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Disinfection: is it time to reconsider Spaulding?
1STERIS Limited, Basingstoke, UK. gerry_mcdonnell@steris.com
The Journal of Hospital Infection
|June 14, 2011
Summary
The Spaulding classification for medical device reprocessing needs re-evaluation. Emerging evidence shows some microbes resist standard disinfection, potentially causing healthcare-associated infections.
Area of Science:
- Microbiology
- Infectious Diseases
- Healthcare Epidemiology
Background:
- The Spaulding classification (1957) categorizes medical devices by risk (critical, semi-critical, non-critical) to guide disinfection and sterilization.
- Current disinfection levels (high, intermediate, low) are based on antimicrobial activity against specific marker organisms.
- Advancements in microbiology reveal a more complex understanding of microbial resistance profiles.
Purpose of the Study:
- To evaluate the continued validity of the Spaulding classification in light of new microbial resistance data.
- To discuss how atypical resistance of viruses, bacteria, protozoa, and prions challenges current disinfection definitions.
- To highlight clinical evidence linking biocide resistance to infection outbreaks due to disinfection failures.
Main Methods:
- Review of disinfection studies involving diverse microorganisms (viruses, bacteria, protozoa, prions).
- Analysis of laboratory data demonstrating atypical tolerance or resistance to disinfection processes.
- Examination of clinical reports on infection outbreaks linked to disinfection failures.
Main Results:
- Several microorganisms exhibit unexpected tolerance or resistance to established disinfection protocols.
- Atypical resistance profiles challenge the efficacy of high-, intermediate-, and low-level disinfection as currently defined.
- Clinical data confirms that disinfection failures due to microbial resistance can lead to patient infections.
Conclusions:
- The Spaulding classification's underlying principles require reassessment due to evolving microbial understanding.
- Current disinfection expectations may be insufficient against certain resistant microorganisms.
- Reconsidering disinfection and sterilization practices is crucial to prevent infection outbreaks and ensure patient safety.
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