Key Takeaways
- Cleaning removes dirt; disinfection kills germs; sterilization kills ALL microorganisms
- Always clean before disinfecting - dirt blocks disinfectants from working
- Use bleach-based products for C. diff rooms - other disinfectants don't kill the spores
- High-touch surfaces (bed rails, call lights, doorknobs) need frequent disinfection
- Contact time matters - disinfectant must remain wet for the required time to work
Last updated: January 2026
Cleaning, Disinfection, and Sterilization
Proper cleaning and disinfection of patient care equipment and the environment is essential for preventing the spread of infection. CNAs play a key role in maintaining a clean and safe healthcare environment.
Definitions: Know the Difference
| Term | Definition | Level of Killing |
|---|---|---|
| Cleaning | Removing visible dirt and debris | Reduces germs, doesn't kill all |
| Disinfection | Killing most germs on surfaces | Kills most pathogens |
| Sterilization | Killing ALL microorganisms | Eliminates 100% of germs |
When Each Level is Required
| Level | Used For | Examples |
|---|---|---|
| Cleaning | Non-critical items, general environment | Bed frames, floors, furniture |
| Low-level disinfection | Surfaces that touch intact skin | Stethoscopes, BP cuffs |
| High-level disinfection | Semi-critical items | Respiratory equipment |
| Sterilization | Critical items entering sterile body areas | Surgical instruments (not CNA scope) |
Classification of Patient Care Items
| Category | Contact Type | Process Required | Examples |
|---|---|---|---|
| Critical | Enters sterile tissue or blood | Sterilization | Surgical instruments, needles |
| Semi-critical | Contacts mucous membranes | High-level disinfection | Respiratory equipment, scopes |
| Non-critical | Contacts intact skin only | Low-level disinfection | BP cuffs, stethoscopes, bed rails |
Cleaning Principles
Basic cleaning rules:
- Clean before disinfecting (dirt blocks disinfectant)
- Clean from cleanest to dirtiest areas
- Clean from top to bottom
- Clean from back to front
- Use appropriate cleaning solutions
- Follow manufacturer's directions
Common Disinfectants in Healthcare
| Disinfectant | Effective Against | Common Uses |
|---|---|---|
| Quaternary ammonium | Many bacteria | General surface disinfection |
| Chlorine (bleach) | Most pathogens including C. diff | C. diff rooms, blood spills |
| Hydrogen peroxide | Broad spectrum | Environmental surfaces |
| Alcohol (70%) | Many bacteria/viruses | Equipment, small surfaces |
| Phenolics | Broad spectrum | Floors, surfaces |
C. diff reminder: Use bleach-based products - many disinfectants don't kill C. diff spores!
Environmental Cleaning
Daily cleaning responsibilities may include:
| Area | Cleaning Focus |
|---|---|
| Bed rails | High-touch surface - disinfect frequently |
| Overbed tables | Wipe before and after meals |
| Call lights | High-touch - clean multiple times daily |
| Doorknobs | High-touch surfaces |
| Light switches | Often overlooked high-touch area |
| Bathroom surfaces | Clean after each use if possible |
| Patient equipment | Clean between patients |
High-Touch Surfaces
Surfaces touched frequently need more attention:
- Bed rails
- Call lights
- Telephone
- Remote controls
- Light switches
- Door handles
- Chair arms
- IV poles (handles)
- Toilet flush handles
- Faucet handles
Terminal Cleaning
Terminal cleaning occurs when a patient is discharged or transferred:
| Step | Action |
|---|---|
| 1 | Remove all trash and linens |
| 2 | Clean all surfaces (top to bottom) |
| 3 | Disinfect all surfaces |
| 4 | Clean and disinfect bathroom |
| 5 | Make bed with clean linens |
| 6 | Replace supplies |
| 7 | Allow room to air out if needed |
Equipment Cleaning
Between patients:
- Clean and disinfect all reusable equipment
- Check manufacturer's instructions
- Allow proper contact time for disinfectant
- Never skip this step
CNA-cleaned equipment often includes:
- Blood pressure cuffs
- Stethoscopes
- Thermometers
- Wheelchairs
- Shower chairs
- Bedpans and urinals
Safe Handling of Cleaning Products
| Safety Measure | Reason |
|---|---|
| Read labels | Know proper use and hazards |
| Wear gloves | Protect skin |
| Don't mix products | Chemical reactions can be dangerous |
| Adequate ventilation | Avoid fume inhalation |
| Store properly | Away from patient care areas |
| Report skin irritation | May need different product |
Contact Time
Contact time (dwell time) is how long a disinfectant must remain wet on a surface to be effective:
- Read product label for required time
- Surface must stay wet for full contact time
- May need to reapply if dries too quickly
- Wiping too soon reduces effectiveness
Test Your Knowledge
What is the difference between cleaning and disinfection?
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Test Your Knowledge
Which disinfectant should be used for a room where a patient with C. diff was staying?
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Test Your Knowledge
What is "contact time" in disinfection?
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D