High-level disinfection (HLD) is a process that eliminates all vegetative bacteria, mycobacteria, enveloped and non-enveloped viruses, fungi and some bacterial spores.
What’s the difference between disinfection and sterilisation?
| Required Level of Disinfection | Eliminates |
|---|---|
| Sterilisation | All forms of microbial life |
| High-level disinfection | Vegetative bacteria, mycobacteria, enveloped and non-enveloped viruses, fungi and some bacterial spores |
| Intermediate-level disinfection | Bacteria, mycobacteria, enveloped and non-enveloped viruses, and most fungi |
| Low-level disinfection | Bacteria, enveloped viruses and some fungi |
When should you high-level disinfect?
The Spaulding Classification determines the appropriate level of disinfection (critical, semi-critical and non-critical) for reusable medical devices. The level of disinfection required will depend on the degree of risk of infection when the device is used.1
| CATEGORY | LEVEL OF CONTACT | DEVICE APPLICATION | REQUIRED LEVEL OF DISINFECTION |
|---|---|---|---|
| CRITICAL | Contact with the bloodstream or sterile tissues. | Surgical instruments e.g. scalpels, tweezers, scissors, kidney dishes and clamps. | Sterilisation |
| SEMI-CRITICAL | Contact with mucous membranes or non-intact skin. | Endoscopes and endocavity ultrasound probes. | High-Level Disinfection |
| NON-CRITICAL | Contact with intact skin. | Skin-surface ultrasound probes Stethoscopes and blood pressure cuffs. | Intermediate-Level Disinfection Low-Level Disinfection |
Any device which comes into contact with blood from non-intact skin or mucous membranes (including non-critical devices used in interventional procedures) classifies, as a minimum, as a semi-critical device and ultimately requires high-level disinfection or sterilisation. Occasions where this would happen to a non-critical device include:
- Ultrasound vascular access procedures (for central line or IV placement)
- Biopsies
- Assessments where there is compromised skin or an open wound
Why should you high-level disinfect?
HLD is essential in healthcare settings to prevent healthcare-associated infections (HAIs) and combat antimicrobial resistance (AMR). HAIs can lead to serious illness, prolonged hospital stays and increased healthcare costs, often resulting from contaminated medical devices or surfaces. HLD eliminates most pathogens, including resistant organisms, reducing the risk of transmission.
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References:
1 CDC Infection Control (2008). A Rational Approach to Disinfection and Sterilization. [online] CDC Infection Control. Available at: https://www.cdc.gov/infection-control/hcp/disinfectionsterilization/rational-approach.html#toc
