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Martin Sanders

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Disinfection of medical instruments is important for preventing the spread of disease. Cleaning and disinfecting reusable equipment after it comes into contact with patients can be expensive, both in the cost of the disinfection procedure, but also in terms of time away from the patients themselves. Not all medical instruments can be fully sterilized after each use. Thankfully, not all reusable instruments need the highest level of disinfection. But how to determine the minimum level of disinfection in a given situation? Earle H. Spaulding devised a rational approach to disinfection and sterilization of patient-care items and equipment Spaulding believed the nature of disinfection could be understood readily if instruments and items for patient care were categorized as critical, semi-critical, and non-critical according to the degree of risk for infection involved in use of the items. Spaulding recognized that the need for disinfection of equipment in medical settings ranged from non-critical to semi-critical to critical, depending on the likelihood of spreading disease. For example, sterilization is necessary for equipment that comes into contact with a patient’s bloodstream or sterile tissue. This category of equipment, such as surgical knives, is designated “critical” because it presents a high risk of disease transmission from patient to patient. Equipment that only touches healthy, unbroken skin presents a low risk of contamination because intact skin acts as an effective barrier to most microorganisms. Examples in this “non-critical” category include bedpans, blood-pressure cuffs, and bedrails. In between those two scenarios, a “semi-critical” level of disinfection presents a medium risk of contamination. This would include equipment such as endoscopes used on mucous membranes or areas of broken skin.

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