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Sterilization vs. High-Level and Low-Level Disinfection [a 3-Point Comparison]

Arthur Trapotsis
Written by: Arthur Trapotsis

MS Biochemical Engineering, MBA, Consultant

In a 1939 paper, microbiologist Earle H. Spaulding introduced a system for determining which medical devices and instruments needed disinfection and which ones required sterilization. In it, he proposed that critical instruments would need to be subjected to more stringent disinfection protocols than non-critical patient care items. Today, this framework is fittingly known as Spaulding Classification and is used in healthcare facilities around the world for its patient safety benefits.

What does this system mean for your hospital or ambulatory surgery center (ASC)? Read on to find out the differences between high- and low-level disinfection and how both processes are distinct from sterilization.

Disinfection Levels Explained: High-Level Disinfection vs. Low-Level Disinfection

After medical instruments are used in procedures, they must undergo a thorough decontamination process before they can be safely reused. After a preliminary cleaning to remove soil, instruments move on to the second phase in the cycle: disinfection. In this step, chemicals are used to eliminate most contaminants — such as viruses and bacteria — from their surfaces.

For some medical devices, disinfection is an important step along the path that leads to sterilization (a similar yet entirely separate process). But did you know that the level of disinfection an instrument or other device requires depends on what it is and how it’s used?

High-level disinfection involves using disinfectants that are capable of eliminating all microorganisms (except for a small number of bacterial spores) and inactivating any viruses present on a used piece of medical equipment. Given the nature of this type of disinfecting agent, high-level disinfection is reserved for semi-critical items, or those which contact mucous membranes or non-intact skin. Anesthesia equipment, some endoscopes, and cystoscopes are only a few examples of this type of device.

Low-level disinfection refers to the use of a disinfecting agent that kills all vegetative bacteria as well as most viruses. This type of disinfection will not eliminate bacterial spores and is overall less effective than its high-level counterpart. Considering this, low-level disinfectants are only suitable for use on reusable patient care devices that come into contact with intact skin only, such as blood pressure cuffs, stethoscopes, pulse oximeters, etc.

What’s the Difference Between High-Level Disinfection and Sterilization?

We’ve already touched on this briefly, but it’s important to reiterate that while it’s also part of the overarching decontamination cycle, sterilization is an entirely different process than disinfection — no matter the level. Though an effective method of removing most harmful microorganisms that remain on critical devices after use, high-level disinfection doesn’t eliminate them completely.

Sterilization, on the other hand, does. There are many different methods for sterilizing medical instruments, but what they all have in common is the ability to eliminate all dangerous contaminants — including bacteria spores. Another key differentiator that separates sterilization from high-level disinfection is the use of specialized equipment. For example, one method of sterilization, steam sterilization, takes place in an autoclave: a piece of machinery that uses a combination of pressure, heat, and moisture to create an environment where harmful organisms can’t survive.

A Comparison: Sterilization, High-Level & Low-Level Disinfection

If you’re still unsure about what makes each of these three decontamination processes unique, the following chart breaks down the differences by what each process entails, the types of instruments and devices involved, and the methods used.

It’s important to keep in mind that there are multiple effective methods of sterilization in use today, which means that the exact process through which sterilization is achieved will depend on the method used. In the previous section, we established that steam sterilization relies on specially designed equipment to create an environment that’s lethal to viruses and bacteria (and their spores). Essentially, the same is true for other sterilization techniques, with the main differences found in the ways those environments are created.

For example, ethylene oxide sterilization takes place in large chambers and uses ethylene oxide gas to sterilize a wide range of instruments and devices. Gamma radiation kills microorganisms by breaking down their DNA, thus preventing division. And the dry heat technique leverages high-heat conduction to inactivate pathogens through oxidation.

Sterilization High-level Disinfection Low-level Disinfection
Processes Depends on the method used Cleaning using high-level disinfectants only Cleaning using low-level disinfectants only
Instruments & Devices Critical devices such as surgical instruments, implants, catheters, etc. Semi-critical devices such as anesthesia equipment, some endoscopes, cystoscopes, etc. Non-critical devices such as stethoscopes, blood pressure cuffs, pulse oximeters, etc.
Methods Steam, ethylene oxide, gamma radiation, dry heat Use of disinfecting agents with one or more of the following active ingredients: Glutaraldehyde, Ortho-Phthalaldehyde, peracetic acid, hydrogen peroxide, hypochlorous acid, hypochlorite Use of disinfecting agents with one or more of the following active ingredients: Chlorine, iodophors, phenols, quaternary ammonium

Is Your Healthcare Facility on the Right Track?

Steam sterilization technology plays a crucial role in the decontamination process by ensuring that medical devices and instruments are safe to use in future procedures. As such, it also serves an essential purpose in providing comprehensive care. Ready to put your ASC sterilization setup to the test? Take our free self-assessment to see whether your current setup sufficiently meets your needs.

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