During rounds in an outpatient clinic, I noticed staff cleaning vaginal ultrasound probes between patients with a quaternary ammonium disinfectant wipe (a low-level disinfectant appropriate for use on devices that come in contact with intact skin). When I asked about the process, the staff explained that because the probe was covered with a probe cover, they assumed a disinfectant wipe was sufficient. While probe covers provide an important layer of protection, they can leak or develop microscopic perforations. Because contamination can still occur, these probes should always be treated as if they have contacted mucous membranes and require a high-level disinfectant (appropriate for use on devices that come in contact with mucous membranes or non-intact skin) instead of a low-level disinfectant.

Gaps in knowledge and execution.

This type of misunderstanding is not uncommon in health care and illustrates a broader challenge: cleaning failures are often not caused by lack of effort but by gaps in knowledge and execution. Despite longstanding guidance, inconsistencies in cleaning and disinfection practices continue to be cited during regulatory and accrediting surveys.

The Spaulding classification system.

One framework used to determine cleaning and disinfection requirements is the Spaulding classification system, which categorizes medical devices according to infection risk. Critical items enter sterile tissue or the vascular system and require sterilization. Semicritical items contact mucous membranes or nonintact skin and generally require high-level disinfection. Noncritical items contact intact skin and typically require cleaning and low- or intermediate-level disinfection.

Other key sources of guidance.

Understanding this classification helps nursing staff prioritize cleaning requirements and avoid assumptions about the level of disinfection required. Once the level of reprocessing is identified, manufacturer instructions for use (IFU) provide the specific steps for cleaning and disinfection, including compatible products and required contact times. Most health care facilities also have policies outlining approved cleaning and disinfection processes for reusable equipment and environmental surfaces. Accrediting agencies frequently ask staff if they know where to locate this information.

Appearances are deceptive.

When surfaces are free of visible dirt, it is easy to assume they are safe. However, a surface that appears clean may still harbor pathogens capable of spreading to patients. Some organisms, including multidrug-resistant organisms, can survive on surfaces for days or even months, contributing to healthcare–associated infections and outbreaks.

The nurse’s role and responsibility in cleaning and disinfection.

Nursing staff may also assume environmental services personnel are responsible for cleaning all surfaces and equipment in the patient environment. While environmental services teams play a critical role, not every surface or device falls under their responsibility. Frequently overlooked items include vital sign machines, glucometers, pulse oximeter probes, mobile workstations, keyboards, and other shared equipment touched multiple times throughout the day. Because nurses often have the most direct contact with patients and reusable equipment, they are uniquely positioned to apply the appropriate cleaning and disinfection processes.

Like the “5 Rights” of medication administration, there are also important principles that support effective cleaning and disinfection.

  • The right instructions matter. All disinfectants, cleaning tools, medical equipment, and surfaces have IFUs that should be followed carefully. Common gaps include staff not knowing where IFUs are located or misunderstanding product-specific requirements.
  • The right disinfectant matters. Not all disinfectants are interchangeable, and all disinfectants used in health care should be Environmental Protection Agency (EPA)–approved for health care use. Common gaps include using nonapproved products, failing to clean visibly soiled surfaces before disinfection, and assuming all wipes are equivalent.
  • The right cleaning tool matters. Some cleaning materials are incompatible with certain disinfectants and may reduce effectiveness. Common gaps include reusing contaminated cloths, using dried-out wipes, or substituting whatever tool is readily available.
  • The right surface matters. Different surfaces and equipment require different approaches. Some equipment may be damaged by incompatible disinfectants, while single-use items should never be reprocessed.
  • The right contact time matters. Disinfectants must remain visibly wet on the surface for the full contact time to work properly. Common gaps include wiping surfaces dry too soon or failing to follow the required dwell time.

Health care environments may never be sterile, but they can be safer. Effective cleaning and disinfection are not about doing more; they are about doing the process correctly and consistently. Small gaps in practice can lead to significant consequences, but small improvements can meaningfully impact patient safety.

Missy Travis, RN, MSN, CIC, FAPIC, is the founder of IP&C Consulting, LLC, a consulting business that supports infection preventionists, health care organizations, business owners, and professional sports teams in developing and sustaining effective infection prevention programs. Her last post was “What’s in the Air? Rethinking Airflow and Infection Risk in Health Care.”