| Steam |
- Nontoxic to patient, staff, environment
- Cycle easy to control and monitor
- Rapidly microbicidal
- Least affected by organic/inorganic soils among sterilization processes listed
- Rapid cycle time
- Penetrates medical packing, device lumens
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- Deleterious for heat-sensitive instruments
- Microsurgical instruments damaged by repeated exposure
- May leave instruments wet, causing them to rust
- Caution: Potential for burns
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| Hydrogen Peroxide Gas Plasma |
- Safe for the environment
- Leaves no toxic residuals
- Cycle time is 28-75 minutes (varies with model type) and no aeration necessary
- Used for heat- and moisture-sensitive items since process temperature <50°C
- Simple to operate, install (208 V outlet), and monitor
- Compatible with most medical devices
- Only requires electrical outlet
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- Cellulose (paper), linens and liquids cannot be processed
- Sterilization chamber size from 1.8-9.4 ft3 total volume (varies with model type)
- Some endoscopes or medical devices with long or narrow lumens cannot be processed at this time in the United States (see manufacturer’s recommendations for internal diameter and length restrictions)
- Requires synthetic packaging (polypropylene wraps, polyolefin pouches) and special container tray
- Caution: Hydrogen peroxide may be toxic at levels greater than 1 ppmTWA
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| 100% Ethylene Oxide (ETO) |
- Penetrates packaging materials, device lumens
- Single-dose cartridge and negative- pressure chamber minimizes the potential for gas leak and ETO exposure
- Simple to operate and monitor
- Compatible with most medical materials
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- Requires aeration time to remove ETO residue
- Sterilization chamber size from 4.0-7.9 ft3 total volume (varies with model type)
- ETO emission regulated by states but catalytic cell removes 99.9% of ETO and converts it to CO2 and H2O
- ETO cartridges should be stored in flammable liquid storage cabinet
- Lengthy cycle/aeration time
- Caution: ETO is toxic, a carcinogen, and flammable
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ETO Mixtures
10% ETO/90% HCFC
8.5% ETO/91.5% CO2 |
- Penetrates medical packaging and many plastics
- Compatible with most medical materials
- Cycle easy to control and monitor
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- Some states (e.g., CA, NY, MI) require ETO emission reduction of 90-99.9%
- Chlorofluorocarbon (CFC) (inert gas that eliminates explosion hazard) banned in 1995
- Potential hazards to staff and patients
- Lengthy cycle/aeration time
- Caution: ETO is toxic, a carcinogen, and flammable
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| Peracetic Acid |
- Rapid cycle time (30-45 minutes)
- Low temperature (50-55°C) liquid immersion sterilization
- Environmental friendly by-products
- Sterilant flows through endoscope which facilitates salt, protein and microbe removal
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- Point-of-use system, no sterile storage
- Biological indicator may not be suitable for routine monitoring
- Used for immersible instruments only
- Some material incompatibility (e.g., aluminum anodized coating becomes dull)
- One scope or a small number of instruments processed in a cycle
- Caution: Potential for serious eye and skin damage (concentrated solution) with contact
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