[Introduction to antiseptics]. / Introducción a los antisépticos.

Antiseptics are anti-infectious agents for local use on the skin or mucosa, which distinguishes them from disinfectants, which are used on inanimate surfaces usually because of their toxicity. The present article explains the differences among the multiple possible antiseptics; special attention is paid to the most common, such as alcohol, chlorhexidine, povidone iodine, and oxygenated water. Finally, we stress the different antiseptic formulations, which increase the usefulness of these agents in specific indications.

[Antiseptic use in primary care]. / Uso de los antisépticos en atención primaria.

Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique.

[Patient advice]. / Consejos para pacientes.

In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material.

Introducción a los antisépticos / Introduction to antiseptics

Los antisépticos son agentes antiinfecciosos de uso local sobre piel o mucosas, lo cual los distingue de los desinfectantes, que se usan sobre superficies inanimadas, debido normalmente a su toxicidad. En este capítulo explicamos las diferencias entre los múltiples posibles antisépticos, prestando especial atención a los más comunes como el alcohol, la clorhexidina, la povidona yodada y el agua oxigenada. Finalmente hacemos hincapié en las diferentes formulaciones de los antisépticos, que los hacen más útiles para indicaciones determinadas

Antiseptics are anti-infectious agents for local use on the skin or mucosa, which distinguishes them from disinfectants, which are used on inanimate surfaces usually because of their toxicity. The present article explains the differences among the multiple possible antiseptics; special attention is paid to the most common, such as alcohol, chlorhexidine, povidone iodine, and oxygenated water. Finally, we stress the different antiseptic formulations, which increase the usefulness of these agents in specific indications

Uso de los antisépticos en atención primaria / Antiseptic use in primary care

Las heridas se pueden clasificar, según el mecanismo de acción, en quirúrgicas o traumáticas (que pueden ser incisas, como las provocadas por un objeto cortante; contusas, causadas por un objeto romo; punzantes, provocadas por objetos afilados y largos; por desgarro, causadas por tracción de los tejidos; por mordedura, que tienen alto riesgo de infección, por lo que no se deben suturar) o, por la evolución del proceso de cicatrización, en agudas o crónicas (úlceras por presión, úlceras vasculares, úlceras neuropáticas, heridas agudas con tórpida evolución). El empleo de antisépticos en cualquiera de los casos suele estar limitado a la limpieza y cuidados iniciales (48-72 h) y al lavado de manos e instrumental, y su uso en heridas crónicas o cronificadas es más discutible. En el caso de quemaduras sucede lo mismo, y es más recomendable el empleo de formulaciones que favorezcan la hidratación. En población pediátrica se suele recomendar el empleo de antisépticos con un perfil de seguridad conocido y baja absorción, especialmente en el caso del cuidado del cordón umbilical, donde la evidencia recomienda el empleo de gluconato de clorhexidina. Otro uso de los antisépticos es el cuidado de heridas producidas por la implantación de objetos dentro de la estética corporal (piercing y similares), siendo recomendable el empleo de antisépticos transparentes que permitan observar la evolución de la técnica

Wounds can be classified according to their mechanism of action into surgical or traumatic (which may be incision wounds, such as those provoked by a sharp object; contusions, caused by a blunt force; puncture wounds, caused by long, sharp objects; lacerations, caused by tears to the tissue; or bites, which have a high risk of infection and consequently should not be sutured). Wounds can also be classified by their healing process into acute or chronic (pressure ulcers, vascular ulcers, neuropathic ulcers, acute wounds with torpid clinical course). The use of antiseptics in any of these wounds is usually limited to cleaning and initial care -up to 48 hours- and to washing of hands and instruments. The use of antiseptics in chronic or persistent wounds is more debatable. The same is true of burns, in which the use of formulations that encourage hydration is recommended. In the pediatric population, the use of antiseptics with a known safety profile and low absorption is usually recommended, especially in the care of the umbilical cord, in which evidence supports the use of chlorhexidine gluconate. Another use of antiseptics is the care of wounds produced by procedures used in body esthetics, such as piercings; in these procedures, it is advisable to use transparent antiseptics that allow visualization of the technique

Consejos para pacientes / Patient advice

En el cuidado de las heridas es tan importante saber qué hacer como saber qué no hacer. Lo primero es valorar la gravedad de la lesión y saber si es necesario acudir a un centro sanitario o no. Si la herida es simple, lo más recomendable es hacer una buena limpieza con suero o agua tras lavado de manos, realizando la desinfección de esta con el antiséptico más adecuado. Los antisépticos no deben usarse para la limpieza de las heridas (usar suero fisiológico o agua del grifo) ni para la cura de heridas con tejido de granulación. No hay que usarlos en el oído o cerca de los ojos; en caso de aplicación accidental en el ojo lavar abundantemente con agua. No usar povidona yodada en gestantes, ni utilizar preparados yodados en neonatos, en pacientes con alteraciones del tiroides o en alérgicos al yodo. Hoy en día, tampoco se debe usar la merbromina/mercurocromo a causa de su contenido en mercurio. Antes de usar un antiséptico han de eliminarse todos los residuos inorgánicos (cuerpos extraños) y los orgánicos desvitalizados, detritus, esfacelos, exudado purulento, escaras, etc. Esta acción facilitará la cicatrización y la acción de los antisépticos, ya que se inactivan en presencia de materia orgánica

In wound care, knowing what to do is as important as knowing what not to do. The first step is to evaluate the severity of the lesion and to know whether it is necessary to attend a health center or not. If the wound is simple, the recommended course of action is cleansing with serum or water after washing one's hands, followed by wound disinfection with the most appropriate antiseptic. Antiseptics not should be used for wound cleansing (physiological serum or tap water should be used) or for wound healing with granulation tissue. Equally, antiseptics should not be used in the ear or near the eyes; if there is accidental application, the eye should be washed in abundant water. Povidone iodine should not be used in pregnant women, nor should iodine preparations be used in neonates, in patients with thyroid alterations or in those allergic to iodine. Currently, merbromine/mercurochrome is not used because of its mercury content. Before an antiseptic is applied, all inorganic residues (foreign bodies) and dead tissue should be removed; detritus, slough, purulent exudate, scabs… This will aid healing and the action of antiseptics, since they become inactive in the presence of organic material