Accessible version: https://www.cdc.gov/infectioncontrol/guidelines/disinfection/ Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 Update: May 2019 William A. Rutala, Ph.D., M.P.H.1,2, David J. Weber, M.D., M.P.H.1,2, and the Healthcare Infection Control Practices Advisory Committee (HICPAC)3 1Hospital Epidemiology University of North Carolina Health Care System Chapel Hill, NC 27514 2Division of Infectious Diseases University of North Carolina School of Medicine Chapel Hill, NC 27599-7030 1 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) 3HICPAC Members Robert A. Weinstein, MD (Chair) Cook County Hospital Chicago, IL Jane D. Siegel, MD (Co-Chair) University of Texas Southwestern Medical Center Dallas, TX Michele L. Pearson, MD (Executive Secretary) Centers for Disease Control and Prevention Atlanta, GA Raymond Y.W. Chinn, MD Sharp Memorial Hospital San Diego, CA Alfred DeMaria, Jr, MD Massachusetts Department of Public Health Jamaica Plain, MA James T. Lee, MD, PhD University of Minnesota Minneapolis, MN William A. Rutala, PhD, MPH University of North Carolina Health Care System Chapel Hill, NC William E. Scheckler, MD University of Wisconsin Madison, WI Beth H. Stover, RN Kosair Children’s Hospital Louisville, KY Marjorie A. Underwood, RN, BSN CIC Mt. Diablo Medical Center Concord, CA This guideline discusses use of products by healthcare personnel in healthcare settings such as hospitals, ambulatory care and home care; the recommendations are not intended for consumer use of the products discussed. Last update: May 2019 2 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Table of Contents Executive Summary ...................................................................................................................................... 8 Introduction.................................................................................................................................................... 9 Methods......................................................................................................................................................... 9 Definition of Terms ........................................................................................................................................ 9 A Rational Approach to Disinfection and Sterilization ................................................................................. 11 Critical Items ......................................................................................................................................... 11 Semicritical Items.................................................................................................................................. 11 Noncritical Items ................................................................................................................................... 12 Changes in Disinfection and Sterilization Since 1981 .......................................................................... 13 Disinfection of Healthcare Equipment ......................................................................................................... 14 Concerns about Implementing the Spaulding Scheme ........................................................................ 14 Reprocessing of Endoscopes ............................................................................................................... 14 Laparoscopes and Arthroscopes .......................................................................................................... 18 Tonometers, Cervical Diaphragm Fitting Rings, Cryosurgical Instruments, and Endocavitary Probes ....................................................................................................................................... 19 Dental Instruments................................................................................................................................ 21 Disinfection of HBV-, HCV-, HIV- or TB-Contaminated Devices .......................................................... 22 Disinfection in the Hemodialysis Unit ................................................................................................... 22 Inactivation of Clostridium difficile ........................................................................................................ 23 OSHA Bloodborne Pathogen Standard ................................................................................................ 24 Emerging Pathogens (Cryptosporidium, Helicobacter pylori, Escherichia coli O157:H7, Rotavirus, Human Papilloma Virus, Norovirus, Severe Acute Respiratory Syndrome [SARS] Coronavirus) ................................................................................................................. 24 Inactivation of Bioterrorist Agents ......................................................................................................... 26 Toxicological, Environmental and Occupational Concerns .................................................................. 27 Disinfection in Ambulatory Care, Home Care, and the Home .............................................................. 28 Susceptibility of Antibiotic-Resistant Bacteria to Disinfectants ............................................................. 29 Surface Disinfection .............................................................................................................................. 30 Air Disinfection ...................................................................................................................................... 32 Microbial Contamination of Disinfectants ............................................................................................. 33 Factors Affecting the Efficacy of Disinfection and Sterilization .................................................................. 34 Number and Location of Microorganisms ............................................................................................. 34 Innate Resistance of Microorganisms .................................................................................................. 34 Concentration and Potency of Disinfectants ........................................................................................ 35 Physical and Chemical Factors ............................................................................................................ 35 Organic and Inorganic Matter ............................................................................................................... 35 Duration of Exposure ............................................................................................................................ 35 Biofilms ................................................................................................................................................. 36 Cleaning ...................................................................................................................................................... 37 Disinfection .................................................................................................................................................. 39 Chemical Disinfectants ......................................................................................................................... 39 Alcohol............................................................................................................................................ 39 Overview. ................................................................................................................................. 39 Mode of Action. ........................................................................................................................ 39 Microbicidal Activity. ................................................................................................................ 39 Uses. ........................................................................................................................................ 40 Chlorine and Chlorine Compounds ................................................................................................ 40 Overview. ................................................................................................................................. 40 Mode of Action. ........................................................................................................................ 42 Last update: May 2019 3 of 163 Guideline for Disinfection and Sterilization in Healthcare Facilities (2008) Microbicidal Activity. ................................................................................................................ 42 Uses. ........................................................................................................................................ 42 Formaldehyde ................................................................................................................................ 43 Overview. ................................................................................................................................. 43 Mode of Action. ........................................................................................................................ 44 Microbicidal Activity. ................................................................................................................ 44 Uses. .......................................................................................................................................