Cleaning, disinfection and sterilization of equipment
- Fundamental
Each item is processed by the risk of its use: items entering sterile tissue are sterilized, items touching mucous membranes get high-level disinfection.
What it is
The Spaulding classification sorts patient-care items by the infection risk of their use. Critical items enter sterile tissue or the vascular system and are sterilized. Semicritical items touch mucous membranes or non-intact skin and need at least high-level disinfection. Noncritical items touch only intact skin, and low-level disinfection is enough. In every case cleaning comes first: organic matter left on an object stops the disinfectant or sterilant from working.
Key points
- Cleaning: removing dirt and organic matter with water and detergent or an enzymatic cleaner, as soon as possible after use.
- Disinfection: eliminates many or all pathogenic microorganisms on inanimate objects, except bacterial spores.
- High-level disinfection: eliminates all microorganisms except small numbers of spores.
- Sterilization: destroys all forms of microbial life, including spores.
- Steam is preferred for items that tolerate heat; low-temperature methods are for heat-sensitive items.
Components
- Pre-cleaning at the point of use or in the sterile processing department.
- Choice of process according to the Spaulding category.
- Packaging suited to the sterilization method.
- Mechanical, chemical and biological indicators.
- Storage that keeps the packaging intact; packs are checked for damage before use.
What it is for
- Stopping equipment from carrying microorganisms from one patient to another.
- Protecting staff who handle soiled equipment.
- Making sure sterile supplies reach the patient still sterile.
The Spaulding classification
| Category | What it contacts | Examples | Minimum process |
|---|---|---|---|
| Critical | Sterile tissue or the vascular system | Surgical instruments, urinary and cardiac catheters, implants | Sterilization |
| Semicritical | Mucous membranes or non-intact skin | Respiratory therapy and anaesthesia equipment, some endoscopes, laryngoscope blades | High-level disinfection |
| Noncritical | Intact skin | Blood pressure cuff, bedpan, crutches, bed rails, bedside table | Low-level disinfection |
In nursing practice
- Noncritical equipment used for a patient on contact precautions is disinfected before use on another patient, or dedicated to that patient.
- Before opening a sterile pack, check it is not torn, wet or punctured; if it is, it is reprocessed.
- Mechanical and chemical indicators are checked for every load; if they suggest failure, the items are not used.
- Each pack is labelled with the sterilizer, the load number and the date.
Common mistakes
- Disinfecting or sterilizing an item without cleaning it first.
- Using high-level disinfectants on noncritical surfaces.
- Letting blood or secretions dry on instruments before sending them for cleaning.
- Using a wet or torn sterile pack.
- Using flash sterilization for convenience or to save time.
Test yourself
Think of the answer, then tap the question to see it.
What minimum process does a semicritical item need under Spaulding?
High-level disinfection, because it touches mucous membranes or non-intact skin.
Why does cleaning always come before disinfection or sterilization?
Because organic matter left on the item shields microorganisms and stops the disinfectant or sterilant from working.
Which category does a blood pressure cuff belong to, and how is it processed?
It is noncritical, because it touches only intact skin, and it is processed with low-level disinfection.
What separates sterilization from high-level disinfection?
Sterilization destroys all forms of microbial life, including spores; high-level disinfection may leave small numbers of spores.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: A Rational Approach to Disinfection and Sterilization (Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008) (Centers for Disease Control and Prevention (CDC), 2008); Recommendations for Disinfection and Sterilization in Healthcare Facilities (2008) (Centers for Disease Control and Prevention (CDC), 2008); Nursing Fundamentals, 9.6 Preventing Infection (Open RN, Wisconsin Technical College System (LibreTexts copy, CC BY 4.0), 2021).
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Representative model, for educational purposes only.