STERIS Limited, Basingstoke, UK.
J Hosp Infect. 2011 Jul;78(3):163-70. doi: 10.1016/j.jhin.2011.05.002.
The Spaulding classification, originally proposed in 1957, is a widely used system for matching the disinfection and sterilization of surfaces, particularly those of re-usable medical/surgical devices, with available processes. It presents a ranking, from simple disinfection through to sterilization, that should be considered in the reprocessing of devices, based on the risks associated with their use, ranging from 'critical' (presenting a high risk), through 'semi-critical' to 'non-critical' (presenting a low risk). The different levels of disinfection are based on demonstrating antimicrobial activity against established marker micro-organisms representing a range of pathogens. Although this classification system is probably as valid today as it was in 1957, the understanding of microbiology and micro-organisms has changed. This article discusses some examples of disinfection studies with viruses, bacteria, protozoa and prions that challenge the current definitions and expectations of high-, intermediate- and low-level disinfection. In many of these examples, the test micro-organisms demonstrate atypical tolerance or resistance profiles to disinfection processes. In addition to laboratory-based studies, there is now clinical evidence for at least some of these micro-organisms that biocide resistance can lead to infection outbreaks due to unexpected disinfection failure. These reports should encourage the reader to challenge current dogma, and reconsider the expectations of disinfection and sterilization practices.
斯鲍丁分类法最初于 1957 年提出，是一种广泛用于匹配表面消毒和灭菌的系统，特别是那些可重复使用的医疗/手术设备的表面，与可用的过程相匹配。它根据与设备使用相关的风险，从“关键”（高风险）到“半关键”到“非关键”（低风险），提出了一个从简单消毒到灭菌的排序。不同的消毒水平是基于对代表一系列病原体的既定标记微生物表现出的抗菌活性来证明的。尽管这种分类系统在今天可能与 1957 年一样有效，但对微生物学和微生物的理解已经发生了变化。本文讨论了一些与病毒、细菌、原生动物和朊病毒有关的消毒研究的例子，这些研究挑战了当前对高水平、中水平和低水平消毒的定义和预期。在这些例子中，测试微生物对消毒过程表现出异常的耐受性或耐药性。除了实验室研究外，现在至少有一些临床证据表明，杀菌剂耐药性会导致感染爆发，这是由于意外的消毒失败。这些报告应该鼓励读者挑战当前的教条，重新考虑消毒和灭菌实践的期望。
