Cleaning, Sterilization, and Disinfection
What to know
Spaulding classification drives reprocessing: critical items (enter sterile tissue) require sterilization; semi-critical items (contact mucous membranes) require high-level disinfection; non-critical items (contact intact skin) require low-level disinfection. Know the difference between cleaning (removes soil), disinfection (kills most microorganisms but not necessarily spores), and sterilization (kills all microorganisms including spores). Understand high-level disinfectants (glutaraldehyde, OPA), autoclave parameters (temperature, pressure, time), and monitoring (biological, chemical, mechanical).
Traps
- Using low-level disinfection for semi-critical items.
- Believing disinfection kills spores (it does not reliably).
- Skipping cleaning before disinfection (soil reduces efficacy).
- Confusing biological with chemical indicators.
- Forgetting that prions and C. difficile spores require special measures.
Worked example / rule of thumb
A flexible endoscope contacts mucous membranes, so it is semi-critical and requires high-level disinfection after cleaning. A surgical instrument contacts sterile tissue, so it is critical and requires sterilization with biological monitoring. Rule of thumb: match the item to the Spaulding category, then to the minimum process.