Introduction

The global increase of antibiotic resistance has resulted in a new recognition of antisepsis and disinfection to limit the spread of multi- or pan-resistant pathogens. Some biocidal agents used for antisepsis or disinfection can, however, evoke tolerance or resistance to the biocidal itself, sometimes also to other biocidal agents or even antibiotics. Antiseptic stewardship aims to reduce any avoidable selection pressure caused by biocidal agents, e.g. by a careful product selection. Some antiseptic products contain two or more active ingredients, but one of them may not add substantially to the overall efficacy but may cause tolerance or resistance in some bacterial species. Other antiseptic products contain one active ingredient with a rather strong adaptation potential, while other biocidal agents for the same type of application may cause less selection pressure. The Florence statement said: “Avoid chemicals except where they provide an evidence-based health benefit and there is adequate evidence demonstrating they are safe. Where antimicrobials are necessary, use safer alternatives that are not persistent and pose no risk to humans or ecosystems”. Based on this guidance, a critical evaluation of 15 biocidal agents and the most common types of antiseptic products will be made.