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Joseph Lister, often considered the father of modern surgery, revolutionized surgical treatment and dramatically reduced surgical mortality by introducing the concept of antisepsis to the surgical theatre.48 It was Lister’s understanding that microorganisms contributed to infection and sepsis from even the most trivial wounds that led to his search for chemicals that would prevent such infection. Lister demonstrated that phenol (carbolic acid), a chemical that was used to treat foul-smelling sewage, could be used to clean out dirty wounds of patients with compound fractures and dramatically increase survival rates. Soon thereafter, the use of phenol was expanded to surgical instrument cleaning and as a surgical hand scrub wash, ushering in the modern surgical era.
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Antiseptics, disinfectants, and sterilants are a diverse group of germicides used to prevent the transmission of microorganisms to patients (Table 104–1). Although these terms are sometimes used interchangeably and some of these xenobiotics are used for both antisepsis and disinfection, the distinguishing characteristics between the groups are important to emphasize. An antiseptic is a chemical that is applied to living tissue to kill or inhibit microorganisms. Iodophors, chlorhexidine, and the alcohols (ethanol and isopropanol) are commonly used antiseptics. A disinfectant is a chemical that is applied to inanimate objects to kill microorganisms. Bleach (sodium hypochlorite), phenolic compounds, formaldehyde, hydrogen peroxide liquid, ortho-phthalaldehyde, and quaternary ammonium compounds are examples of currently used disinfectants. Neither antiseptics nor disinfectants have complete sporicidal activity. A sterilant is a chemical that is applied to inanimate objects to kill all microorganisms as well as spores. Ethylene oxide, glutaraldehyde, hydrogen peroxide gas, and peracetic acid are examples of sterilants. Not unexpectedly many of the xenobiotics used to kill microorganisms also demonstrate considerable human toxicity.5,18,68
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