| Steam |
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Nontoxic to patients, staff, environment
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Cycle easy to control and monitor
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Rapidly microbicidal
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Least affected by organic/inorganic soils among sterilization processes listed
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Rapid cycle time
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Penetrates medical packaging, device lumens
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It is deleterious for heat-sensitive instruments.
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Microsurgical instruments are damaged by repeated exposure.
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It may leave instruments wet, causing them to rust.
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There is potential for burns.
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| HP gas plasma |
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Safe for the environment and health care personnel
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Leaves no toxic residuals
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Cycle time ≥28 min, and no aeration necessary
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Used for heat- and moisture-sensitive items because process temperature <50°C
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Simple to operate, install (208-V outlet), and monitor
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Compatible with most medical devices
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Only requires electrical outlet
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Cellulose (paper), linens, and liquids cannot be processed.
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Endoscope or medical device restrictions are based on lumen internal diameter and length (see manufacturer’s recommendations).
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It requires synthetic packaging (polypropylene wraps, polyolefin pouches) and a special container tray.
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HP may be toxic at levels >1 ppm TWA.
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| 100% ETO |
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Penetrates packaging materials, device lumens
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Potential for gas leak and ETO exposure minimized by single-dose cartridge and negative-pressure chamber
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Simple to operate and monitor
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Compatible with most medical materials
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It requires aeration time to remove ETO residue.
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ETO is toxic, a carcinogen, and flammable.
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ETO emission is regulated by states, but catalytic cell removes 99.9% of ETO and converts it to carbon dioxide and water.
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ETO cartridges should be stored in flammable liquid storage cabinet.
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It has a lengthy cycle/aeration time.
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| Vaporized HP |
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Safe for the environment and health care personnel
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Leaves no toxic residue; no aeration necessary
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Cycle time 55 min
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Used for heat- and moisture-sensitive items (metal and nonmetal devices)
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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).
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It is not used for liquid, linens, powders, or any cellulose materials.
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Requires synthetic packaging (polypropylene).
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There are limited materials compatibility data.
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There are limited clinical use and comparative microbicidal efficacy data.
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| HP and ozone |
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Safe for the environment and health care personnel
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Uses dual sterilants, HP, and ozone
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Does not need aeration because of no toxic byproducts
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Compatible with common medical devices
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Cycle time 46 min
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FDA cleared for general instruments, single-channel flexible endoscopes, and rigid and semirigid channeled devices
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Endoscope or medical device restrictions are based on lumen internal diameter and length (see manufacturer’s recommendations).
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There are limited clinical use (no published data on material compatibility/penetrability/organic material resistance) and limited microbicidal efficacy data.
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It requires synthetic packaging (polypropylene wraps, polyolefin pouches) and a special container tray.
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