Flowcharts guide staff in high-level disinfection

Ensure patient safety after instrument reuse

A single misstep in protocols for high-level disinfection of equipment used in physician offices may translate to transmission of infection to a patient.

To help staff avoid lapses when processing equipment that needs high-level disinfection, Judie Bringhurst, RN, BSN, CIC, an infection control practitioner at Duke University Medical Center in Durham, NC, has developed two interrelated flowcharts.

"We have these enlarged and laminated for our clinics," says Bringhurst, who provides infection control oversight for Duke's affiliated clinics and medical offices. "This is something you can put on your door, right in front of you as you are actually doing the process to remind you of each step. So if you follow all of this and look at it for each step, you are going to be fine."

The first flowchart outlines seven steps to follow to ensure proper high disinfection using glutaraldehyde or orthophthaldehyde (OPA). (See "Steps for High-Level Disinfection of Equipment Using Glutaraldehyde or OPA,".) It includes a critical step that calls for cleaning equipment of all soil and debris using an enzymatic detergent, paying special attention to instruments with lumens or hard-to-reach places. Because reported outbreaks of water bugs such as Pseudomonas aeruginosa have been linked to improper rinsing of disinfected equipment with tap water, Bringhurst's policy specifies that rinsed scopes must be subsequently subjected to an alcohol rinse.1 The policy states that "if disinfecting a scope, water rinse must be followed by an alcohol rinse and [the] scope must then be thoroughly dried, using medical-grade forced air through all lumens."

Test strips effective QC measure

Another key aspect of high-level disinfection is the use of effective test strips to insure the efficacy of the chemical solution. This quality control measure is referred to in Step 2 of the flowchart, but warrants a separate flowchart to ensure staff understand the measures to follow. (See chart "Quality Control for OPA and Glutaraldehyde Test Strips,".) "This Step 2 is covered in a whole flow chart by itself because there is a lot of confusion about that," Bringhurst says. "All of the companies that make test strips say you should test them when you open a new bottle. We test them when you open a new bottle and every week [thereafter]."


  1. Centers for Disease Control and Prevention. Pseudomonas aeruginosa Infections Associated with Transrectal Ultrasound-Guided Prostate Biopsies — Georgia, 2005. MMWR 2006; 55(28):776-777.