Antiseptics Causing Infection!

Dr Mohanta.G.P

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Antiseptics Causing Infection!

“Report says ‘quality’ disinfectant caused ---Hospital Blinding”, a recent newspaper headline claims. Four patients in Ahmedabad during March 2016 had lost their vision after they had undergone a cataract surgery in the hospital. Food and Drugs Laboratory of Vadodara confirmed that the disinfectant solution used was of standard quality in terms of content of active substance. It is reported that disinfectant had 98.8% Chlorhexidine Gluconate and 103.93% of another ingredient called Cetrimide. On the other hand, the Medical College which tested the disinfectant claimed that there were gram negative bacteria in the disinfectant solution. It raises two main issues: quality specification needs introspection; and how can the disinfectant itself be contaminated. The use of this contaminated disinfectant is the cause of this blinding incident. The ‘disinfectant’ and ‘antiseptic’ are two different terminologies, they are used interchangeably (though not appropriate) in this article as both are intended to reduce infection. Cetrimide and chlorhexidine are combined to have better activity and reduced chance of developing resistance.

The antiseptics are meant for reducing the number of bacteria on patients’ skin prior to surgery or injection. The instruments and needles are also immersed in the antiseptic solutions prior to use. Ahmedabad’s case is not the first case of antiseptics contamination. There have been reports in the literature but often ignored. As early as in 2013, the USFDA warned the possibility of contamination of topical antiseptics and its harm. The reported outcome of the use of contaminated antiseptics ranges from localised infection at the injection site to systemic infection causing deaths. The common antiseptics containing Alcohol, Chlorhexidine Gluconate, and Quaternary Ammonium Compounds, are found to have issue of contamination. Some of the products even recalled from USA market.

As the topical antiseptics are not manufactured to be sterile, the contamination with bacteria may happen during manufacturing. Even if they are manufactured with sterile processing system, they can also be contaminated if proper care is not taken during use. “Not sterile” does not assure of sterility but it must not contain harmful bacteria. The healthcare professionals and the consumers should consider these points for safe and effective use of antiseptics:

·         Read the label carefully and use as directed in the label;

·         Single use containers should be used at one time to one patient. Discard the remaining portion;

·         Single use products should not be diluted after opening; and

·         Consider these antiseptic products as a source of infection too when trying to determine the cause of post-operative or post-injection infections.