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Soap Metallic salts of fatty acids alkaline in nature derived from animal fat, vegetable oil based, or super fatted (which are less drying but less effective in cleansing). Detergents Agents used to purify or clean by reducing surface tension which washes away dirt and debris. Categorized into anionic wetting agents (soaps and soap substitutes, less drying but very mild bacteriostatic effect), and cationic wetting agents. Benzalkonium Chloride Cationic wetting agent and detergent removes dirt, bacterial and dead cells, and denatures lipoproteins in cell walls and membranes. Has keratolytic action (skin breakdown), and effective against some G+ and G- bacteria, but not spores. Used for the preoperative cleaning of normal skin, cleansing broken skin, and sterilizing instruments. Antiseptic An agent that kills or prevents the growth of microbes when applied to living tissue (ie: skin). Broad spectrum, lethal to microbes, able to retain potency in presence of bodily fluids, low surface tension, safe therapeutic index and low potential to sensitization of the skin. Disinfectant An agent that prevents infection by the destruction of pathogenic microbes on non-living surfaces. Has wide spectrum, high efficacy as a germicide, rapid acting and lethal to organic matter. Chemically stable, long half life, and inexpenisve Ethyl Alcohol Effective at decreasing surface tension, damaging proteins in bacterial cell walls, and useful in increasing the effectiveness of other agents. Relatively low potency and effective against most pathogens. Less than 40% concentration leads to decreased effectivity, greater than 70% concentration can lead to spore formation. Common agent for skin prep, cleaning, or as an antiseptic before venipuncture Isopropyl Alcohol Effective at decreasing surface tension, damaging proteins in bacterial cell walls, and usefull in increasing the effectiveness of other agents. Effective at concetrations higher than 70%, ineffective against spore forming microbes. Causes vasodilation beneath skin, increases bleeding after venipuncture. Used for skin prep, disinfecting equipment and sterilizing rubber goods and suture material. Slightly more effective than EtOH Iodine One of the most potent and useful germicides, broad spectrum acts by oxidizing microbial protoplasm. Can be irritating to skin, stains clothing and skin, effectiveness decreased by organic matter, and relatively insoluble. Used as an antiseptic superior to others, treating wounds and abrasions, disinfecting drinking water. Povidone Iodine Iodine compound (iodophor), less effective than iodine alone but less irritating and sensitizing to skin. Used in the skin prep of the patient and the surgeon, has widespread use as an antiseptic on skin and membranes Silver Sulfadiazine A silver salt, has astringent (skin damaging, scarring) and caustic actions. Acts on bacterial cell surface to drastically alter cell wall and membrane. Highly effective, rapid acting and sustained action. Reacts with NaCl on contact with skin to have a sulfonamide action. Used in burn treatment. Thimerosal An organic mercurial agent used as an antiseptic for surgical prep of skin, mucous membranes, and open wounds. Can also be used as a preservative for biological agents. Area treated with mercurial compound should NOT be bandaged. Hydrogen Peroxide Releases oxygen on contact with blood or tissue. The mechanical fizzing action from the release of oxygen by catalase has a germicidal action. Effective only when oxygen is released (fizzing), so should not be bandaged. Effectiveness decreased by organic debris, use on intact skin is questionable. Hexachlorophene A substituted phenol compound that has bacteriostatic properties by denaturing protein. Widely used as an antiseptic and hand cleaner, but the effectiveness requires repeated daily application. Not effective for single use. Most effective against Gram+, the protection builds with repeated use. Used in preoperative hand and skin scrubbing, doubtful effectiveness as prophylactic scrub for skin infections. Effectiveness is decreased by cleansing with other agents. Chlorhexidine Gluconate Versatile broad spectrum agent used for cleaning of surgical sites and surgeon's hands. Residual action, rapid acting and low sensitization. One of the popular and primary scrubs and cleaning agents. Emollients Fats or oils used for their local action on the skin to lubricate, soften, and protect skin (traps moisture in). Agents can be vegetable oils or animal fats Lanolin An animal fat emollient from hydrous wool fat. Caution should be considered due to allergies. Astringents Agents applied to the skin to produce a local and limited protein coagulation effect. Coating serves to protect the underlying tissue and create a barrier. Causes skin dehydration, tightening, shrinking of tissues, and contraction of skin pores. Used in the treatment of hyperhydrosis (aluminum chlorhydride in deodorants), aid in wound healing, and reduce weeping from wounds Acetic Acid An astringent solution that can be prepared at home by using 1/4 vinegar to 1 part water. Keratolytic Agents Agents that produce damage to the cornified layer of the skin and cause it to separate and slough off. Removes keratin. Used to enhance the emollient effects of cream, reduce pore occlusion as with acne, and to remove excess keratin. Salisylic Acid A keratolytic agent that solubilizes cell surface proteins that keep the stratum corneum intact, resulting in desquamation. Systemic toxicity can result from percutaneous absorption. Low concentrations are used for a keratoplastic effect while up to 50% concentrations used for significant destruction for warts and calluses. Keratoplastic Agents Agents that stimulate the epidermis and have mild keratolytic effects but don't produce rapid destruction and desquamation. Traumatize the skin to stimulate the basal layer. Coal tar is the most commonly used agent Protectants Agents used to promote occlusive protection from the environment and give mechanical support. Used to cover and protect normal skin, ulcers, or wounds. Reduces friction, absorbing moisture, and discouraging microbes. Absorbents Agents that absorb moisture and reduce friction. Includes starch and tacl (ie baby powder) Irritants Agents that act locally on the skin to produce inflammation and/or increase blood flow which then contributes to the feeling of comfort and warmth. Counterirritants Agents like methyl salicylate (Ben-Gay) that are applied topically and help relieve pain in viscera, muscles, and joints Dextranomer Non-enzymatic wound cleaner forms an inert matrix that acts like a sponge to absorb small particles