Sterilization or Disinfection of Patient-Care Equipment
The following general principles apply to most questions CDC receives about sterilization or disinfection of patient-care equipment in relation to HIV. However, this information is not comprehensive. Therefore, it is advisable to obtain a copy of the reference material listed at the end of this document.
- Standard chemical germicides at concentrations much lower than commonly used in practice can rapidly inactivate HIV.
- Chemical germicides that are registered as "sterilants" with the U.S. Environmental Protection Agency (EPA) and cleared for marketing for use on medical devices by the Food and Drug Administration (FDA) may be used either for sterilization or high-level disinfection of medical devices, depending on contact time.
- In general, reusable instruments or devices that enter sterile tissue, including the vascular system of any patient, and devices through which blood flows should be sterilized before reuse. Reusable devices or items that contact intact mucous membranes should be sterilized or receive high-level disinfection before reuse.
- Medical devices that require sterilization or disinfection should be thoroughly cleaned to reduce material/bioburden before being exposed to the germicide, and the germicide and device manufacturers' instructions should be closely followed.
- Extraordinary attempts to disinfect walls, floors, or other environmental surfaces are not necessary. However, cleaning and removal of soil should be done routinely. An inexpensive environmental surface germicide effective against HIV is a solution of sodium hypochlorite (1 part household bleach to 99 parts water or 1/4 cup bleach to 1 gallon of water) prepared daily. Bleach, however, is corrosive to metals (especially aluminum) and should not be used to decontaminate medical instruments with metallic parts.
Chemical germicides that are EPA-approved for use as "hospital disinfectants" and that are tuberculocidal/virucidal when used at recommended dilutions and contact times can be used to decontaminate spills of blood or other body fluids that contain blood in the following areas:
- In patient-care areas, visibly soiled areas should first be cleaned and then chemically decontaminated. For disinfection, the precleaned areas should be moistened with the appropriate germicide and allowed to air dry.
- In the laboratory, large spills of cultured or concentrated infectious agents should be flooded with a liquid germicide before cleaning, then decontaminated with fresh germicidal chemical after organic material has been removed. It is not necessary to flood spills of blood or other body fluids with germicide before cleaning.
Gloves should always be worn during cleaning and decontaminating procedures.
If you have questions about a particular germicidal product, contact your local or state health department, or the Antimicrobial Program Branch, Registration Division, EPA. The EPA regulates the use of chemical germicides.
If you have questions about cleaning, disinfecting, or sterilizing a particular medical device, first contact the manufacturer of the device. If sufficient information cannot be obtained in this manner, contact the FDA regional office or the FDA Center for Devices and Radiological Health, Division of Compliance Program, telephone 301-443-4690. The FDA regulates the use of medical devices and of liquid chemical germicides used to disinfect or sterilize medical devices.
Favero MS, Bond WW. Sterilization, disinfection, and antisepsis in the hospital. In: Manual of Clinical Microbiology, 1991; chapter 24:183-200. American Society for Microbiology. Washington, DC.
Rutala WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313-342.