Practical Guide – Cleaning and Disinfection in Healthcare Services
How to correctly select, use, and apply detergents, disinfectants, antiseptics, and other sanitizers to ensure safety, compliance, and equipment preservation.
Why was this Guide developed?
Cleaning and disinfection are part of the routine of almost all healthcare services. Dental offices, medical clinics, hospitals, laboratories, aesthetic centers, podiatry, and veterinary medicine rely on these processes to reduce the risk of cross-contamination, protect professionals and patients, and preserve the quality of care provided.
- Comprehensive reading: ideal for students, professionals starting their careers, and managers.
- Quick reference: use as a reference manual with tables, flowcharts, and decision matrices.
Chapter 1 – Fundamentals of Cleaning and Disinfection
The effectiveness of disinfection directly depends on the quality of the cleaning performed beforehand. Blood, saliva, secretions, proteins, fats, and biofilms can form a physical barrier that prevents contact between the sanitizing agent and microorganisms.
| Process | Main objective | Eliminates all microorganisms? | Replaces another process? |
|---|---|---|---|
| Cleaning | Remove dirt, debris, and organic matter. | No. | No. It is the initial step. |
| Disinfection | Reduce or eliminate pathogenic microorganisms. | Not necessarily. | Does not replace cleaning. |
| Antisepsis | Reduce microbial load on living tissues. | No. | Does not replace cleaning or disinfection. |
| Sterilization | Eliminate all forms of microbial life, including spores. | Yes. | Does not replace cleaning. |
| Error | Possible consequence |
|---|---|
| Applying disinfectant over organic matter | Reduction of microbiological efficacy. |
| Not performing cleaning before sterilization | Sterilization process failure. |
| Using only detergent when disinfection is needed | Persistence of pathogenic microorganisms. |
| Not respecting the contact time | Incomplete disinfection. |
Technical Basis: RDC ANVISA nº 15/2012 • NR-32 • Spaulding Classification.
Chapter 2 – The Tools of Cleaning and Disinfection
No sanitizing agent is universal. Each category was developed to perform a specific function.
| Category | Purpose | Where to use | Does not replace | Examples |
|---|---|---|---|---|
| Neutral detergent | Remove light soils | Surfaces and floors | Disinfection | Daily cleaning |
| Enzymatic detergent | Remove organic matter | Instruments | Disinfection/Sterilization | Blood, proteins |
| Disinfectants | Reduce/eliminate microorganisms | Surfaces and items | Cleaning | 70% Alcohol, Quaternary, Hypochlorite |
| Antiseptics | Reduce microorganisms on living tissues | Skin and mucous membranes | Disinfection | Chlorhexidine, PVPI |
| Soaps | Hand and skin hygiene | Skin | Antisepsis when indicated | Liquid soap, surgical scrub |
Chapter 3 – How to Choose the Ideal Sanitizing Agent
| Question | Why is it important? | Impact on choice |
|---|---|---|
| Is the goal to clean or disinfect? | Cleaning and disinfection have different purposes. | Defines the product category. |
| Is there organic matter? | Can reduce the efficacy of the sanitizing agent. | May require prior cleaning. |
| Which microorganism do you want to control? | Not all products have the same spectrum. | Defines the most suitable active ingredient. |
| What is the surface material? | Some sanitizing agents can damage materials. | Prevents degradation of assets. |
| Is the product regulated? | Ensures safety and compliance. | Reduces risks of improper use. |
Chapter 4 – Correct Selection of Sanitizing Agent Category
What do I need to do? The answer to this question naturally leads to the most appropriate category of sanitizing agent.
| Need identified | Normally indicated category | Objective |
|---|---|---|
| Remove dust and light dirt | Neutral detergent | Cleaning |
| Remove blood, proteins, and organic matter | Enzymatic detergent | Specialized cleaning |
| Reduce or eliminate microorganisms on surfaces | Disinfectant | Disinfection |
| Skin preparation for procedures | Antiseptic | Antisepsis |
| Routine hand hygiene | Common or antiseptic soap | Hand hygiene |
Most commonly used active ingredients on main equipment and surfaces in healthcare services
| Equipment or Surface | Predominant material | Most commonly used active ingredient* | Use with caution | Avoid | Practical observation |
|---|---|---|---|---|---|
| Dental chair | Vinyl (faux leather) | Quaternary Ammonium | 70% Alcohol for continuous use | Organic solvents | Helps preserve the synthetic upholstery. |
| Dental stool | Vinyl | Quaternary Ammonium | Frequent 70% Alcohol | Organic solvents | Prevents premature drying. |
| Hospital stretcher | Metal structure + vinyl-covered mattress | Quaternary Ammonium | Repeated 70% Alcohol on the mattress | Organic solvents | The structure and mattress may require different care. |
| Hospital bed | Electrostatic paint + metal rails | 70% Alcohol or Quaternary Ammonium | Sodium Hypochlorite for continuous use | Aggressive solvents | Check compatibility with the paint. |
| Waterproof hospital mattress | Vinyl / PVC | Quaternary Ammonium | 70% Alcohol used continuously | Organic solvents | Contributes to extending the lifespan of the covering. |
| Surgical table | Stainless steel + paint | 70% Alcohol | Frequent Hypochlorite | Corrosive products | Confirm the manufacturer's IFU. |
| Emergency cart | Electrostatic paint | Quaternary Ammonium | Sodium Hypochlorite | Aggressive solvents | Preserves finish and visual identification. |
| Infusion pump | Technical plastic | Quaternary Ammonium | 70% Alcohol for continuous use | Aggressive solvents | Always follow manufacturer's instructions. |
| Multiparameter monitor | Polycarbonate and technical plastics | Quaternary Ammonium | Frequent 70% Alcohol | Organic solvents | Prevents micro-cracks and opacification. |
| Pulmonary ventilator | Technical plastics and paint | Quaternary Ammonium | Excessive 70% Alcohol | Aggressive solvents | Cleaning must respect the equipment's IFU. |
| Stainless steel countertop | Stainless steel | 70% Alcohol | Sodium Hypochlorite for continuous use | Highly corrosive products | Widely used in CS, laboratories, and surgical centers. |
| Granite countertop | Granite | Quaternary Ammonium | Sodium Hypochlorite | Acidic products | Preserves the stone's sealing. |
| Marble countertop | Marble | Quaternary Ammonium | Sodium Hypochlorite | Acidic products | Helps preserve shine and finish. |
| Porcelain tile floors | Porcelain tile | Sodium Hypochlorite or Quaternary Ammonium** | Products incompatible with grout | Abrasive products | Choice depends on the cleaning purpose. |
| Washable walls | Ceramic or washable paint | Sodium Hypochlorite or Quaternary Ammonium | Abrasive products | Aggressive solvents | Assess the surface finish. |
| Glass doors and partitions | Glass | 70% Alcohol | Abrasive products | Aggressive solvents | Maintains transparency and finish. |
| Acrylic barrier | Acrylic | Quaternary Ammonium | Frequent 70% Alcohol | Organic solvents | Preserves transparency. |
| Face shield | Polycarbonate | Quaternary Ammonium | Repeatedly 70% Alcohol | Organic solvents | Reduces risk of micro-cracks. |
In practice: always consult the manufacturer's instructions before defining the sanitizing agent. Basis: RDC ANVISA nº 15/2012 • IFU of equipment and sanitizing agent manufacturers • Good practices for infection control in healthcare services.
Important observations
* The active ingredients presented represent the most commonly used in healthcare service routines for each equipment or surface. The definitive recommendation must always consider the Instructions for Use (IFU) of the equipment and sanitizing agent manufacturer.
** On floors and walls, the choice between Sodium Hypochlorite and Quaternary Ammonium depends on the purpose of the procedure (routine cleaning, disinfection, or decontamination), surface compatibility, and institutional protocols.
Chapter 5 – Best Practices in the Use of Sanitizing Agents
| Factor | Why is it important? | Best practice |
|---|---|---|
| Dilution | Changes in concentration can reduce efficacy. | Prepare according to manufacturer's instructions. |
| Contact time | The sanitizing agent needs time to act. | Respect the recommended minimum time. |
| Storage | Inadequate conditions can degrade the product. | Store according to manufacturer's instructions. |
| Compatibility | Prevents damage to surfaces and equipment. | Confirm before application. |
| Prior cleaning | Organic matter can reduce the action of the sanitizing agent. | Remove debris before disinfection. |
- Keep in original packaging.
- Store in a clean, dry place.
- Organize stock by expiration date.
- Separate incompatible products.
In practice: never reuse empty packaging. Higher concentrations do not always mean greater efficacy.
| Verification | Checked |
|---|---|
| Is the sanitizing agent category appropriate for the purpose? | ☐ |
| Is the product within its expiration date? | ☐ |
| Was the dilution prepared correctly? | ☐ |
| Is the surface compatible with the sanitizing agent category? | ☐ |
| Will the contact time be respected? | ☐ |
| Were the manufacturer's guidelines consulted? | ☐ |
Chapter 6 – Control, Monitoring, and Continuous Improvement
| Aspect | What to check | Objective |
|---|---|---|
| Products used | Appropriate category and expiration date | Ensure efficacy and compliance |
| Storage | Environmental conditions and organization | Preserve stability of sanitizing agents |
| Dilutions | Concentration and identification of solutions | Prevent preparation errors |
| Procedures | Compliance with established routines | Standardize processes |
| Team | Training and updating | Reduce operational failures |
In practice: trained teams use sanitizing agents more safely and consistently. Basis: RDC ANVISA nº 15/2012 • NR-32.
Chapter 7 – Putting Knowledge into Practice
| Step | Question | Action |
|---|---|---|
| 1 | What do I need to do? | Identify the purpose. |
| 2 | Is there organic matter? | Assess the need for prior cleaning. |
| 3 | Which sanitizing agent category meets this need? | Select the correct category. |
| 4 | Is the surface compatible? | Confirm before application. |
| 5 | Does the manufacturer recommend any specific conditions? | Consult the instructions for use. |
| 6 | Will the contact time be respected? | Ensure process efficacy. |
💡 Dental Access Best Practices
There isn't one "best" sanitizing agent for all situations. The correct choice begins with the purpose of the process, involves evaluating organic matter and surface compatibility, and ends with strict adherence to the manufacturer's guidelines.
Flowchart — How to select the sanitizing agent
|
🟢 Cleaning
↓
Light dirt
Neutral detergent Organic matter
Enzymatic detergent |
🟡 Disinfection
↓
Is the surface already clean?
YES
Select disinfectant NO
Clean first |
🔴 Antisepsis / Hygiene
↓
Application on living tissue?
YES
Antiseptic Hands
Soap |
The final choice must be individualized according to the technical assessment of the responsible professional.
Frequently Asked Questions (FAQ)
1. What is the difference between cleaning and disinfection?
Cleaning removes visible dirt and some microorganisms through mechanical action and appropriate detergents. Disinfection is performed after cleaning and aims to reduce or eliminate microorganisms present on the surface, using a suitable disinfectant.
2. Can I apply a disinfectant directly to blood or secretions?
This is not the recommended procedure. In the presence of organic matter, initial cleaning should be performed with the appropriate sanitizing agent, and only then should disinfection proceed, according to the protocol adopted by the institution.
3. Is every sanitizing agent suitable for all surfaces?
No. The choice should consider the type of surface, the chemical compatibility of the material, and the instructions from the equipment and sanitizing agent manufacturers.
4. Can I use 70% alcohol on any equipment?
No. Although widely used in healthcare settings, some materials may experience drying, opacification, or other damage when repeatedly exposed to alcohol. Always consult the manufacturer's Instructions for Use (IFU).
5. Can sodium hypochlorite be used on any surface?
No. Hypochlorite is an important disinfectant, but it can cause corrosion in metals, alter the finish of some materials, and damage certain coatings when used improperly.
6. What should be done when there is blood on a surface?
The general recommendation is to remove the organic matter using the indicated cleaning procedure and then perform disinfection according to the institutional protocol.
7. Does mixing sanitizing agents increase effectiveness?
No. Mixing sanitizing agents can reduce product effectiveness, cause chemical incompatibilities, and pose risks to professionals.
8. How do I know which sanitizing agent to use?
The decision should consider four main factors:
- purpose of application;
- presence of organic matter;
- type of surface;
- material compatibility.
9. Can the concentration of the sanitizing agent be altered?
No. Dilutions and concentrations must strictly follow the manufacturer's instructions. Higher concentrations do not necessarily mean greater effectiveness.
10. How to choose the most suitable active ingredient?
This Guide presents the most commonly used active ingredients for each application. To understand the differences between them, their advantages, limitations, compatibilities, and specific indications, consult the corresponding Comparison – Buying Guide.
11. Where can I find the regulations governing cleaning and disinfection in healthcare services?
Legal and regulatory aspects are covered in the content Technical Standards – Cleaning and Disinfection in Healthcare Services, which complements this Practical Guide.
12. Where can I learn the step-by-step procedures?
Demonstrative procedures will be available in the See How To Do It series, with short videos on preparation, application, and best practices related to sanitizing agents.
Conclusion
The correct use of sanitizing agents begins long before product application. It involves understanding the purpose of the process, selecting the appropriate category, assessing the presence of organic matter, checking compatibility with surfaces, and strictly following the manufacturer's instructions.
- RDC ANVISA nº 15/2012 – Good Practices for the Processing of Healthcare Products.
- NR-32 – Occupational Safety and Health in Healthcare Services.
- ANVISA Regulations applicable to sanitizing agents.
- Manufacturer's Instructions for Use (IFU).
