Sterilization, Disinfection, and Antisepsis

InstrumentLevel of DisinfectionMethods (Examples)
Critical instrument or device: any instrument that enters tissue (eg, needles, surgical instruments, urinary catheters, some semicritical items)SterilizationSteam, low-temperature gas plasma, immersion in liquid chemical sterilants, ethylene oxide gas
Semicritical instrument or device: any instrument that contacts mucous membranes but does not enter tissue (eg, laryngoscope)High-level disinfectionWet pasteurization at 70°C for 30 min, chemical sterilants, liquid chemical high-level disinfectants (eg, >2% glutaraldehyde, 0.55% OPA, 7.5% hydrogen peroxide alone or in combination with peracetic acid)
Noncritical instruments or devices: instruments that touch only intact skin (eg, stethoscopes, blood pressure cuffs), including those with visible bloodIntermediate-level disinfection1:50 dilution sodium hypochlorite (1000 ppm chlorine), 70%–90% isopropyl and ethyl alcohol, phenolic germicidal detergent solution, iodophor germicidal detergent solution
Environmental surfaces: knobs, handles, carts, or tabletops (with no visible blood)Soap and water or low-level disinfectionEPA-approved disinfectants labeled for use against hepatitis B virus and/or tuberculocidal activity (eg, quaternary ammonium compounds), 1:500 dilution sodium hypochlorite (100 ppm chlorine)
  • Adapted from Wendt C, Frei R, Widmer AF. Decontamination, disinfection and sterilization. In: Jorgensen JH, Pfaller MA, Carroll KC, et al, eds. Manual of Clinical Microbiology. 11th ed. Washington, DC: American Society of Microbiology; 2015:183–216; Rutala WA. APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control. 1996;24(4):313–342; and Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Guideline for disinfection and sterilization in healthcare facilities, 2008. Available at: Accessed March 6, 2017. OPA, ortho-phthalaldehyde.