The National Institute for Occupational Safety and Health (NIOSH), the U.S. Environmental Protection Agency (EPA), and the Ethylene Oxide Sterilization Association (EOSA) request assistance in preventing explosions at industrial ethylene oxide (EtO) sterilization facilities and EtO repackaging plants. EtO is a flammable gas. During sterilization procedures, EtO can easily form explosive mixtures when it is vented to certain types of emission control devices such as catalytic oxidizers. Between 1994 and 1998, EtO was involved in 10 explosions at industrial EtO sterilization facilities and EtO repackaging plants. One of these explosions caused 1 death and 59 injuries among workers. All of these incidents caused damage to the plants, most of which used catalytic oxidizers to control EtO emissions. This Alert informs owners, managers, supervisors, engineers, safety professionals, and workers about the explosions, injuries, and deaths that may occur at industrial EtO sterilization facilities and repackaging plants. Steps are recommended for preventing these explosions. Recommendations for workers include: prevent overfeeding of the OECD; store and handle EtO properly; deal with leaks and spills; be prepared for rescue; prevent skin and eye contact; use respiratory protection and personal protective equipment (PPE). Recommendations for employers include: prevent overfeeding of the oxidizing emission control devices (OECD); store and handle EtO properly; deal with leaks and spills; be prepared for rescue; implement engineering controls; install emergency equipment; provide respiratory protection and PPE; provide training; and prepare workers for rescue.