Spaulding Classification and Chemical Disinfectants

The Spaulding Classification Framework

The Spaulding classification system categorizes patient care items based on the degree of infection risk involved in their use. Sterile processing technicians play a vital role across the entire instrument processing cycle. Technicians clean and decontaminate, inspect, assemble, package, sterilize when indicated, and store instruments according to device manufacturers' instructions for use (IFU) and facility policy. The Spaulding system establishes a minimum processing level based on infection risk; technicians must also follow the device and processing-product IFUs and facility policy to determine the required method.

The system establishes three specific categories: critical, semicritical, and noncritical. Critical items are devices that enter normally sterile tissue or the vascular system. Because these devices breach the body's natural defense barriers, critical items carry the highest risk of transmitting infection and must be sterilized prior to patient use. Examples of critical items include surgical instruments, vascular catheters, and orthopedic implants.

Semicritical items come into contact with intact mucous membranes or non-intact skin. These devices require high-level disinfection at a minimum, although sterilization may also be used. Typical semicritical items include flexible gastrointestinal endoscopes, laryngoscope blades, and respiratory therapy equipment that contacts mucous membranes. Noncritical items contact only intact skin and do not touch mucous membranes. Noncritical items generally require cleaning and low-level disinfection; however, intermediate-level disinfection may be required based on contamination, the manufacturer's IFU, and facility policy. Examples include blood pressure cuffs, crutches, and patient beds.

Regardless of whether an item is critical, semicritical, or noncritical, chemical processing cannot succeed without proper initial preparation. Thorough cleaning to remove organic soil is required before disinfection because soil can interfere with disinfectant action. For example, if blood or bodily fluids remain dried onto an instrument surface, the underlying microbes are shielded from contact with the chemical disinfectant, preventing effective germicidal destruction.