Cleaning, decontamination and disinfection (21%)

Cleaning comes first

This is a 21 percent domain, tied for the largest. The CDC guideline is blunt: disinfection and sterilization fail when organic and inorganic soil is left behind. Point-of-use treatment keeps soil from drying. In decontamination you sort, disassemble according to the IFU, brush lumens with a brush that actually fits, and choose utility water for washing and cleaner critical water for the final rinse.

Ultrasonic cleaners work by cavitation. They clean; they are not the sterilizer. Washer-disinfectors need unobstructed spray arms, the right chemistry, and an efficacy test you can interpret. Leak-test flexible endoscopes before they are fully immersed, and follow that scope's IFU.

Spaulding and chemicals

Spaulding's three classes are on the outline and in the CDC guideline. Critical items enter sterile tissue or the vascular system and must be sterile. Semicritical items touch mucous membranes or nonintact skin and need high-level disinfection at a minimum. Noncritical items touch intact skin and get low-level disinfection.

High-level disinfectant contact time, temperature, and reuse life come from the product label, not from memory. Test minimum effective concentration. Glutaraldehyde and OPA need ventilation, PPE, and a thorough rinse. Quaternary ammonium compounds are low-level disinfectants for noncritical surfaces, not a shortcut for surgical instruments.