Tables and Figure: Table 6

Guideline for Disinfection and Sterilization in Healthcare Facilities (2008)

Summary of advantages and disadvantages of commonly used sterilization technologies
common sterilization technologies advantages and disadvantages for.
Sterilization Method Advantages Disadvantages
  • 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
  • Deleterious for heat-sensitive instruments
  • Microsurgical instruments damaged by repeated exposure
  • May leave instruments wet, causing them to rust
  • Caution: Potential for burns
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
  • 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
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
  • 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
ETO Mixtures

8.6% ETO/91.4% HCFC
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
  • 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
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
  • 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
Modified from Rutala. 825


HCFC hydrochlorofluorocarbon.