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
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
  • 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

Abbreviations:

HCFC hydrochlorofluorocarbon.