Table 2.

Summary of advantages and disadvantages of chemical agents used as chemical sterilants^a or as high-level disinfectants

Sterilization Method	Advantages	Disadvantages
Peracetic acid/HP	•No activation required •Odor or irritation not significant	•Material 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 material compatibility	•Respiratory irritation from glutaraldehyde vapor •Pungent and irritating odor •Relatively slow mycobactericidal activity (unless other disinfectants added such as phenolic, alcohol) •Coagulates blood and fixes tissue to surfaces •Allergic contact dermatitis
HP	•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
OPA	•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 protein gray (eg, skin, mucous membranes, clothing, and environmental surfaces) •Limited clinical experience •More expensive than glutaraldehyde •Eye irritation with contact •Slow sporicidal activity •Anaphylactic reactions to OPA in patients with bladder cancer with repeated exposure to OPA through cystoscopy
Peracetic acid	•Standardized cycle (eg, Liquid Chemical Sterilant Processing System using Peracetic Acid, rinsed with extensively treated potable water) •Low temperature (50°C–55°C) liquid immersion sterilization •Environmental friendly byproducts (acetic acid, O2, H20) •Fully automated •Single-use system eliminates need for concentration testing •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 (eg, 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 •An AER using 0.2% peracetic acid not FDA cleared as sterilization process but HLD
Improved HP (2.0%); HLD	•No activation required •No odor •Nonstaining •No special venting requirements •Manual or automated applications •12-mo shelf-life, 14-d reuse •8 min at 20°C HLD claim	•Material compatibility concerns due to limited clinical experience •Antimicrobial claims not independently verified •Organic material resistance concerns due to limited data

Abbreviations: AER, automated endoscope reprocessor; OPA, ortho-phthalaldehyde.

^aAll 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 aforementioned characteristics are documented in the literature; contact the manufacturer of the instrument and sterilant for additional information. All products listed are cleared by the FDA as chemical sterilants except ortho-phthalaldehyde, which is an FDA-cleared HLD.

Adapted from Refs.10, 11, 12, 13, 20