Page 54 - Journal of Special Operations Medicine - Summer 2016

As an antiseptic, the recommended concentration is 5g as a topical antiseptic. To make a full-strength con-
per 1L of water. As a disinfectant, the concentration is centration, dilute 3oz (95mL) of sodium hypochlorite
20g per 1L, with a soak time of 15 minutes for surgical in 32oz (about 1L) of water. To make a half-strength
instruments. concentration that would be less corrosive and safe to
use on skin, dilute 3 tablespoons (48mL) of sodium
Its triple use for water purification, antiseptic, and disin- hypochlorite, plus ½ teaspoon (2.5mL) of sodium bi-
fectant makes this a lucrative option; however, solutions carbonate in 32oz (1L) of water. The recommended
should be stored for no more than 1 week, and once immersion time for instrument sterilization is 30
used for disinfection it should be discarded daily. minutes. This is a reasonable disinfection option in
the operational environment, but it does have some
4. Iodized Polyvidone (Povidone-Iodine) (Betadine ): distinct advantages and disadvantages that should be
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As a topical antiseptic used for skin preparation be- considered before its use.
fore surgery and minor procedures, povidone-iodine, or • Advantages: Dakin’s is inexpensive and easily made
Betadine as it is more commonly known, is a chemical from locally procurable products. It is well suited as
disinfectant that most Western medical personnel are fa- a low-level disinfectant of environmental surfaces and
miliar with. The UNHRC recommends this as both an medical equipment that come in contact with, but do
antiseptic and a disinfectant for both skin and instru- not penetrate, mucosal surfaces.
ments. It is available in a concentrated 10% solution, it • Disadvantages: It must be prepared just prior to use
is part of the standard medical equipment set, and it has as it can decompensate rapidly with exposure to heat
several uses. and light. One protocol suggests that Dakin’s solu-
tion may be stored for up to 1 month if placed in a
The 10% concentrated solution can be used to clean container and covered with aluminum foil to protect
the skin prior to surgery, to clean umbilical cords, to it from light exposure. Any open containers should be
treat cutaneous mycoses and viral infections, and to dis- used within 48 hours. 4
infect the medical provider’s hands before a surgery or
procedure. Dakin’s solution is also corrosive. It will particularly
corrode nickel, chromium steel, iron, and other metals.
When diluted to 2.5%, it can be used as a disinfectant As such, it should not be stored in metal containers. To
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of medical instruments. This is accomplished by mix- prevent destruction of medical instruments, it should be
ing 1 part 10% solution with 3 parts water. The recom- used only on stainless steel, solutions greater than 0.1%
mended soak time is 15 minutes. The 2.5% solution can (1000ppm or 25mL of liquid bleach per 1L of water)
also be used to disinfect wounds and burns. If diluted to should not be used repeatedly, and instruments should
a 0.5% solution (1 part 10% solution, 19 parts water), not come in contact with bath solutions for longer than
it can be used to treat infections and mycoses on the 30 minutes. Although it has good antimicrobial prop-
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mucosa. erties, its corrosive nature limits its exposure time to 30
minutes or less, and its use should be limited to low-
Povidone-iodine (Betadine ) presents a lucrative alter- level disinfection and below.
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native, but as in chloramines, if used for instrument dis-
infection, the solution should be discarded daily. It is Antiseptics
also relatively expensive, and some patients may have
an allergic reaction to topical iodine. Antiseptics are agents that are useful on skin, wounds,
and mucosal surfaces; however, most are inappropriate
Low-Level Chemical Disinfection for surgical instruments. Povidone-iodine and Dakin’s
• Sodium Hypochlorite (Dakin’s Solution): English chem- solution are useful antiseptics under the proper concen-
ist Henry Drysdale Dakin and French surgeon Alexis trations, but the following agents can also be considered:
Carrel developed Dakin’s solution during the First
World War as a wound antiseptic. Dakin’s solution 1. Chlorhexidine (Hibiclens): Chlorhexidine is a typical
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is a simple and easily procured agent for disinfecting antiseptic, and it is well known to most practitioners, as
medical instruments and cleaning infected wounds, it is frequently used in the clinic and hospital setting. It
thus making it both a disinfectant and an antisep- is an affective antiseptic that can be used for cleaning of
tic. It consists of a diluted mixture of 5.25% sodium the skin, mucosa, burns, ulcers, and abscesses. It, how-
hypochlorite (household bleach) and 1 teaspoon of ever, is cytotoxic to the meninges and cerebral tissues
sodium bicarbonate (baking soda). If baking soda is and therefore should not be allowed to come in contact
not available, it can be prepared with sodium hypo- with these tissues. It should not be used to prepare the
chlorite alone; however, the addition of baking soda skin for spinal taps or epidurals, nor is it appropriate for
reduces its corrosive nature and makes it safe to use sterilizing instruments.

40 Journal of Special Operations Medicine Volume 16, Edition 2/Summer 2016