Sterilization and disinfection

Equipment must be cleaned first, before attempting to disinfect or sterilize it

Spaulding Classification of Medical Equipment

Classification	Contact with	Processing	Examples
Critical	Sterile tissue or vascular system	Cleaning followed by sterilization	Surgical instruments, biopsy instruments, and foot care equipment
Semi-critical	Non-intact skin or mucous memranes, but not penetrating the skin	Cleaning followed by a minimum high level disinfection	Respiratory equipment, flexible endoscopes
Non-critical	Intact skin	Cleaning followed by low level disinfection	Trourniquets, BP cuffs, linen, and furtniture

Endoscopes, which secondarily enter steril tissues, should be considered critical

Needs separate areas for receiving soiled instruments, decontaminating, cleaning, sterilizing, and storing
Treated essentially like an OR, with controlled temperature and humidity, with dedicated ventilation system
Negative pressure in decontamination areas and positive pressure in clean areas

High temperature sterilization whenever possible
Low-temperature sterilization can be done for heat sensitive critical and semi-critical items
- Uses gas, including hydrogen peroxide gas plasma or vapour, or ozone (but that needs 4 hours)
- Needed for things with plastic, for example
Liquid emersion can be done for heat sensitive crticical and semi-critical items
- Hydrogen peroxide most common liquid

Spore tests: compare a strip that went through the autoclav to a control that was held outside
ATP system test strips

Equipment must be stored until results are available from the spore test for that batch
Controlled temperature and humidity