TOPIC 4. ANTISEPSIS IN SURGERY – CONCEPT AND MAIN PRINCIPLES
1. Definition and purpose
Antisepsis is the use of antimicrobial methods or chemical agents on living tissue to reduce or inhibit microorganisms. Its purpose is to prevent infection, reduce microbial load and support treatment of contaminated wounds.
2. Types of antisepsis
3. Common antiseptic agents
Alcohols (ethanol/isopropanol): rapid broad antimicrobial activity on intact skin; not sporicidal and unsuitable for deep open wounds; flammable until dry.
Chlorhexidine: broad activity against many bacteria and some fungi/viruses, with residual activity on skin. Avoid contact with eyes, middle ear and neural tissue; use formulation-specific precautions.
Povidone-iodine: broad-spectrum antiseptic used for skin and selected wound applications. Consider allergy, tissue compatibility and thyroid-related cautions in selected patients.
Hydrogen peroxide: has oxidative antimicrobial activity but can damage tissue and impair healing; routine use in deep wounds is generally avoided.
Other agents: hypochlorous solutions and selected wound antiseptics may be used according to indication and local protocol.
4. Principles of practical antisepsis
- Choose an agent appropriate to the tissue, site, organism risk and procedure.
- Use the correct concentration and contact time; allow alcohol-based preparations to dry fully before draping or electrosurgery.
- Do not mix agents unless specifically supported by protocol.
- Clean visible dirt and organic material first; antiseptics do not replace mechanical cleansing.
- Use sterile saline or appropriate irrigation solution for wound irrigation; avoid cytotoxic agents in viable deep tissue unless specifically indicated.
- Assess for allergy, irritation, toxicity and contraindications.
- Antiseptics do not replace systemic antibiotics when a true infection requires them, and antibiotics do not replace drainage or source control.
5. Antisepsis versus antibiotic treatment
Antiseptics are generally applied locally to skin or tissue to reduce microbial burden. Antibiotics are medicines used to treat or prevent bacterial infection in the body, systemically or locally in selected circumstances. Surgical infection management often requires source control (drainage, debridement or removal of infected material) in addition to antimicrobial therapy.
Exam point: The best wound infection strategy is not simply “apply a stronger antiseptic.” It is appropriate irrigation, removal of devitalised tissue and foreign material, drainage when required, assessment for deep infection and targeted antibiotics when indicated.