Tables and Figure: Table 5

Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)

Summary of advantages and disadvantages of chemical agents used as chemical sterilants1 or as high-level disinfectants

Chemical agents for sterilization advantages and disadvantages.
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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Page last reviewed: September 18, 2016

Content source: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Healthcare Quality Promotion (DHQP)