In healthcare settings, microorganisms (bacteria, fungi, viruses) are present throughout the environment and can cause infection. The environment can serve as a breeding ground for these organisms. Cleaning and disinfecting surfaces and medical equipment, especially those that are frequently touched, is important to decrease and prevent the spread of these organisms to people.
Cleaning = removal of all visible dust, soil, and any other foreign material
Decontamination = removal of disease-producing microbes to make safe for handling
Disinfection = process that destroys nearly all disease-producing organisms, except spores
Sterilization = process that destroys microorganisms and spores
Different types of equipment and environmental surfaces need different levels of cleaning, disinfection, or sterilization depending on the use of the item/surface and the risk of becoming infected with germs that may be on the item/surface.
1) Critical items are items that enter normally sterile tissue or the vascular system or through which a sterile body fluid (e.g., blood) flows. These items are associated with high risk of infection if they are contaminated with any microorganism and must be sterilized before using. Examples include surgical instruments, cardiac and urinary catheters, and implants.
2) Semicritical items are items that contact mucous membranes (e.g., eyes, nose, or mouth) or non-intact skin. At a minimum, semicritical items require high-level disinfection using chemical disinfectants and rinsing with sterile water. Examples include respiratory therapy and anesthesia equipment, some endoscopes, cystoscopes, and laryngoscope blades.
3) Noncritical items are items that have contact with intact skin but not mucous membranes and are associated with little risk of spreading germs. Noncritical items require at least low-level disinfection. Noncritical care items include bedpans, blood pressure cuffs, blood glucometers, crutches, and computers. Noncritical environmental surfaces include bed rails, tray tables, bedside tables, walls, floors, toilets, sinks, and furniture.
Ambulatory surgical centers
Checklists for monitoring compliance with cleaning practices
Environmental Protection Agency (EPA)
Guidelines for Environmental Infection Control in Healthcare Facilities: Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). June 6, 2003. MMWR.
Indiana State Department of Health HAI Prevention Education Module – Course 1: Environmental Cleaning
Not Just a Maid Service – Film developed by the Illinois Department of Public Health and the Illinois Quality Improvement Organization that highlights the role of environmental service workers in the prevention of Clostridium difficile infection.
Premier Safety Share, Bulletin: CDC releases 2008 guidelines for disinfection and sterilization. Bleach dilutions clarified with household measurement terms, November 24, 2008.
Rutala WA, Weber DJ, et al., and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.