1. Chemical Sterilization
1. Gas
Ethylene oxide
H202 Gas Plasma
2. Liquid
Glutaraldehyde
Cold Packs
*For items that cannot withstand high heat or steam
Ex. Plastics, power equipment, fiber optic equipment

2. Gas Sterilization: Ethylene Oxide
At room temperature is a colorless gas, flammable, explosive, and toxic (carcinogenic)
 skin burns, respiratory irritation, headaches, birth defects
Requires special unit with proper ventilation and proper training  emergency protocols in place
Ampules should be stored in a cool, safe place
Emitted into environment through a vent hose
Most of ETO is converted to C02 and H20
MSDS and OSHA

3. Gas Sterilization: Ethylene Oxide
Can sterilize long, plastic tubes
Packs must only be wrapped in crepe paper or plastic pouches
No liquids!

4. Ethylene Oxide Use
Multiple packs are placed in a specific plastic bag, along with:
Glass ampule containing liquid (on top)
Dosimeter (in center of bag)
Humidity chip (gas needs minimum of 35% to destroy microorganisms)
Biological indicator (optional)
Bag is sealed and placed in the unit and air is vacuumed out
You must then break ampule, and close and lock door quickly
Ran for 12 hours at room temperature

6. *Must air out for 12 hours in a hood/ventilator or 7 days in a well ventilated area
Anprolene® is most common brand
Require annual safety inspections and preventative maintenance

7. Hydrogen Peroxide Gas Plasma
Gas Sterilization:
Hydrogen Peroxide Gas Plasma
Cannot be used for wood, paper, linen, some plastics, liquids
No endoscopes; no tubes longer than 12 inches
Expensive
Advantages:
By-products- water vapor and O2
Cycle only takes about an hour
VIDEO

8. Gas Plasma Use Packs placed in chamber (in special material)
Vacuum evacuates air
Hydrogen peroxide is injected from a cassette and vaporized initiates destruction of microorganisms
After 50 minutes the pressure is lowered and radio waves create gas plasma
Free radicals kill microorganisms, along with UV light
Chemical indicator- shows H202 was present
Biological indicator – checks functionality of machine

9. Liquid Sterilization
Cold Sterilization – soaking instruments in disinfectant to eliminate microorganisms
Cold tray packs – stores instruments used in minor or “dirty” procedures OR endoscopy
3 hours contact time; changed regularly
Instruments must be dry before use!
Ex. Dental, minor wounds, laparoscope

10. Examples:
Chlorhexidine solution
Benzalkonium – better for anti-rust properties
Glutaraldehyde

11. Glutaraldehyde 20 minutes = sterile Used mainly for endoscopes
Will usually expire 30 days upon opening
Must rinse instrument before using on living tissue!

12. Sterilization Method
Advantages
Disadvantages
Steam
Nontoxic to patient, staff, environment
Cycle easy to control and monitor
Rapidly microbicidal
Rapid cycle time
Can sterilize liquids
No good for heat-sensitive instruments
May leave instruments wet, causing them to rust
Potential for burns
Hydrogen Peroxide Gas Plasma
Safe for the environment
Leaves no toxic residuals
Cycle time is minutes (varies with model type) and no aeration necessary
Used for heat- and moisture-sensitive items since process temperature
Simple to operate, install (208 V outlet), and monitor
Only requires electrical outlet
Paper, linens and liquids cannot be processed
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)
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
Compatible with most medical materials
Requires aeration time to remove ETO residue
ETO is toxic, a carcinogen, and flammable
ETO emission regulated by states but catalytic cell removes 99.9% of ETO and converts it to CO2 and H2O
Lengthy cycle/aeration time
Emitted to environment