Tables and Figure
Table 5. Summary of advantages and disadvantages of chemical agents used as chemical sterilants1 or as high-level disinfectants
| Sterilization Method |
Advantages |
Disadvantages |
| Peracetic Acid/Hydrogen Peroxide |
- No activation required
- Odor or irritation not significant
|
- Materials compatibility concerns (lead, brass, copper, zinc) both cosmetic and functional
- Limited clinical experience
- Potential for eye and skin damage
|
| Glutaraldehyde |
- Numerous use studies published
- Relatively inexpensive
- Excellent materials compatibility
|
- Respiratory irritation from glutaraldehyde vapor
- Pungent and irritating odor
- Relatively slow mycobactericidal activity
- Coagulates blood and fixes tissue to surfaces
- Allergic contact dermatitis
- Glutaraldehyde vapor monitoring recommended
|
| Hydrogen Peroxide |
- No activation required
- May enhance removal of organic matter and organisms
- No disposal issues
- No odor or irritation issues
- Does not coagulate blood or fix tissues to surfaces
- Inactivates Cryptosporidium
- Use studies published
|
- Material compatibility concerns (brass, zinc, copper, and nickel/silver plating) both cosmetic and functional
- Serious eye damage with contact
|
| Ortho-phthalaldehyde |
- Fast acting high-level disinfectant
- No activation required
- Odor not significant
- Excellent materials compatibility claimed
- Does not coagulate blood or fix tissues to surfaces claimed
|
- Stains skin, mucous membranes, clothing, and environmental surfaces
- Repeated exposure may result in hypersensitivity in some patients with bladder cancer
- More expensive than glutaraldehyde
- Eye irritation with contact
- Slow sporicidal activity
|
| Peracetic Acid |
- Rapid sterilization cycle time (30-45 minutes)
- Low temperature (50-55°C) liquid immersion sterilization
- Environmental friendly by-products (acetic acid, O2, H20)
- Fully automated
- Single-use system eliminates need for concentration testing
- Standardized cycle
- May enhance removal of organic material and endotoxin
- No adverse health effects to operators under normal operating conditions
- Compatible with many materials and instruments
- Does not coagulate blood or fix tissues to surfaces
- Sterilant flows through scope facilitating salt, protein, and microbe removal
- Rapidly sporicidal
- Provides procedure standardization (constant dilution, perfusion of channel, temperatures, exposure)
|
- Potential material incompatibility (e.g., aluminum anodized coating becomes dull)
- Used for immersible instruments only
- Biological indicator may not be suitable for routine monitoring
- One scope or a small number of instruments can be processed in a cycle
- More expensive (endoscope repairs, operating costs, purchase costs) than high-level disinfection
- Serious eye and skin damage (concentrated solution) with contact
- Point-of-use system, no sterile storage
|
Modified from Rutala.69
1 All products effective in presence of organic soil, relatively easy to use, and have a broad spectrum of antimicrobial activity (bacteria, fungi, viruses, bacterial spores, and mycobacteria). The above characteristics are documented in the literature; contact the manufacturer of the instrument and sterilant for additional information. All products listed above are FDA-cleared as chemical sterilants except OPA, which is an FDA-cleared high-level disinfectant.
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