Chlorhexidine, Iodine & Silver: Uses and Modes of Action

This lesson will discuss four commonly heard of chemical antiseptics: namely, iodine and iodophors, silver nitrate,
silver sulfadiazine, and chlorhexidine, and it will cover the ways by which they kill microbes.

Wound Care with Antiseptics

For a very long time, people have put all sorts of stu on cuts, scrapes, and burns to help them heal
more quickly. I'm sure you've done this as well when you fell o a bike as a little kid. Everything
from alcohol to hydrogen peroxide may have been used, and all of these compounds are known as
antiseptics, meaning they are used on living tissue, such as your skin, to try and get rid of as many
microbes as possible. Antiseptics can never get rid of all microbes on living tissue, but they try to do
their best.

In this lesson, we'll cover a few more compounds used as antiseptics, some of which I'm sure
you've heard of.

Iodine and Iodophors

Besides alcohol and hydrogen peroxide, another type of substance sometimes used to clean
wounds that you have probably heard of is called iodine. Iodine is a chemical element used in
nutrition, medical diagnostic techniques, and antiseptic wound care, among other things.

Our body doesn't make iodine, so we must obtain it from other sources, such as iodine-forti ed
salt. If we don't get enough iodine, we can develop many conditions, such as goiter, which is
essentially an enlarged thyroid gland.

But iodine doesn't need to be ingested with salt in order to exert its bene cial e ects. In certain
preparations, which can be deadly if ingested in large enough amounts, iodine is used as an
antiseptic for wound care. These preparations are sometimes known as a tincture of iodine.

The way by which iodine kills is through the inactivation of protein synthesis and disruption of
protein and nucleic acid structure in a microbe.

You can liken the proteins a microbe uses to the little apps on your smartphone and the nucleic
acids to the processor of your phone - called the I-odine. If you stop the app makers from making
their apps and delete the apps altogether from your phone, or you kill o the processor, then you'll
have no use for your smartphone. Likewise, if you destroy the nucleic acids of a microbe or stop
them from using and producing their proteins, the microbe will simply die o .
Iodine should not be confused with an iodophor, which is a compound that combines iodine with
another compound, such as povidone, to be used as antiseptic or disinfectant. Using an iodophor is
usually preferable to iodine alone, as an iodophor allows for the sustained release of iodine, which
minimizes the potentially toxic e ects of iodine.

Silver Compounds
Another type of antimicrobial agent that may be a bit dangerous to use has been in use in one
shape or form for hundreds of years. This agent is called silver. That's right, the same stu pirates
used to ght over is actually used in some preparations as an antimicrobial.

Notably, one preparation is known as silver nitrate. This is a compound that is sometimes used to
prevent gonorrheal eye infections in newborns. Ironically, this compound can actually cause more
harm than good, as it can damage the eye and, therefore, antibiotics may be used in its stead.

Besides silver nitrate, another well-known, silver-based compound is known as silver sulfadiazine,
and it's a topical cream made from a combination of silver and sulfadiazine, a type of antibiotic that
is used as an antibacterial agent.

Depending on the preparation it's used in, silver is able to exert its antimicrobial e ects by
interfering with protein and enzyme function as well as by disrupting the microbe's nucleic acid
genome. This is very similar to what iodine does as well. Once again, we basically delete the apps
and shut down the processor in our smartphone when we use silver as an antimicrobial agent.

Chlorhexidine
Finally, another type of chemical antiseptic that is used is known as chlorhexidine. It is a chemical
antiseptic that is commonly used in handwashing products due to its ability to kill bacteria, some
fungi, and certain viruses.

As you can tell by that de nition, chlorhexidine isn't a sterilant, meaning it can't kill everything. For
example, it isn't e ective against hardy bacterial spores or non-enveloped viruses.

The way by which chlorhexidine manages to destroy certain bacteria, viruses, and fungi is actually
pretty darn cool. It destroys these microbes by one of two ways.

At low concentrations, it damages the outer and inner membranes of the microbe, which causes
the leakage of important substances out of the cell. At high concentrations, it coagulates the
cytosol, or the liquid, found inside of the cell. This coagulation inactivates important functions in the
cell, resulting in its death.

We can use some real-life examples to demonstrate how chlorhexidine works. At low
concentration, it basically pops the cell like a balloon by creating holes in it.
At higher concentrations, you can imagine our microbe's cytosol as a bowl of animal fat. At high
temperatures this fat is liquid. However, if you were to put it in a fridge, it would solidify. Anything
that was once moving around in the fat, such as important enzymes involved in energy production,
would no longer be able to move around and function properly. That's how chlorhexidine
inactivates a microbe at high concentrations.

Lesson Summary
While not every antiseptic we went over in this lesson kills microbes in such an interesting manner,
it's still important to at least review them by name one more time.

One of the chemical agents we went over is known as iodine. Iodine is a chemical element used in
nutrition, medical diagnostic techniques, and antiseptic wound care, among other things.

Iodine should not be confused with an iodophor, which is a compound that combines iodine with
another compound, such as povidone, to be used as antiseptic or disinfectant. Using an iodophor is
usually preferable to iodine alone, as an iodophor allows for the sustained release of iodine, which
minimizes the potentially toxic e ects of iodine.

Another chemical antiseptic we went over is known as silver nitrate. This is a compound that is
sometimes used to prevent gonorrheal eye infections in newborns.

Silver nitrate isn't the only silver-based antiseptic out there. In fact, silver sulfadiazine, a topical
cream made from a combination of silver and sulfadiazine, a type of antibiotic that is used as an
antibacterial agent, is commonly used as well.

Finally, another type of chemical antiseptic that is also commonly used is known as chlorhexidine.
It is a chemical antiseptic that is commonly used in handwashing products due to its ability to kill
bacteria, some fungi, and certain viruses.

Learning Outcomes
Once you have nished the lesson, you should be familiar with the following antiseptics: iodine,
iodophors, silver nitrate, silver sulfadiazine, and chlorhexidine, and you should be able to explain
how these antiseptics kill microbes.