Choosing a new sterilization system is a complex process.
Hospitals have sterilized heat- and water-sensitive medical supplies with ethylene oxide for more than 30 years. But EtO is highly explosive unless diluted. At year-end, the most common diluent, ozone-eroding chlorofluorocarbons, will be banned from production.
Many hospitals have converted to either hydrochlorofluorocarbons or carbon dioxide with minor modifications to their equipment, according to ECRI, a technology assessment firm based in Plymouth Meeting, Pa.
Neither solution is perfect. Hydrochlorofluorocarbons will be banned in 2030 because they also harm the ozone. The use of carbon dioxide adds an hour to the lengthy EtO sterilization cycle.
"All of these have advantages and disadvantages," said Chris Lavanchy, associate director of the ECRI Health Devices Group. "You really need to look at different components to know your costs."
For example, some states, such as California, Michigan and New York, are asking hospitals to reduce EtO emissions, which will make EtO sterilization more expensive.
Two firms, Advanced Sterilization Products and AbTox, sell alternatives to EtO sterilization. The systems are smaller than most EtO sterilizers but faster so operating costs can be comparable or lower. So far, however, the Food and Drug Administration hasn't approved their use to sterilize some instruments with hollow tubes.