN
IN TABLE 19.4 ON PAGE 319 TO
320)
5. Toxicity of the agent
-Toxic volatile substance should be
kept in covered containers to
reduce the level of exposure to
irritant vapour
-face protection and impermeable
nitrile rubber gloves should be
worn
(see Table 19.5 for the HSE
Recommendations for
endoscopy disinfection on page
321)
TYPES OF COMPOUND
1. Acids and esters
a. Benzoic acid
>widely used
>can be alone or included in a
combination with other
preservatives
>disadvantage: development
of resistance by some
organism
b. Sorbic acid
>widely used
>most effective at pH 4 or
below
c. Sulphur dioxide, sulphites and
metabisulphites
>preservative in the food and
beverage industries
>preservatives and
antioxidant
d. Esters of p-hydroxybenzoic
acid
(parabens)
>widely used
>overcome the marked pH
dependence on activity of the
acids

2. Alcohols
a. Alcohols used for disinfection
and antisepsis
-aliphatic alcohols are used
for disinfection and
antisepsis
-poor penetration of organic
matter
-restricted to clean condition
-cleansing action and
volatility
-ethanol
> concentrations between
60% to 95% are
bactericaidal
> 70% solution is usually
employed for disinfection
of skin, clean instruments,
or surfaces
>higher concentration,
ethanol is active against
fungi and most lipidcontaining viruses
>solvent and preservative
-isopropyl alcohol
>slightly greater
bactericidal activity than
ethanol
>twice as toxic
>less active against viruses
>used at concentrations of
60%-70%
>alternative to ethanol
>preservative for cosmetics
b. Alcohols as preservatives
Benzyl alcohol
- antibacterial and weak
local anaesthetic
- used at 2%
- use in cosmetics is
restricted
Chlorbutamol
-used at concentration of
0.5%
-preservative in injections
and eye drops
Phenylethanol

-in-use concentration of
0.25-0.5%
-greater activity against
Gram-negative organisms
Phenoxyethanol
-in-use concentration at
1%
-more active against Ps.
aeruginosa
Bronopol
-in-use concentration of
0.01-0.1%
-exposed to light at
alkaline pH and
accompanied by increase
in temperature,
decomposition may occur
resulting to a change in
color from yellow to
brown
3. Aldehydes
a. Glutaraldehyde
-has a broad spectrum of
antimicrobial activity and
rapid rate of kill, most
vegetative bacteria being
killed within a minute of
exposure
b. Ortho-phthaldehyde
-excellent mycobactericidal
activity with complete kill of
M. tuberculosis within 12
minutes at room
temperature
c. Formaldehyde
-decontamination of
isolators, safety cabinets and
rooms
d. Formaldehyde-releasing
agents
-reduce the irritancy
associated with
formaldehyde while maintain
activity
4. Biguanides
a. Chlorhexidine

-antiseptic
-its base is not readily
soluble in water, therefore
its freely soluble salts,
acetate, gluconate, and HCl
-nontoxic when applied to
skin or mucous membranes
and is an important
preoperative antiseptic
b. Polyhexamethylene
biguanides
-antimicrobial activity
exceeds that of monomeric
biguanides
5. Halogens
a. Chlorine
-large number of
antimicrobially active
chlorine compounds are
commercially available, one
of the most important being
liquid chlorine
b. Hypochlorite
-oldest and remain the most
useful of the chlorine
disinfectants
c. Organic chlorine compounds
-disinfectant and antisepsis
-antimicrobial of these
compounds are similar to
hypochlorite when acidic
conditions of use are
maintained
d. Chloroform
-narrow spectrum of activity
-marked reductions in
concentration may occur
through volatilization from
products, resulting in the
possibility of microbial
growth
e. Iodine
-wide spectrum of
antimicrobial activity
-disadvantage: staining of
skin an fabrics coupled with

possible sensitizing of skin

and mucous membranes
f. Iodophors
-eliminate the disadvantages
of iodine while retaining its
antimicrobial activity
6. Heavy metals
-mercury and silver have
antibacterial properties and
preparations of these metals
were among the earliest used
antiseptic
7. Hydrogen peroxide and
peroxygen compounds
-high level disinfectants
-used in disinfection of soft
contact lens
8. Phenols
-widely used disinfectants and
preservatives
-good antimicrobial activity
-rapidly bactericidal but not
sporicidal
-more active at acid pH
Disadvantage: caustic effect on
skin and tissues and their
systemic toxicity
9. Surface-active agents
-surfactants
-anionic, cationic, non-ionic or
ampholytic
-cationic compounds play the
most important role in an
antimicrobial context
-Cationic surface-active agents
>falls within the grouo known
as the quaternary ammonium
compounds (QAC)
>QAC exhibit greatest activity
against Gram-positive bacteria
10.
Other antimicrobials
a. Diamidines
-reduced by acid pH and in
presence of blood and serum
b. Dyes
-have static activity but are
no longer applied topically

for the treatment of

infections because of
carcinogenictiy
c. Quinoline derivatives
-little used now
DISINFECTION POLICIES

-aim to control the use of chemicals

for disinfection and antisepsis and
give guidelines on their use
(SEE TABLE 19.7 ON PAGE 333)