Surgical antiseptics.

The skin cannot be sterilized because approximately 20% of the resident flora are beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganisms on the skin surface and to reduce the resident flora to a low level. Four antiseptics which have been popular over the past two decades are discussed. Benzalkonium chloride is somewhat unstable on the skin and is too prone to contamination to be in general use. Hexachlorophene is not recommended due to narrow spectrum and risks secondary to percutaneous absorption. The iodophors are excellent antiseptics, but recent studies raise questions about effectiveness and contamination. Chlorhexidine is a very safe and effective antiseptic. Comparison studies with chlorhexidine, hexachlorophene, and iodophors show chlorhexidine to be the most effective agent. Chlorhexidine can be toxic to the middle ear and irritating to the eyes with direct contact. Caution should be used in these areas with chlorhexidine and other antiseptics.