Alcohol Prep Pads...BZK Towelettes…Hand Wipes…Wound Wipes...What?! ©

Sterile Alcohol Prep Pad, Cleansing Wipe, BZK Antiseptic Towelette and Anti-microbial Hand Wipe; all examples of antiseptic wipes, photo by the author

  

Do you remember when old time first aid kits contained small foil packed alcohol wipes¹, or as they are called today, alcohol prep pads?  Have you noticed that today’s first aid kits contain BZK (benzalkonium chloride) antiseptic towelettes?  The first time that I noticed this was several years ago, when two Red Cross Wilderness First Aid trainers that I know, began to discourage us from using alcohol prep pads on open wounds, telling that we should instead use BZK wipes instead, during our recertification training. 

Now no one really notices the antiseptic wipes in their first aid kit, but what exactly are they for and what are the differences between the different types?

Antiseptic wipes are used to disinfect things and are easy to carry and are a convenient way of killing germs and sterilizing the surface of the anything that they are wiped on.  They can be used to clean minor wounds, sterilize first aid equipment, prepare skin for surgery or for injection.  Since they are single use, there is no risk of cross contamination and because they are individually wrapped they are easy and convenient to carry in your pocket, purse, small first aid kit or survival kit.  They can also be used to disinfect keyboards, cell phones, office equipment, tableware and dishes; children’s toys, frequently touched, sterilize before use items; toilet seats, and for other cleaning and disinfection purposes.  But, what are the differences between alcohol and BZK and which is the right one to use and when?

BZK or Benzalkonium Chloride Wipes

  

Examples of Benzalkonium Chloride wipes, photo by the author

An example of a combined BZK and alcohol wipe, photo by author.

  

Benzalkonium Chloride or BZK wipes are excellent for cleaning minor cuts, scrapes and burns as BZK will not damage wound beds.  BZK wipes do not sting and they do not dry out the skin, the way that alcohol wipes do, so they are ideal for use on sensitive skin.  As a disinfectant, BZK works by disrupting the pathogen’s membrane and is effective against gram-positive and some gram-negative bacteria; enveloped, or lipophilic, viruses, yeasts, fungi and protozoa².  The concentration of benzalkonium chloride in BZK towelettes ranges from .1% to .13%.

Alcohol Prep Pads

  

An example of an alcohol prep pads, photo by author.

Alcohol prep pads are typically made of isopropyl alcohol, the type that you can’t drink³ (it is also called isopropanol, 2-propanol or rubbing alcohol), at a concentration of 70% in water⁴.  Alcohol prep pads can be used as a disinfectant for cleaning around a wound or prepping unbroken skin, but should not be used to clean an open wound: alcohol can cause damage to the wound bed and can delay or even prevent healing.  Also, they can be used to disinfect medical instruments such as thermometers, tweezers or scissors.  As a disinfectant, alcohol works by dissolving lipids and denaturing and coagulating proteins, making it very effective against gram-positive and gram-negative bacteria, including multidrug-resistant pathogens, such as MRSA and VRE; and enveloped, or lipophilic viruses, such as herpes simplex virus, HIV, influenza virus, hepatitis B and C viruses (as long as the concentration of alcohol is 60%-70%): it is not effective against bacterial spores, protozoan oocysts and nonlipophilic viruses.  Many hospitals use 70% isopropyl alcohol for disinfection and sterilization of surfaces and medical tools. 

There is another type of wound wipe that is available, povidone-iodine prep pads, these can be used as both an antiseptic for wound cleansing and sterilization and as a topical antibiotic.  I don’t carry this type of prep pad since some people are allergic to iodine.  Before using this on someone, always, ALWAYS, ask if they are allergic to iodine or shellfish and if they say yes, don’t use this product on them.

So, as you can see, if you are going to disinfect an object or unbroken skin, either a alcohol prep pad or a BZK towelette can be used.  However, if you are going to clean an open wound, you should use a BZK towelette or a povidone-iodine pad, provided that the person it is being used on is not allergic to iodine or shellfish.  Personally, I carry both some alcohol prep pads, for disinfecting tools and unbroken skin, and BZK towelettes, for cleaning wounds, in my first aid kit and my survival kit.  I do not carry povidone-iodine prep pads as I feel that the risk of an allergic reaction is too high.

The author’s toiletries kit, photo by the author

 

“Woodsman’s Tips”

While we are on the subject of wipes and towlettes, here are some “Woodsman’s Tips”.

I like to bring a bottle of alcohol based hand sanitizer in my toiletries kit.  The hand sanitizer in the photograph is 65% ethyl alcohol and the Antibacterial Moist Towelettes are .115% benzalkonium chloride , and when pulled out of the pack are 6” tall by 7” long (15.2 cm x 17.8 cm).  The hand sanitizer is obviously used for cleaning your hands and other surfaces, but I also use it as fire sustainer to help light fires when conditions are wet.  Mostly, I use the towelettes to take hand baths or to freshen up with, when I am out in the wilderness; however, they can also be used as extra large wound wipes.

Alcohol prep pads also have a number of non-medical uses, such as removing ink or sap from fabric or other surfaces (for more on this read “Sap Is Really Sticky….”, HERE) and also, they can be used as a fire starter in an emergency.

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Notes

¹  Really old first aid kits contained a screw topped bottle of Merthiolate or Mercurochrome in them.  However the U.S. Food and Drug Administration (FDA) banned these products in the 1990s over concerns with the ingredients thimerosal and merbromin, which are commonly called mercury: “The type of mercury in Mercurochrome could be harmful to humans if left on the skin for extended periods or if ingested.”

Blackmon, Nancy, “Obviously, merthiolate affected me”

²  For more on how BZK works, see specifically the citations below, from “Antiseptic efficacy of benzalkonium chloride”:

11.  Fazlara, A., and Ekhtelat, M. 2012. The disinfectant effects of benzalkonium chloride on some important foodborne pathogens. American-Eurasian Journal of Agricultural & Environmental Science, 12 (1): 23-29

21.  McDonnell, G., and Russell, A.D. 1999. Antiseptics and disinfectants: activity, action, and resistance. Clinical Microbiology Reviews, 12 (1): 147-179.

³  Ethanol alcohol, the type that you can drink, can also be used as a disinfectant, however be aware that an 80 proof bottle of vodka is only 40% alcohol and when compared to isopropyl alcohol it is not as effective a disinfectant.

⁴  To be effective, according to the U.S. Center for Disease Control, the concentration of alcohol should be 60% to 70%; at higher concentrations it evaporates too quickly, reducing the amount of time that the pathogen is exposed to the alcohol and at lower concentrations it needs more contact time to become effective.  100% alcohol is not an effective disinfectant, as it coagulates the proteins in the shell of the bacteria or virus, effectively walling them off from the alcohol and allowing them to survive; in addition to the fact that it evaporates to quickly to be effective.  Other sources state that between 50% to 80% is the effective range, with 70% being ideal due to the high osmotic pressure of 70% alcohol and water. 

Boyce, John M., M.D. and Pittet, Didier, M.D. “Guideline for Hand Hygiene in Health-Care Settings”

“Why is 70% ethanol used for wiping microbiological working areas?” 

Sources

“Antiseptic efficacy of benzalkonium chloride”, MicrobeWiki, November 19, 2012 https://microbewiki.kenyon.edu/index.php/Antiseptic_efficacy_of_benzalkonium_chloride, accessed August 23, 2019

Blackmon, Nancy, “Obviously, merthiolate affected me”, The Andalasia Star-News, April 8, 2012 [Andalusia Star-News, 2019] https://m.andalusiastarnews.com/2012/04/18/obviously-merthiolate-affected-me/, accessed August 22, 2019

Boyce, John M., M.D. and Pittet, Didier, M.D. “Guideline for Hand Hygiene in Health-Care Settings”, October 25, 2002, https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5116a1.htm, accessed August 22, 2019

Turpin, Kyle, “Ethanol vs. Isopropyl Alcohol to Disinfect”, [Leaf Group Ltd., 2019] https://www.hunker.com/12000188/ethanol-vs-isopropyl-alcohol-to-disinfect, accessed August 22, 2019

“Which AntisepticWipes Should I Use?", July 7, 2016, [Express Medical Supply Blog, 2019] https://www.exmed.net/blog/expressmedicalsupply/post/2016/07/07/infection-control-which-antiseptic-should-i-use.aspx, accessed August 23, 2019

“Why is 70% ethanol used for wiping microbiological working areas?” December 12, 2012, [ResearchGate, 2019] https://www.researchgate.net/post/Why_is_70_ethanol_used_for_wiping_microbiological_working_areas, accessed August 23, 2019