Infection prevention and control

Disinfectants, antiseptics, and sterilization

Agent	Mechanism	Sporicidal	Why
Alcohols (isopropanol, ethanol)	Disruption of cell membranes, Denaturation of proteins	No	Dissolves membrane lipids; disrupts protein structure (requires water for optimal protein denaturation).
Chlorhexidine	Disruption of cell membranes, Coagulation of cytoplasm	No	Cationic; binds to negatively charged cell walls, disrupting membranes and causing leakage, inhibits ATP synthesis.
Hydrogen peroxide	Produces destructive free radicals that oxidize cellular components	Yes	Generates highly reactive hydroxyl radicals that damage lipids, proteins, and DNA.
Iodine	Halogenation of proteins & nucleic acids	Yes	Adds halogen atoms to proteins and DNA, disrupting their structure and function, penetrates the cell wall quickly.

Tip

Alcohols and chlorhexidine are not sporicidal because they both target on cell membrane, but spores have tough, multi-layered coats protecting membrane.

Procedural
- Consider a peripherally inserted central line (PICC).
- Use of subclavian or internal jugular insertion sites (femoral vein has a higher risk of infection)
- For the procedure:
  - Perform skin preparation with chlorhexidine and alcohol.
  - Follow hand hygiene and strict aseptic technique.
  - Place the line under ultrasound guidance.
Postprocedural
- Replace lines that were inserted emergently within 2 days.
- Perform regular maintenance.
- Routine replacement of CVCs is not necessary for functional catheters with no evidence of infection.