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
  • 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
  • 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.