Sterilisation – categories of instruments

Sterilisation – categories of instruments

Preventing infection risks relies on a strict asepsis protocol, in which the sterilization of medical devices plays a central role. To optimize reprocessing procedures, it is essential to classify instruments based on their level of criticality. This classification, determined by the infection risk associated with each instrument’s use, defines the required level of treatment—particularly whether sterilization is necessary after every use.

classification of medical devices according to spaulding

The most commonly used system is the one introduced by Earle H. Spaulding in 1968, still recognized today by numerous health authorities including the CDC (Centers for Disease Control and Prevention).

This system distinguishes three categories:

1. Critical devices

Definition: instruments that penetrate sterile tissue or the vascular system

Examples: surgical burs, bone forceps, periosteal elevators, implant drills, implant holders

Required treatment: mandatory sterilization, preferably steam sterilization in an autoclave, following ISO 17665 and EN 13060 standards

2. Semi-critical devices

Definition: instruments that contact mucous membranes or non-intact skin without penetrating sterile tissue

Examples: intraoral mirrors, periodontal probes, retractors

Required treatment: high-level disinfection, though sterilization is strongly recommended in dental settings for enhanced safety

3. Non-critical devices

Definition: devices that contact only intact skin

Examples: dental chair, blood pressure monitor, stethoscope

Required treatment: low- to intermediate-level disinfection, depending on the assessed risk

practical implications in the dental office

In high-risk environments like dental practices, many instruments are classified as critical or semi-critical. Therefore, it is imperative to:

Clearly identify each instrument’s level of criticality

Adjust cleaning, disinfection, and sterilization protocols accordingly

Follow guidelines from authorities such as HAS, CDC, and ADF regarding cycle durations, temperatures, and sterilization conditions

Document every step in the sterilization chain (traceability, cycle validation, equipment maintenance)

Clear labeling and early sorting of instruments during pre-cleaning significantly streamline protocol compliance.

summary chart: instrument criticality and recommended treatment

Criticality

Type of contact

Examples

Recommended treatment

Critical

Sterile tissue / vascular system

Drills, forceps, implant holders

Mandatory sterilization

Semi-critical

Mucous membranes / non-intact skin

Probes, mirrors, retractors

Sterilization recommended

Non-critical

Intact skin

Chair, blood pressure cuff

Intermediate disinfection

Sur le sujet

Sterilisation paper blue