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CCMA - Clinical Patient Care - Section 3.7

Distinguish between levels of disinfection and sterilisation and select the appropriate method for instruments and surfaces.

Use the Spaulding classification to distinguish critical, semi-critical, and non-critical instruments, and match each category to the correct level of sterilisation or disinfection. Describe autoclave operating principles and the quality checks that confirm a sterilisation cycle was effective.

SterilisationDisinfectionAutoclaveSpaulding classification

Practice question for this objective

Free sampleClinical Patient Caremedium

A medical assistant is reprocessing equipment after a clinic session. A flexible nasopharyngoscope used to inspect intact mucous membranes needs to be made safe for the next patient. According to the Spaulding classification, what is the BEST reprocessing method for this device?

  • AClean the scope with enzymatic detergent, then immerse it in a high-level disinfectant such as ortho-phthalaldehyde for the manufacturer-stated contact time. Correct
  • BWipe the insertion tube with a quaternary ammonium low-level disinfectant for one minute, then store in the cabinet for the next case.
  • CPlace the scope unwrapped into a gravity-displacement autoclave at 121 degrees C and 15 psi for 30 minutes to achieve sterilisation.
  • DRinse the scope under warm tap water, then wipe externally with 70 percent isopropyl alcohol before returning it to the tray.
Apply the Spaulding classification to select high-level disinfection for semi-critical instruments that contact intact mucous membranes. The Spaulding classification ties the reprocessing level to the tissue contacted. Devices touching intact mucous membranes are semi-critical and require thorough cleaning followed by high-level disinfection using agents such as ortho-phthalaldehyde or glutaraldehyde for the labelled contact time. This inactivates all microorganisms except large numbers of bacterial spores, which is appropriate because intact mucosa resists residual spore contamination.

Why A is correct: A nasopharyngoscope contacts intact mucous membranes, which places it in the semi-critical category. Cleaning followed by high-level disinfection with an agent such as OPA inactivates vegetative bacteria, mycobacteria, fungi, and most viruses, which is the level required by Spaulding for this contact.

Why B is wrong: Low-level disinfection with a quat is acceptable for non-critical items such as blood pressure cuffs, but it is tempting here because the scope only touched mucosa. It will not inactivate mycobacteria or non-enveloped viruses that semi-critical items can carry.

Why C is wrong: Steam sterilisation is correct for critical heat-stable items, and the cycle parameters quoted are accurate for a standard autoclave load. Flexible endoscopes contain heat-sensitive optics and adhesives that would be destroyed by saturated steam, so this method is inappropriate for this device.

Why D is wrong: Alcohol is a useful intermediate-level disinfectant for some surfaces, which makes this look reasonable for a quick turnaround. It does not penetrate the internal channels, evaporates before achieving the contact time needed for high-level disinfection, and skips the critical cleaning step.

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