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. 2016 Aug 9;30(3):609–637. doi: 10.1016/j.idc.2016.04.002

Table 3.

Summary of advantages and disadvantages of commonly used sterilization technologies

Sterilization Method Advantages Disadvantages
Steam
  • Nontoxic to patients, 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 packaging, device lumens

  • It is deleterious for heat-sensitive instruments.

  • Microsurgical instruments are damaged by repeated exposure.

  • It may leave instruments wet, causing them to rust.

  • There is potential for burns.

HP gas plasma
  • Safe for the environment and health care personnel

  • Leaves no toxic residuals

  • Cycle time ≥28 min, and no aeration necessary

  • Used for heat- and moisture-sensitive items because 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.

  • Endoscope or medical device restrictions are based on lumen internal diameter and length (see manufacturer’s recommendations).

  • It requires synthetic packaging (polypropylene wraps, polyolefin pouches) and a special container tray.

  • HP may be toxic at levels >1 ppm TWA.

100% ETO
  • Penetrates packaging materials, device lumens

  • Potential for gas leak and ETO exposure minimized by single-dose cartridge and negative-pressure chamber

  • Simple to operate and monitor

  • Compatible with most medical materials

  • It requires aeration time to remove ETO residue.

  • ETO is toxic, a carcinogen, and flammable.

  • ETO emission is regulated by states, but catalytic cell removes 99.9% of ETO and converts it to carbon dioxide and water.

  • ETO cartridges should be stored in flammable liquid storage cabinet.

  • It has a lengthy cycle/aeration time.

Vaporized HP
  • Safe for the environment and health care personnel

  • Leaves no toxic residue; no aeration necessary

  • Cycle time 55 min

  • Used for heat- and moisture-sensitive items (metal and nonmetal devices)

  • Medical device restrictions are based on lumen internal diameter and length; see manufacturer’s recommendations (eg, stainless steel lumen 1 mm diameter, 125 mm length).

  • It is not used for liquid, linens, powders, or any cellulose materials.

  • Requires synthetic packaging (polypropylene).

  • There are limited materials compatibility data.

  • There are limited clinical use and comparative microbicidal efficacy data.

HP and ozone
  • Safe for the environment and health care personnel

  • Uses dual sterilants, HP, and ozone

  • Does not need aeration because of no toxic byproducts

  • Compatible with common medical devices

  • Cycle time 46 min

  • FDA cleared for general instruments, single-channel flexible endoscopes, and rigid and semirigid channeled devices

  • Endoscope or medical device restrictions are based on lumen internal diameter and length (see manufacturer’s recommendations).

  • There are limited clinical use (no published data on material compatibility/penetrability/organic material resistance) and limited microbicidal efficacy data.

  • It requires synthetic packaging (polypropylene wraps, polyolefin pouches) and a special container tray.

Abbreviations: ETO, ethylene oxide; HP, hydrogen peroxide; TWA, time-weighted average.

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