Ethylene Oxide and Hydrogen Peroxide Gas Plasma Sterilization: Precautionary Practices in U.S. Hospitals.

Objective: Evaluate precautionary practices and extent of use of ethylene oxide (EtO) and hydrogen peroxide gas plasma (HPGP) sterilization systems, including use of single chamber EtO units.

Design: Modular, web-based survey.

Participants: Members of professional practice organizations who reported using EtO or HPGP in the past week to sterilize medical instruments and supplies. Participating organizations invited members via email which included a hyperlink to the survey.

Methods: Descriptive analyses were conducted including simple frequencies and prevalences.

Results: A total of 428 respondents completed the module on chemical sterilants. Because most respondents worked in hospitals (87%, n=373) analysis focused on these workers. Most used HPGP sterilizers (84%, n=373), 38% used EtO sterilizers, with 22% using both. Nearly all respondents using EtO operated single chamber units (94%, n=120); most of them reported that the units employed single use cartridges (83%, n=115). Examples of where engineering and administrative controls were lacking for EtO include: operational local exhaust ventilation (7%; n=114); continuous air monitoring (6%; n=113); safe handling training (6%; n=142); and standard operating procedures (4%; n=142). Examples of practices which may increase HPGP exposure risk included lack of standard operating procedures (9%; n=311) and safe handling training (8%; n=312).

Conclusions: Use of precautionary practices was good but not universal. EtO use appears to have diminished in favor of HPGP which affords higher throughput and minimal regulatory constraints. Separate EtO sterilization and aeration units were still being used nearly one year after U.S. EPA prohibited their use.