FACULTY OF NURSING

BY MRS SUDHARANI
BY-
Unit III Pharmacology of commonly
used
ANITISEPTICS, DISINFECTANTS
DISINFEC
AND
INSECTICIDES
Presented By-
Prof Sudharani Banappagoudar
Academic Head
Rama University Faculty Of Nursing
Kanpur
 Syllabus –
Unit III: Pharmacology of commonly used
ANITISEPTICS, DISINFECTANTS AND
INSECTICIDES

harmacology of commonly
sed: Composition, action, dosage
route, indications,
Antiseptics.
contraindications, drug
Disinfectants. interactions, side effects,
Insecticides. adverse, effects, toxicity & ro
of nurse.
23/201
ANITISEPTICS
ANITISEPT
Definition of terms
• Antiseptic = agent that causes destruction or inhibition of
growth of micro organisms (bacteria, viruses, fungi) on living
surfaces such as skin & mucous membranes.
• Disinfectant = agent that causes destruction or inhibition of
growth of microorganisms (bacteria, viruses, fungi) on non
living surfaces (instruments, equipments, pieces of furniture,
rooms, etc).
• Spores are (usually) not destroyed !!!
Definition of terms (continued)

• Antisepsis = use of chemical solutions for disinfection

(prefix: ”anti” = against) e.g. removal of transient
microorganisms from the skin and a reduction in the resident
flora
• Asepsis = absence of infectious microoorganisms (prefix: ”a”
= absence)
• Aseptic techniques - aimed at minimising infection e.g.
• The use of sterile instruments
• The use of a gloved no touch technique
istory of antiseptics
naz Semmelweis
818 - 1865)
ungarian physician working in Vienna
cross contamination → high incidence of
death after childbirth
He made doctors to wash hands in
chloride of lime before touching patients
Dramatically reduced incidence of
childhood fever.
History of antiseptics (continued)

• Joseph Lister (1827 - 1912)

Brittish surgeon
carbolic acid (phenol) for hands
and wounds during operations
o maintain aseptic conditions
→ aseptic surgery
Properties of antiseptics/disinfectants

1. Microbicidal activity
2. Non staining & good odour
3. Active against all pathogens
4. Active in presence of pus, blood & exudates
5. Rapid acting
6. Non irritating to tissues / non corrosive
7. Non absorbable
8. Non sensitizing/
Mechanisms of action

Disrupt cellular structures and/or processes E.g.

• Oxidation of bacterial protoplasm

• H202, Halogens, potasium permanganate
• Coagulation (denaturation) of proteins
• Phenols, chlorhexidine, alcohols, aldehydes
• Increasing permeability of bacterial cell membrane
• Cetrimide, soaps.
Mnemonic: PHARMA GOD • Phenol derivatives
Phenol derivatives. • Oxidizing agents
• Halogens
Halogens. • Biguanides
Alcohols, Aldehydes, Acids. • Quaternary amonium compoun
urface antigens metallic salts • Alcohols
Metalls). • Aldehydes
Miscellaneous. • Acids
• Surface antigens metallic salts
Gases. (Metalls)
Oxidizing agents. • Dyes.
• Gases.
Dyes. • Miscellaneous.
Classification
Depending on concentration:

me chemicals can act either as antiseptics or as disinfectants e.g

henol solution 0.2% = antiseptic; 1% = disinfectant
Phenol & derivatives
Phenol
Earliest use (19th century), reference standard
mechanism: denaturation of bacterial proteins
Uses: disinfection of urine/faeces/pus contaminated
surfaces/areas
Extremely irritating, corrosive
Cresol
Methyl dderivative of phenol, less damaging to tissues than
phenol
3-10 times more active used for disinfection of utensils, excreta &
for washing hands
Phenol & derivatives – contd

Chloroxylenol (Dettol)
• Does not coagulate proteins
• Non corrosive, Non irritating to skin
• Commercial 4.8 % solution used for surgical antisepsis
• Skin cream and soap: 0.8%
• Mouth wash 1% .
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous.
Oxidizing agents
Peroxides:
short-acting germicidal effect through release of nascent oxyg
which irreversibly alters microbial proteins
little or no action on bacterial spores
nascent oxygen rendered inactive when it combines with orga
matter
e.g. Hydrogen peroxide solution (3%)
releases oxygen in contact with catalase on wound surfaces an
mucous membranes; effervescent action mechanically helps
remove pus and cellular debris from wounds and is valuable f
cleaning infected tissue.
Oxidizing agents - contd
Peracetic acid
Broad antimicrobial spectrum (like hydrogen peroxide) +
greater lipid solubility
Effective against bacteria, yeasts, fungi, and viruses (0.001–
0.003%)
sporicidal at 0.25–0.5%
Solutions of 0.2% peracetic acid applied to compresses are
effective at reducing microbial populations in severely
contaminated wounds
Oxidizing agents - contd
• Potassium permanganate:
• broad antimicrobial properties,
• effective algicide (0.01%) and virulicide (1%) for
disinfection, but concentrations >1:10,000 tend to irritate
tissues
• Old solutions turn chocolate brown and lose their activity
• stains tissues and clothing brown (disadvantage)
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous.
Halogens & halogen containing compounds

Iodine tinctures: 2% iodine + 2.4% sodium iodide (NaI) in 50%

ethanol; it is used as a skin disinfectant. Strong iodine tincture
contains 7% iodine and 5% potassium iodide (KI) dissolved i
95% ethanol; it is more potent but also more irritating than
tincture of iodine.

Iodine solutions: 2% iodine + 2.4% NaI dissolved in aqueous

solution; it is used as a nonirritant antiseptic on wounds and
abrasions. Strong iodine solution (Lugol's solution) contains
5% iodine and 10% KI in aqueous solution.
Halogens & halogen containing compounds
lorine - Potent germicidal effect against most bacteria, viruses,
rotozoa, and fungi at a concentration of 0.1 ppm, but much higher
oncentrations are required in the presence of organic matter
Alkaline pH ionizes chlorine and decreases its activity by reducing i
enetrability.
ritant to the skin and mucous membranes
widely used to disinfect water supplies and inanimate objects (eg,
tensils, bottles, pipelines)
odium hypochlorite solutions (bleach) 2–5% can be used as a
isinfectant, and a more diluted form (0.5%) can be used for irrigati
uppurating wounds, but it dissolves blood clots and delays clotting
oot canal therapy in dentistry
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous
Biguanides
Chlorhexidine
• Acts by disrupting bacterial cell membrane & denaturation
of bacterial proteins
• Non irritant, more active against Gram + bacteria
• Used in for surgical scrub, neonatal bath, mouth wash &
general skin antiseptic
• Most widely used antiseptic in dentistry 0.12-0.2% oral
rinse or 0.5 -1 % tooth paste.
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases
• Miscellaneous
Quaternary amonium compounds
ergents:: destroy bacteria, fungi & viruses by altering
rmeability of cell membrane
ficiently remove dirt and grease
idely used as antiseptics & disinfectants for surgical instrumen
oves etc.
ps: Anionic detergents
eak antiseptics with cleansing action
ashing with soap and warm water - one of the most effective
ethods of preventing disease transmission
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous
Alcohols
Ethanol
• Antiseptic, cleansing agent at 40-90%
• Act by precipitation of bacterial proteins
• Irritant, should not be applied on mucous membranes,
ulcers, open wounds
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium
compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases
• Miscellaneous
Aldehydes - Formaldehyde

Also used as sterilization agents!

• Used for fumigation
• 37 % aqueous solution (formalin)
• denaturates proteins
• Used for preserving dead tissues
• Use as antiseptic restricted due to bad odour & irritation
• Glutaraldehyde is a better sterilizing agent
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous
Acids

Boric acid
weak antiseptic , bacteriostatic
used for mouth wash, irrigation eyes, glossitis
Adverse effect: vomiting,abdominal pain on systemic
absorption
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compounds
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes.
• Gases.
• Miscellaneous.
Metals: metallic salts
Silver:
Silver ions precipitate proteins + interfere with essential metabolic
activities of microbial cells
0.1% aqueous silver solution – bactericidal but irritating
0.01% solution – bacteriostatic
0.5% solution - sometimes applied as a dressing on burns to reduce
infection
Colloidal silver compounds – slowly releasing silver ions
more sustained bacteriostatic effect
non-irritant
mild antiseptics, also used in ophthalmic preparations
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compound
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes
• Gases
• Miscellaneous.
Dyes
Gentian violet (Crystal violet)
topical antiseptic; commonly used for:
Marking the skin for surgery preparation and allergy testing
Effective against Candida albicans and related infections
such as thrush, yeast infections, tinea, etc.
• In resource limited settings,, gentian violet is used to manage
burn wounds, inflammation of the umbilical cord stump
(omphalitis) in neonates, oral candidiasis, mouth ulcers
ACRIFLAVINE :

• Active against gram +ve bacteria,

gonococci

• Store in amber colored bottle.

• Nonirritant

• Use chronic ulcers and wounds

 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compound
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes
• Gases
• Miscellaneous
Ethylene Oxide
Acts by alkylating proteins and nucleic acid.
Highly inflammable and explosive.
Used for sterilization of heart – lung machine, plastic equipment,
sutures, dental equipment and cardiac catheters.
Not used for fumigation as it is explosive.
Formaldehyde
• 40% solution is called formalin.
• Formaldehyde solution is used for disinfection of sputum,
removal of warts, on palms and soles to treat hyperhidrosis,
preservation of anatomical and pathological specimens.
• Formaldehyde gas used for fumigation of wards and OT’s
rarely for sterilization of heart instruments and gloves.
• In dentistry it is used to harden the residual pulp tissue.
 • Phenol derivatives
Classes • Oxidizing agents
• Halogens
• Biguanides
• Quaternary amonium compound
• Alcohols
• Aldehydes
• Acids
• Metalls
• Dyes
• Gases
• Miscellaneous
• Nitrofurazone has bactericidal action on fungi. It is
used topically for burns and ulcers.
DISINFECTANTS
Selection criteria of Disinfectants:
Disinfectant effectiveness depends on many factors. These include:
Type of contaminating microorganism. Each disinfectant has uniq
antimicrobial attributes.
Degree of contamination. This determines the quality of disinfecta
required and time of exposure.
Amount of proteinaceous material present. High protein based
materials absorb and neutralize some chemical disinfectants.
Presence of organic matter and other compounds such as soaps m
neutralize some disinfectants.
Chemical nature of disinfectant. It is important to understand the
mode of action in order to select the appropriate disinfectant.
Concentration and quantity of disinfectant. It is important to choose the
proper concentration and quantity of disinfectant that is best suited to
each situation.
Contact time and temperature. Sufficient time and appropriate
temperature must be allowed for action of the disinfectant and may
depend on the degree of contamination and organic matter load.
Residual activity and effects on fabric and metal should be considered
for specific situations.
Application temperature, pH and interactions with other compounds
must be considered.
Toxicity to the environment and relative safety to people that may be
exposed.
Cost.
LOW LEVEL DISINFECTANTS
• Phenolic Disinfectants
• Quaternary Ammonium Compounds: Contain NH4+. The
labels often list a form of ammonium chloride (AC) such as
alkyl aryl, benzyl, didecyl, dimethyl, ethylbenzyl, octyl or a
combination thereof. Benzalconium chloride (BC) is a more
tissue friendly Quaternary Ammonium than Ammonium
chloride . Quaternary Ammonium disinfectants are effectiv
against Gram + and Gram - bacteria, and enveloped viruses.
INTERMEDIATE LEVEL DISINFECTANTS
Alcohols
Hypochlorites
Iodine And Iodophor Disinfectants
HIGH LEVEL DISINFECTANTS
• Hydrogen Peroxide.
• Gluteraldehyde.
• Formaldehyde.
• Ortho-phthalaldehyde.
• Peracetic Acid.
• Peracetic Acid and Hydrogen Peroxide.
• Special Consideration for Creutzfeldt-Jakob
Creutzfeldt Disease (CJD
Assignment - Creutzfeldt-
Jakob Disease (CJD)
Special Consideration for Creutzfeldt-Jakob
Disease (CJD).
• Contaminated instruments should be thoroughly cleaned to
remove any organic material, immersed in a solution of
sodium hydroxide[1N] (NaOH) or ½ strength bleach
solutions (20000 ppm) for 1 hour, rinsed well, and then
placed in a water bath and sterilized at 121°C for one hour.
Hard surfaces should be cleaned to remove any visible soil,
then flooded with [2N] NaOH or undiluted bleach (50000
ppm) for 1 hour, then mopped up and rinsed with water.
• Any personnel handling NaOH solution/ bleach solution must
use appropriate PPE.
 INSECTICIDES
(These are the part of pesticides.)
Classification of pesticides
hese are organic or inorganic compound obtain from natural
roducts, Depending upon the purpose for which the pesticides
re used, they are classified as follows:
nsecticides
Herbicide
ungicides
Rodenticides
Algaecide
Molluscicides
Miticides
Nematocides
INSECTICIDES - Definition

• Insecticides are the chemicals used to kill the

insects.
lassification
Dichloro-diphenyl-trichloroethane
trichloroethane (DDT) – Organic
nsecticides
Group: Organochlorine Compound
Physical Appearance: White amorphous powder
Mode of Action: Contact poison--nervous system paralysis
Mode of application: residual spray.
Dosage of Application: 5% susp. / 100-200gm / sq ft
Effective against: Lice, Fleas, Ticks, Flies, Mosquitoes
Period of effectiveness: 18 months
Disadvantage: Persistence in living organisms like plants, human
and some wild animals leading to ecosystem damage, insecticide
resistance
BHC ( Benzene Hexa-Chloride)
Chloride) – Organic Insecticides.
• Group: Organochlorine Compounds
a) Technical HCH- 13-16% 16% Gamma isomer
b) Pure HCH – 99% Gamma isomer (lindane)
• Physical Appearance: White or chocolate coloured powder,
musty smell
• Mode of Action: Kills insects by direct contact and its vapour
• Mode of application: 50% Emulsifiable Concentrate
• Dosage of Application: 25 – 50 mg per sq.foot
• Effective against: Lice, Fleas, Ticks, Flies,
• Period of effectiveness: Residual action for 3 months
Abate (Temephos)
• Group: Organophosphorus compound
• Physical Appearance: Brown Viscous liquid
• Mode of Action: Contact poison
• Mode of application: 50% EC. Only insecticide approved for
use in potable water
• Dosage of Application: 1ppm
• Effective against: Anopheles stephensi
Malathion – Organophosphate Insecticides
Group: Organo- phosphorus compound
Physical Appearance: Yellow or clear brown colored liquid
Mode of Action: Contact Poison
Mode of application:
a) Malathion Technical (95%) for use as space spray
b) 50% Water Dispersible Powder (WDP) & emulsifiable
Concentrate (EC) for residual control
c) 90% dust for use against fleas and lice
Dosage of Application: 2 g/m2 for Mosquitoes
Effective against: mosquitoes, houseflies, cockroaches, bedbugs,
lice
enthion (Baytex) – Organophosphate Insecticides
Group: Organo-prosphrous Compounds
Physical Appearance: Brown liquid, Smell of garlic
Mode of Action: Contact poison, larvicide (Oils suffocate and
poison the aquatic stages of mosquito)
Mode of application: residual spray
Dosage of Application: 1 ppm
Effective against: Culex quinquefasciatus (non-potable
(non water)
ouseflies
Disadvantage: Injurious to aquatic vegetation and fish if not
properly used.
Mineral Oil (Mosquito larvicidal oil, Malariol) – Mineral
oils Insecticides:
• Group: Kerosene oil, diesel oil, petrol and crude engine oil
• Physical Appearance: Colourless or muddy Oil
• Mode of Action: Contact poison, Cuts off air supply
• Mode of application: Spray on the surface of water
• Dosage of Application: 40 – 90 liters / 10000 sq m
• Effective against: Mosquito larvae
• Period of effectiveness: To be applied once a week
Pyrethrum – Plant based Insecticides
• Group: Natural Insecticides, plant extract
a) Flowers of chrysanthemum cinerariafolium
b) Active principles: pyrethrum 1 and 2,cinerins 1 and 2
• Physical Appearance: Colorless liquid
• Mode of Action: Contact poison
• Mode and Dosage of application: 50 to 100 ml of pyrethrum
solution in kerosene oil is sprayed per 100 m3 of space.
• Effective against: Adult mosquito, other insects.
• Period of effectiveness: instant, no residual action.
Paris Green – Synthetic inorganic Insecticides
• Group: Inorganic, Larvicidal
• Physical Appearance: Emerald green crystalline powder
• Mode of Action: Stomach Poison
• Mode and Dosage of application: Applied as 1% granules to
water in which breeding occurs
• Effective against: Anopheline larave,
• Period of effectiveness: One week
Diazinon
• Group: Organo phosphorus compound
• Physical Appearance: Volatile liquid
• Mode of Action: Fumigant action, Contact Poison
• Mode of application: Fumigation
• Dosage of Application: 20 – 40 % at dose of 100 mg/sq foot
• Effective against: Flies, Mosquitos
• Used in DDT resistance
Different Classification
• CARBAMATE INSECTICIDES-carbaryl
INSECTICIDES , Dimetan, Pyrolan,
Zectran, carbofuran
• Organophosphorus compounds
• Malathion, Parathion, Diazinon
• Botonical compounds- Pyrethrum, Limonoids, Rotenone
• Ectoparaciticides –permethrin,
permethrin, lindane, Benzyl benzoate,
Crotamiton, Sulfur
Permethrin
• Broad spectrum causes neurological paralysis in insects.
• 100 % cure rate nearly
• Single application needed in most cases.
• Few patients experience itching ,burning.
• first drug of choice for scabies & pediculosis.
Scabies: Apply all over the body except face & head . Wash
after 8- 12 hrs.
Head louse: massage about 30 g in to scalp and wash after
10 min.
Lindane
• Broad spectrum insecticide which kills lice and mites by
penetrating their chitinous cover
• Properties similar to permethrin.
• Cure rate low & resistance seen.
• Disadvantage: being lipid soluble CNS toxicity like vertigo ,
convulsions seen.
• Application similar to permithrin.
• combination with benzyl benzoate is more effective.
Benzyl benzoate
• Oily liquid with aromatic smell.
• Cure rate 76 – 100% ; second application required after 24
hrs.
• Toxicity is low. Application similar to permethrin.
• Use has declined due to skin irritation.
• Contra indicated in children because of neurological
symptoms & skin irritation.
• combination with lindane highly effective.
Crotamiton
• low cure rates
• Better results if applied for 5 days in children
• Less irritation and toxicity
• May be preferred in children as second choice
Ivermectin
Anti helminthic drug which has been recently found effective against
scabies & pediculosis.
A single 0.2 mg /kg ( 12mg in adults) has 91- 100 % cure rate.
Contra indicated in children  5yrs , pregnant & lactating women.
Nursing Responsibilities:
Nurse must know the time course of action of the specific agent
because the various antiseptics and disinfectants require different
durations of exposure to be effective.
Washing with antiseptic by nurses, physician and others, who
contact patients will do more to protect patients from infection
than will application of antiseptics to patients themselves.
For routine hand alcohol, antiseptics, hand scrubs, are preffered to
soap and water.
Wear personal protective equipment which include boots, aprons,
gowns, gloves, masks, protective spectacles and caps.
contd.
Make sure the correct name of the solution is on the container each
time refill it, do not top off antiseptic dispenses.
Do not store gauze or cotton wool in antiseptics, this promote
contamination.
Nurse should establish a routine schedule for preparing new solutions
and cleaning reusable containers.
Label reusable containers with date, each time they are washed dried
and refilled.
All containers should have lids, which should be well tightened.
Nurse should keep in mind that concentrated antiseptic solutions
should be stored in a cool, dark area, never store them in direct
sunlight or excessive heat.
Smoking, eating, and drinking in chemical storage areas id strictly
prohibited.
References
Dr. P.K. Panwar, Essentials of pharm
macology for nurses, AITBS pub. 2
India, Pg no. 35 – 37.
Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics f
nurses, Jaypee pub. 2016 India Pg no 123 – 130.
Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. – 495.
Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Bar
pub 2010 India, Pg no 492.
Govind s. Mittal, Pharmacology at a glance, Paras medical book pub. 20
India 30.
Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 Ind
1st edition, Pg no 240.