Good Practice: Reusable Medical Device Reprocessing

Physiotherapists use many different types of medical devices in their practice. Everything from goniometers and reflex hammers to IFC sponges and wound debridement tools are all considered medical devices. Many of these devices are reusable only if properly cleaned and disinfected. This article will highlight device reprocessing using several scenarios so that you can understand your responsibilities when it comes to the Infection Control Standard of Practice.

This Standard of Practice has three main expectations regarding device reprocessing:

• Follows manufacturer’s specifications, relevant legislation, and Alberta Health standards and policies for the use, cleaning, disinfection, and reprocessing of equipment and devices.
• Documents details of reprocessing and sterilization of reusable critical and semi-critical medical equipment including parameters used. Retains this documentation for five (5) years.
• Disposes of devices and materials according to best practice recommendations and established protocols.

How can you implement these expectations into your physiotherapy practice?

There are a range of measures that can be applied to device reprocessing, once you understand how to categorize reusable medical devices.

Engineered Measures involve changing the physical environment to eliminate reservoirs of infectious agents, reducing the source of the hazard, or limiting the risk of exposure to the hazard.

Administrative Measures are policies, procedures, and training used to disrupt the transmission of infectious agents. Often these measures are set in place by leadership within the organization, but physiotherapists should be able to bring any identified concerns forward.

Elimination Measures remove or lower the risk of having an infectious agent enter the workplace or be transmitted.

Personal Measures consist of actions that individual physiotherapists, acting independently, can take to reduce the risk of infection.

** include infographic page 5 of IPC guide highlighting the 4 measures

Spaulding Classification

The Spaulding Classification of Medical Devices is a system you can use when making decisions on how to clean and disinfect or sterilize reusable medical equipment. The Spaulding Classification separates equipment into three categories: non-critical, semi-critical, and critical. Each category will be addressed with a scenario to help you understand what this might look like in practice.

Non-Critical: The device is in direct contact with intact skin

Gavin works at a busy outpatient clinic where he is a sole-charge physiotherapist. Each day he sees multiple clients in his treatment space. The organization he works for has implemented many administrative measures such as cleaning and disinfection policies to reduce the risks of infection to the clients that he treats. There are many non-critical items in his space like gym equipment, treatment tables, and assessment tools that need to be cleaned and then disinfected between each patient/use.

Cleaning and disinfection of non-critical reusable devices and equipment should go through a “wipe twice” approach – first cleaning and subsequently disinfecting surfaces.^1,2

Virucidal disinfectants or diluted bleach solution must be used to complete the disinfection step of cleaning and disinfecting these surfaces.^3,4

1. If using bleach, physiotherapists must follow label directions for proper dilution ratios.
2. Virucidal disinfectants must have a DIN number. Physiotherapists must check the Health Canada database to confirm that the virucide in use is effective against infectious agents such as COVID-19 and other microorganisms commonly found in health-care settings.5

Cleaning and disinfecting products must be used according to manufacturer’s directions for application and contact time. Contact time is an important part of disinfection and must be followed to achieve the desired results of disinfection.

Cleaning products that do not have a DIN or are not bleach (e.g., vinegar, tea tree oil) must not be used in clinical practice as they are not proven effective and are not approved for use.

Semi-Critical: The device is in direct contact with mucus membranes or non-intact skin

Jadah is a physiotherapist whose main focus of practice is pelvic health. As part of her practice she does pessary fittings. Her clinic realized early on that there was a discrepancy between the manufacturer’s requirements and the Spaulding classification requirements to properly clean and disinfect the pessary fitting rings prior to reusing them.

In cases where there is a discrepancy between the Spaulding Classification of the device and manufacturer’s directions for reprocessing, physiotherapists are directed to use the higher level of disinfection/sterilization. In this case, Jadah must use the higher level of reprocessing required by the manufacturer. After weighing several options, she decided to outsource her semi-critical device reprocessing as she was unable to reprocess the equipment properly in her practice setting.

In this scenario, personal measures would be the use of appropriate PPE during client care. The decision to hire a third party to perform disinfection/sterilization would be both an engineered and administrative measure to reduce the risk of infection.

Critical: The device is entering sterile tissues such as vascular tissue

Lee works at a chronic wound clinic where she often has to do debridement of open wounds. Due to the nature of her work, there are many administrative and engineered methods to ensure that her clients do not get an infection while in her care.

Anytime she has to provide treatment which requires the use of critical devices there are strict procedures she must follow in the set-up and performance of her treatments to decrease the risk of infection. Any tools she uses during her care are sent to a facility within the hospital for cleaning and sterilization according to manufacturer specifications. The chronic wound clinic has developed both engineered and administrative measures to address the infection risks of this practice.

Although it is becoming more common for these devices to be classified as single use/disposable, it is important to be aware that physiotherapists are still using critical equipment within their practice. Using single use/disposable items in care is an example of an elimination measure as the risk of infection is mitigated if the device is safely disposed of.

It is important to note that items that are intended for single use/disposable must not be reused regardless of whether they were sterilized/disinfected.

Physiotherapists are expected to confirm that the practice settings they work in have the appropriate measures in place to:

• Clean and disinfect all non-critical reusable equipment between patients, according to manufacturer’s directions.
• Allocate sufficient time, staff resources, and supplies to enable cleaning and disinfection, including PPE for use during cleaning and disinfection according to product requirements.
• Establish clear responsibilities and accountabilities for staff involved in cleaning and disinfection activities.
• Provide appropriate training for cleaning and disinfection.
• Reinforce and recognize the importance of this work.

Sean FitzGerald, PT, Practice Advisor

Page updated: 12/11/2025