Items Requiring Sterilization or High-Level Disinfection in the ICU
In the ICU, equipment must be categorized by infection risk and processed accordingly: critical items (those entering sterile tissue) require sterilization, semicritical items (those contacting mucous membranes) require high-level disinfection or sterilization, and noncritical items (touching intact skin only) require low-level disinfection. 1
Critical Items Requiring Sterilization
These items penetrate sterile tissue or the vascular system and must be sterile:
- Surgical instruments used for any invasive procedures 1
- Needles and catheters (cardiac catheters, urinary catheters, central lines) that enter bloodstream or sterile body cavities 1
- Implants of any kind 1
Semicritical Items Requiring Sterilization or High-Level Disinfection
Respiratory Equipment (Between Different Patients)
- Endotracheal tubes and tracheostomy tubes - sterilize or high-level disinfect reusable components 1
- Anesthesia breathing circuit components: tracheal tubes, face masks, inspiratory/expiratory breathing tubing, Y-piece, reservoir bag, humidifier and tubing - clean then sterilize or subject to high-level liquid chemical disinfection or pasteurization 1
- Resuscitation bags (hand-powered) - sterilize or high-level disinfect between patients 1
- Bronchoscopes (flexible and rigid fiberoptic) - sterilize or high-level disinfect 1
- Respirometers and ventilator thermometers (portable) - sterilize or high-level disinfect between patients 1
- Small-volume medication nebulizers (in-line and hand-held) - between treatments on the same patient, clean, disinfect, rinse with sterile water, and dry 1
Other Semicritical Equipment
- Laryngoscopes - high-level disinfection required 1
- Mist tent nebulizers, reservoirs, and tubings - replace with sterilized or high-level disinfected equipment between different patients 1
Equipment That Does NOT Require Routine Sterilization
Do not routinely sterilize or disinfect:
- Internal machinery of anesthesia equipment 1
- Internal machinery of pulmonary-function testing machines between patients 1
- Internal machinery of ventilators 1
However, change mouthpieces and filters of spirometers and peak flow meters between patients 1
Special Considerations for ICU Equipment
Large-Volume Humidifiers
- Do not use large-volume room-air humidifiers that create aerosols unless they can be sterilized or subjected to high-level disinfection at least daily and filled only with sterile water 1
Nebulization Fluids
- Use only sterile fluid for nebulization and dispense aseptically 1
- Use single-dose vials whenever possible for aerosolized medications 1
Equipment Used During High-Risk Procedures
During procedures like intubation, bronchoscopy, and mechanical ventilation, ensure safe disposal or adequate sterilization of equipment used on infected or potentially infected patients 1
Critical Processing Principles
Cleaning Before Disinfection/Sterilization
Cleaning must always precede high-level disinfection and sterilization - this is the most critical step to reduce bioburden 2, 3
Classification System
The Spaulding classification guides processing decisions 1, 2:
- Critical items → Sterilization mandatory
- Semicritical items → High-level disinfection or sterilization
- Noncritical items (blood pressure cuffs, stethoscopes) → Low-level disinfection with detergent or EPA-approved germicide 1
Common Pitfalls to Avoid
- Never skip the cleaning step - organic material prevents effective sterilization/disinfection 2, 3
- Do not base processing decisions on patient diagnosis - use the same standards regardless of whether the patient has a known infection 1
- Avoid residual disinfectant contamination on instruments, particularly for ophthalmic equipment, as this can cause iatrogenic tissue damage 4
- Do not reuse single-dose medication vials or allow contact between multi-dose containers and the patient 4
- Follow manufacturer's instructions for reprocessing times, temperatures, and chemical concentrations 1