When to use different kinds of prep pads and antiseptics

[marauder3030]

Hi everyone,

Thanks for the great forum and information here.

I have a few different types of prep pads and ointments and wanted to clarify when exactly it is appropriate to use each one:

- Isopropyl alcohol prep pads
- Povidone-iodine prep pads
- Antiseptic prep pads - benzalkonium chloride 0.13% v/v
- Triple antibiotic gel sachets - bacitracin zinc, neomycin sulfate, polymyxin B sulfate
- Savlon antiseptic cream (in a tube) - chlorhexidine hydrochloride 1mg/g, cetrimide 5mg/g
- Dettol Antiseptic Disinfectant Liquid
- Hydrogen Peroxide solution

When would you use one but not another? Which would be most useful to include in a first aid kit? etc.

I recently did a first aid course here in Australia and they warned us not to use iodine on wounds because some people are allergic. However I'm not sure how common this is?

Thanks for your help.

[JohnE]

Alcohol pads, only use on unbroken skin. Isopropyl alcohol cause pain in open wounds, damages living skin cells and is best used to disinfect things, not wounds.

BZK's, use after you've stopped any bleeding to clean up minor wounds before bandaging.

Iodine, best used, IMO, around a wound to help provide a disinfected area in which to apply sterile bandaging. If applied properly and allowed to dry it also helps with tape adhesion.

Triple anti, depends on severity, depth, and type of wound. Some people are sensitive to myocins. Best used by applying a small amount on a gauze pad or a band aid ad and then applied to the wound. Less is better, using too much is wasteful and messy.

Not familiar with your other antisepic examples.

Peroxide is not a disinfectant or an antiseptic. It's best used as a rinse to help clean out ear canals. It helps to kill living skin cells and doesn't do what some people are convinced it does. I'd avoid it and I wouldn't bother carrying it. If you do, it should be kept in a lightproof container.

[marauder3030]

Thanks John, very helpful answer!

[JohnE]

I do what I can...;^)

[chrispy]

Make it simple. Isopropyl alcohol, cleaning and prepping of unbroken skin. Iodine for wound cleaning, and 'painting' of healing wounds. Normal saline for cleaning of fresh wounds (in cooler climates, warm to body temp to continue wound healing, otherwise cells will 'shock' for up to 2 hours and stop healing for that time). Chloroxedine with Saline (blue liquid) can also be used for initial wound clean, but is loosing favour evidence wise. It is very useful for mouth wounds as a was/gargle.

Research indicates that antiseptic's etc have limited value as they need to be targeted to the particular bug you want to fight. Being CLEAN, is more important than having an expansive list of stuff that may be used.

When all else fails, a teaspoon of table salt in boiled water, allowed to cool will do roughly the same as the above for wound cleaning.

Chrispy

[painiac]

Throw most of that shit away, but keep the alcohol swabs for skin prep, and the hydrogen peroxide for cleaning blood off of intact skin or from clothing (nothing works better).

Topical antibiotics are useless.

Both replies in this thread so far are good. You don't really need saline, though: all you need is clean water. Tonicity is only important if you're doing wet-to-dry dressings in long-term wound care where tissue maceration is a potential issue, and if you don't know how to do those you don't need to bother with saline.

[DrJack]

Throw most of that shit away, but keep the alcohol swabs for skin prep, and the hydrogen peroxide for cleaning blood off of intact skin or from clothing (nothing works better).

Topical antibiotics are useless.

Both replies in this thread so far are good. You don't really need saline, though: all you need is clean water. Tonicity is only important if you're doing wet-to-dry dressings in long-term wound care where tissue maceration is a potential issue, and if you don't know how to do those you don't need to bother with saline.

This sums it up well.

And you only need the alcohol if you are going to pierce/cut the intact skin.

My personal favorite is to carry some travel size bottles of contact solution. Sterile saline, cheap, point and shoot for irrigation

[Blacksheep]

I have a pile of this shit for the first aid kit I am putting back together...


so for first aid purposes, toss the alcohol since its only used to kill bacteria on the skin before cutting it,
--- since I'm not about to play forest surgeon

what if anything do you recommend for scrapes\road rash?


I will probably throw a small saline in for wound irrigation as previously mentioned, that works

[Metallitera]

what if anything do you recommend for scrapes\road rash?

Soap & water, cover with clean bandage.

At the ER i work in we use the sinks to irrigate most wounds if at all possible. The docs were sayin thay theres research out there sayin soap and water work just as well if not better than saline irrigation....and TONS cheaper.

[Stercutus]

Wife says that they use saline for a lot of irrigation at the current er place. She said that another er she was at they keep saline locked up as a pharma and only bring it out when the docs say so. I guess it depends?

[medic photog]

For me, alcohol and benzo preps for IV site cleaning, PVP iodine for wound area cleaning or such things as IO access, chest sticks, suturing, and other closure options. Wound cleaning is saline, saline, saline, and more saline irrigation. If you can score IV bags more the better over the hard plastic bottles since they store easier and can be used for wound irrigation of IV infusions. I carry several surgical scrubs for my own cleanliness and have both iodine and benzo scrubs in case the patient has iodine issues.

[painiac]

what if anything do you recommend for scrapes\road rash?

Soap & water, cover with clean bandage.

At the ER i work in we use the sinks to irrigate most wounds if at all possible. The docs were sayin thay theres research out there sayin soap and water work just as well if not better than saline irrigation....and TONS cheaper.

Very much this. Irrigate always. If necessary, use a couple 4x4 gauze pads to scrub the debris out of road rash. (By the way, it's REALLY nice if you have some lidocaine to apply topically before doing this...)

The only time you should prioritize sterile saline over soap and water (or even just water if no soap is handy) for irrigation is if you have bone sticking out, and if that's the case you can be damn sure antibiotics will be needed. An open fracture is life-threatening, and should really be cleaned up thoroughly in an OR under sterile conditions whenever possible.

[Blacksheep]

bone sticking out is something to have a general plan for in the back of my mind,
but I am usually prone to more "cosmetic" damage, just making sure I have the right stuff in my kit for what it will commonly be used for.

so you guys recommend soap and water over the other pads...noted
if I may dig a little farther without sounding like I am questioning this advice,

are certain pads still a decent option?... or would you forgo them entirely?
I ask from the point of view of making a small "boo boo" kit, and squeezing in soap and water might not be as easy as a few pads,..

what about wet naps? same basic concept, wet napkin in sealed unit... not sure if there are any active agents though...

[DrJack]

Breaking open a capsule of Diphenydramine HCl and sprinkling it over an open wound is a decent sub if you don't carry lido for wound cleaning and even sutures and whatever.

[painiac]

are certain pads still a decent option?... or would you forgo them entirely?
I ask from the point of view of making a small "boo boo" kit, and squeezing in soap and water might not be as easy as a few pads,..

Unfortunately, liquid is more effective by leaps and bounds, but also the most difficult to carry. Honestly, anything superficial enough that a pad can actually clean it is so superficial that you will surely survive not cleaning it.

When I used to keep pads in my FAK, I'd usually find they'd managed to dry out by the time I got around to opening them.

In lieu of carrying liquid, you can pack a canteen pot for boiling a natural water source,which you can then use for wound irrigation via syringe. A 60mL syringe is easiest to use, but a 30mL syringe is easier to pack.

[JayceSlayn]

are certain pads still a decent option?... or would you forgo them entirely?
I ask from the point of view of making a small "boo boo" kit, and squeezing in soap and water might not be as easy as a few pads,..

Unfortunately, liquid is more effective by leaps and bounds, but also the most difficult to carry. Honestly, anything superficial enough that a pad can actually clean it is so superficial that you will surely survive not cleaning it.

When I used to keep pads in my FAK, I'd usually find they'd managed to dry out by the time I got around to opening them.

In lieu of carrying liquid, you can pack a canteen pot for boiling a natural water source,which you can then use for wound irrigation via syringe. A 60mL syringe is easiest to use, but a 30mL syringe is easier to pack.

In my FAK I've got a 12 cc irrigation syringe (size was the easiest to cram in the kit) and a vial of ~90 g of salt. Salt was intended to be used for electrolyte replacement as well as making a saline solution in boiled water if the need arose for irrigation.

Follow up question regarding aforementioned plans: Is taking the time to sit down and make a sterile saline solution (hopefully already have water and don't need to acquire - but boiling and then waiting to cool) going to be too long to spend not doing other proactive things about your situation? I guess, if you are going to patch someone or yourself up from a really bad gash, is staying in one place for 30 minutes while you irrigate before wrapping things up and moving on (say, self-rescue situation) going to put you behind or ahead overall? Obviously this is going to be very situation-specific, like everything, but I can see that even with very thorough irrigation you're going to get an infection at some level. The serious effects of said infection may be a day or two out still, but in any case you are going to want to seek higher care (and hopefully antibiotics) soon. Irrigating yourself becomes more important the longer timeline you have to proper care?

EDIT: another trick I've been told for semi-off label usage of FAK contents (hopefully one of our medical pros could advise if correct or not): is that you could use a PVP Iodine pad as a halogen source for disinfecting water. Should take about the same ratio and time as normal iodine for disinfection? If that worked, it wouldn't be saline (unless you added the salt too), but that could be used as sterile water for irrigation too?

[medic photog]

I'm sure a PVP iodine swab would work as a water purification agent to a degree, how well, I don't know since I've never tried it. For that issue I carry an MSR mini waterworks filter. It has a ceramic filter element that is field maintainable and does a great job.They are pricey and hard to get right now I'm guess because so many are being ear marked for military or other governmental use. They are designed to be threaded on to a Nalgene bottle but a simple fix i add a section of plastic tubing to fit into your canteen or whatever water carrying device you are using. On a side not MSR Dromidary bags have the same threaded opening as a Nalgene bottle so possible getting a good sized one to filter in to and then using that as a holding device to fill canteens from makes sense. I always fall back on the good old Potable Aqua tablets. Boiling water works but you have to boil for a certain time and elevation changes can add to that increasing fuel usage as an extra headache to consider. I'm lucky enough to be able to grab wound flush agent in small 15cc, I think, containers from my facility visits and I carry a bunch of them.

[Blacksheep]

well I'm planning on adding in saline for wound irrigation in the pouch kit,
I'm thinking of a pocket kit...
this kind of injury is probably 80% of what I tend to do to myself

minor scrapes mostly, something I don't need to worry about infection too much, but knowing how it should be treated is good...

what about bactine? I'm considering loading a .5 oz sprayer bottle with it, I remember it worked fairly well to numb scrapes and what not as a kid..
( I tend to repurpose all kind of various little bottles and containers to make things smaller and lighter... been meaning to do a write up I have at least 20 examples)

edit, I made the mini sprayer... thats going in the booboo kit, so apparently bactine is actually just BZK with a little lidocaine as well