Guide — Clinical Skills
Equipment Reprocessing & Disinfection
How the Spaulding classification and the cleaning-disinfection-sterilization hierarchy determine which agents and methods make reusable RT equipment safe between patients.
9 min read · Clinical Skills
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Reusable respiratory equipment contacts airways, mucous membranes, and sometimes sterile tissue, so it must be reprocessed between patients to prevent healthcare-associated infection. Reprocessing is a graded hierarchy: the required level is set by how the device is used, per the Spaulding classification. Water reservoirs (nebulizers, humidifiers) are a classic reservoir for gram-negative organisms (Pseudomonas, Legionella), which is why single-use disposables now dominate RT.
Key Concepts
Spaulding classification — device use sets the minimum reprocessing level:
- Critical items — enter sterile tissue or the vascular system. Require sterilization. RT examples: instruments entering sterile spaces; bronchoscope biopsy forceps.
- Semicritical items — contact mucous membranes or non-intact skin but do not penetrate them. Require high-level disinfection (HLD) at minimum. RT examples: flexible bronchoscopes, reusable breathing circuits, resuscitation (bag-valve) devices, laryngoscope blades, nasopharyngeal airways.
- Noncritical items — contact intact skin only. Require low-level disinfection or cleaning. RT examples: BP cuffs, stethoscopes, ventilator external surfaces, pulse oximeter probes.
The cleaning → disinfection → sterilization hierarchy:
- Cleaning— physical removal of organic material and soil (blood, secretions) with detergent or enzymatic cleaner and water. Always precedes disinfection or sterilization — organic matter inactivates disinfectants and shields microbes. You cannot disinfect or sterilize a dirty item.
- Disinfection — eliminates many or all pathogens except large numbers of bacterial spores.
- Low-level — kills most vegetative bacteria, some fungi and viruses; not mycobacteria or spores (quaternary ammonium compounds).
- Intermediate-level— also kills mycobacteria and most viruses/fungi; not spores (70–90% alcohols, iodophors, phenolics).
- High-level (HLD) — kills all microorganisms except large numbers of bacterial spores; does kill mycobacteria. Uses chemical sterilants at shorter contact times.
- Sterilization — destroys all microbial life, including bacterial spores.
High-level disinfectants and sterilization methods:
| Method | Level | Key points |
|---|---|---|
| Pasteurization | HLD | Thermal immersion, ~70°C (158°F) × 30 min. Kills vegetative organisms and most viruses; does NOT kill spores. No toxic chemical residue; common for reusable circuits/nebulizers. |
| Glutaraldehyde (≥2%) | HLD (sterilant if prolonged) | HLD in ~20–45 min at room temperature; sterilizes only with ~10-hour immersion. Pungent mucous-membrane/ respiratory irritant; requires activation, good ventilation, and thorough water rinsing before use. Limited reuse life (~14–28 days). |
| Ortho-phthalaldehyde (OPA, 0.55%) | HLD | Faster than glutaraldehyde (~5–12 min), no activation needed, less odor/irritation — but stains proteins/skin gray. Avoid for instruments used in bladder-cancer cystoscopy patients (anaphylaxis reports on repeat exposure). |
| Steam (autoclave) | Sterilization | Saturated steam under pressure — e.g., 121°C (250°F) at ~15 psi for ~15–30 min, or 132–135°C for shorter cycles. Reliable, economical, nontoxic; destroys heat- and moisture-sensitive items. |
| Ethylene oxide (EtO) gas | Sterilization | Low-temperature sterilization for heat- and moisture-sensitive items. Long cycle plus mandatory aeration (often 12+ hours) to remove toxic residual gas. Toxic, flammable, carcinogenic/mutagenic. Newer low-temp alternatives: hydrogen peroxide gas plasma, vaporized hydrogen peroxide, peracetic acid. |
Assessment & Findings
- Ask “what does this item contact?” — Spaulding tells you the minimum level. When in doubt, escalate to the higher level.
- Verify cleaning first: a visibly soiled scope cannot be validly disinfected.
- Bronchoscopes are the highest-risk RT semicritical device — inadequate reprocessing (residual moisture, biofilm, damaged channels) has caused documented outbreaks; they require meticulous HLD with drying/storage per protocol.
RT Priorities / Interventions
- Clean before you disinfect or sterilize — every time.
- Select the method by device use (Spaulding) AND by heat/moisture tolerance: autoclave heat-stable items; EtO or another low-temp method for heat-sensitive items.
- After chemical HLD (glutaraldehyde/OPA), rinse thoroughly with sterile/filtered water and dry — residual disinfectant injures mucosa.
- Use sterile water (not tap/distilled) in nebulizer and humidifier reservoirs, change per policy, and avoid pooling condensate — water is a gram-negative reservoir.
- Prefer single-use disposables where available; they eliminate reprocessing risk.
Common Pitfalls
- Skipping or short-cutting cleaning, then wondering why HLD failed — organic soil inactivates every chemical disinfectant.
- Calling pasteurization “sterilization” — it does NOT kill spores; it is high-level disinfection.
- Reprocessing a single-use device (SUD) ad hoc at the bedside — SUD reprocessing is FDA-regulated and only valid through a validated third-party reprocessor.
- Using a low-level disinfectant (e.g., quaternary ammonium) on a semicritical item that needs HLD.
- Storing a bronchoscope wet — residual moisture supports biofilm and gram-negative growth.
Board Exam Pearls
- Spaulding: critical → sterilize; semicritical → high-level disinfection; noncritical → low-level disinfection/cleaning.
- Cleaning always comes before disinfection or sterilization.
- Pasteurization = high-level disinfection (kills vegetative organisms, NOT spores).
- Sterilization is the only process that destroys bacterial spores.
- Autoclave = heat-stable items; ethylene oxide = heat/moisture- sensitive items (needs long aeration for toxic residual).
- Reusable breathing circuits and resuscitation bags are semicritical → HLD minimum.
FAQ
What is the Spaulding classification?
A framework that sets the minimum reprocessing level by how a device is used: critical items (enter sterile tissue) need sterilization, semicritical items (contact mucous membranes) need at least high-level disinfection, and noncritical items (contact intact skin) need low-level disinfection or cleaning.
Is pasteurization the same as sterilization?
No. Pasteurization is high-level disinfection — heated-water immersion (~70°C for 30 minutes) that kills vegetative bacteria and most viruses but NOT bacterial spores. Only true sterilization (autoclave, ethylene oxide, etc.) destroys spores.
Why must cleaning come before disinfection?
Organic material such as blood and secretions inactivates chemical disinfectants and physically shields microorganisms, so a dirty item cannot be reliably disinfected or sterilized. Cleaning removes that soil first.
When is ethylene oxide used instead of steam autoclaving?
For heat- and moisture-sensitive items that steam would damage (many plastics and electronics). EtO sterilizes at low temperature but requires a long cycle and mandatory aeration to remove toxic residual gas.
Keep Building
Reprocessing is one piece of infection control in respiratory care.
Review standard precautions, isolation practices, and transmission-based controls in the companion guide.
Infection Prevention in Respiratory Care →Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.
- Cairo JM. Mosby's Respiratory Care Equipment. 11th ed. Elsevier; 2022.
- Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities. Centers for Disease Control and Prevention; 2008 (updated 2019).