Infection Prevention and Aseptic Technique
Classify first, then reprocess
The Spaulding classification drives every reprocessing question. Critical items enter sterile tissue or the vascular system and require sterilization. Semicritical items contact mucous membranes - laryngoscope blades, supraglottic airways, stylets, bronchoscopes, oral and nasal airways - and require high-level disinfection at minimum. Noncritical items touch intact skin, such as blood pressure cuffs and stethoscopes, and need low-level disinfection.
Steam sterilization runs at about 121°C (250°F) for 15–30 minutes or 132°C (270°F) for roughly 4 minutes at the appropriate pressure, with drying. Verify with biological indicators - Geobacillus stearothermophilus for steam - plus chemical indicators and mechanical parameters. Glutaraldehyde provides high-level disinfection, not sterilization in practical use.
Precautions and the environment
Standard precautions apply to every patient: hand hygiene before and after glove use, PPE matched to anticipated exposure, sharps discarded immediately at the point of use, and immediate reporting of exposures. Approximate percutaneously transmitted infection risk per needlestick: hepatitis B ~30%, hepatitis C ~1.8%, HIV ~0.3%; post-exposure prophylaxis exists for HBV and HIV.
Operating room ventilation delivers 20–25 air changes per hour with HEPA filtration, positive pressure relative to corridors, and restricted traffic. Airborne precautions (e.g., suspected tuberculosis) require an N95 or better and a negative-pressure room.
Rule of thumb: if it touches a mucous membrane, it cannot be wiped down and reused - high-level disinfection is the floor.
Trap: believing an alcohol wipe sterilizes; it does not even reliably achieve high-level disinfection.