《Antiseptics on wounds an area of controversy.doc》由会员分享，可在线阅读，更多相关《Antiseptics on wounds an area of controversy.doc（26页珍藏版）》请在金锄头文库上搜索。
1、Antiseptics on Wounds: An Area of ControversyAnna Drosou, MD, Anna Falabella, MD, Robert S. Kirsner, MD Wounds 15(5):149-166, 2003. 2003 Health Management Publications, Inc.Posted 06/11/2003Abstract and IntroductionAbstractAntiseptics have long and commonly been used on wounds to prevent or treat in
2、fection. However, citing cytotoxicity data, many authors have advised against their use on open wounds. This article discusses antiseptics and their use on open wounds, as well reviews relevant animal studies and clinical trials examining the effects of commonly used antiseptics, including iodine co
3、mpounds (povidone iodine and cadexomer iodine), chlorhexidine, hydrogen peroxide, acetic acid, and silver compounds. This article examines their effects on wound healing and reepithelization and their efficacy on reducing bacterial number in wounds and incidence of wound infections. The authors foun
4、d despite cytotoxicty data, most antiseptics have not been shown to clearly impede healing, especially newer formulations like cadexomer iodine (which speeds healing) and novel silver delivery systems. These compounds appear to be relatively safe and efficient in preventing infection in human wounds
5、. Given this review, the role of antiseptics on wounds and their role in wound care management should be reconsidered.IntroductionAntiseptics are agents that destroy or inhibit the growth and development of microorganisms in or on living tissue. Unlike antibiotics that act selectively on a specific
6、target, antiseptics have multiple targets and a broader spectrum of activity, which include bacteria, fungi, viruses, protozoa, and even prions.1,2 Several antiseptic categories exist, including alcohols (ethanol), anilides (triclocarban), biguanides (chlorhexidine), bisphenols (triclosan), chlorine
7、 compounds, iodine compounds, silver compounds, peroxygens, and quaternary ammonium compounds.1 The most commonly used products in clinical practice today include povidone iodine, chlorhexidine, alcohol, acetate, hydrogen peroxide, boric acid, silver nitrate, silver sulfadiazine, and sodium hypochlo
8、rite.Antiseptic uses and indications vary. Several antiseptic agents mainly focus on cleansing intact skin and are used for prepping patients preoperatively and prior to intramuscular injections or venous punctures, pre- and postoperative scrubbing in the operating room, and hand washing by medical
9、personnel. Some also contain detergents, which render them too harsh for use on nonintact skin.3 The usefulness of antiseptics on intact skin is well established and broadly accepted. However, the use of antiseptics as prophylactic anti-infective agents for open wounds, such as lacerations, abrasion
10、s, burns, and chronic ulcers, has been an area of intense controversy for several years.Two official guidelines have been released recently concerning antiseptic use on wounds. Povidone iodine has been Food and Drug Administration (FDA)-approved for short-term treatment of superficial and acute woun
11、ds.4 The statement includes that povidone iodine has not been found to either promote or inhibit wound healing. On the other hand, guidelines for the treatment of pressure ulcers by the US Department of Health and Human Services strongly discourage the use of antiseptics and promote the use of norma
12、l saline for cleansing pressure ulcers.5In clinical practice, antiseptics are broadly used for both intact skin and wounds, although concerns are raised based upon their effect on human cells and wound healing. Opinions are conflicting. Some authors strongly disapprove the use of antiseptics in open
13、 wounds.6-8 On the other hand, others believe antiseptics have a role in wound care, and their use may favor wound healing clinically.9,10Reasons to Use Antiseptics on WoundsThe main rationale for using antiseptics on open wounds is prevention and treatment of infection and, therefore, increased rat
14、e of the healing process. It is established that infections may delay healing, cause failure of healing, and even cause wound deterioration.11 Microbial pathogens delay wound healing through several different mechanisms, such as persistent production of inflammatory mediators, metabolic wastes, and
15、toxins, and maintenance of the activated state of neutrophils, which produce cytolytic enzymes and free oxygen radicals.12 This prolonged inflammatory response contributes to host injury and delays healing. Moreover, bacteria compete with host cells for nutrients and oxygen necessary for wound heali
16、ng.13 Wound infection can also lead to tissue hypoxia, render the granulation tissue hemorrhagic and fragile, reduce fibroblast number and collagen production, and damage reepithelization.7,14-16 Consequently, although creation of an optimal environment for the wound healing process is currently the primary objective of wound care, addressing infection still plays a critical role in wound management.Despite the universal acceptance of the det
