Spaulding Classification

The Spaulding classification scheme was devised as a logical way to determine the disinfection schemes required for items used during patient care. Despite being over half a century old, it remains the clearest and most concise way of assessing an object's infection risk. This is important as it ensures all items receive an appropriate level of decontamination without overburdening an infection control system.

Objects are split into one of three categories depending on their normal use. An item can either be critical, semicritical or noncritical. Critical items pose the highest threat of infection transmission while noncritical pose the lowest. Items in different classes go through different decontamination processes.

Critical Items

These are objects that are designed to contact normally sterile tissue (like blood) or enter the vascular system. Any microbial load on such an object could introduce an infection to an otherwise healthy patient. As such, items deemed critical must be sterilized using steam methods if possible, but via an alternate method if they are heat sensitive.

Some examples of critical items:

• Forceps
• Scalpels
• Bone saws

Semicritical items

Such items ordinarily make contact only with mucous membranes or the skin. They do not enter open wounds or penetrate soft tissues. Reusable semicritical items should be steam-sterilized if the item can withstand such treatment, however high-level disinfection is the minimum acceptable process. Semicritical items should be thoroughly cleaned to remove debris and soil prior to further decontamination processing.

Some examples of semicritical items:

• Endoscopes and speculums
• Dental mirrors and other simple hand tools
• Reusable trays for making tooth impressions

Noncritical items

Items that are noncritical normally only ever contact intact skin and do not touch mucous membranes. Due to their low infection transmission risk, only low-level disinfection is routinely required for such objects.

Some examples of noncritical items:

• Stethoscope
• Bedpan
• Walking crutches