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The Guideline for Manual High-Level Disinfection was approved by the AORN Guidelines Advisory Board and became effective as of October 19, 2023. Information about the systematic review supporting this guideline, including the PROSPERO registration number, systematic review questions, description of the search strategy and evidence review, PRISMA 2020 flow diagram, evidence rating model, and evidence summary table is available at


This document provides guidance for performing safe and effective manual high-level disinfection (HLD) of reusable semicritical items and preventing patient and health care worker injury associated with the handling and use of liquid chemical high-level disinfectants.

High-level disinfection is a process that deactivates microorganisms with the exception of bacterial spores and prions.1  Failure to correctly perform HLD can lead to transmission of pathogens via contaminated medical or surgical devices.2  The vast majority of patient infections and exposures related to processing medical or surgical devices have involved HLD of reusable semicritical items.2 

High-level disinfectants are harmful to human tissue and the environment.3  Health hazards associated with the use of high-level disinfectants vary from minor irritation of mucous membranes to more serious injury (eg, chemical burns).1  Health care organizations are responsible for informing health care workers about chemical hazards in the workplace and for implementing measures to reduce personnel exposure and mitigate identified hazards.4  Implementing safe processes for handling and using chemical high-level disinfectants is essential for preventing injury to both patients and personnel.3 

The following topics are outside the scope of this document:

  • processing critical items for sterilization,

  • processing semicritical items using thermal HLD (ie, pasteurization),

  • processing items using automated processes for HLD or liquid chemical sterilization (See the AORN Guideline for Processing Flexible Endoscopes5 ),

  • processing endocavity ultrasound probes and other semicritical items using nebulized hydrogen peroxide mist,

  • using foam or gel high-level disinfectants (eg, chlorine dioxide),

  • processing semicritical items potentially contaminated with prions,

  • processing noncritical items for intermediate- or low-level disinfection,

  • assessing risk and notifying patients regarding HLD failures, and

  • using specific high-level disinfectants.

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