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Good day Kaustubh,
This is a truly forward-looking question.
I foresee that in 15 years that EtO sterilizers will rarely be found inside medical centers, and those that remain in medical centers in 15 years will be older machines that will not be replaced when they no longer function. Medical devices requiring EtO sterilization will be sent to specialist processing centers.
The ban on using Freon to counteract the risk of fire and explosions that come with using EtO caused a dramatic change in how people viewed low-temperature sterilization. Many innovations have been tried, some more successfully than others have.
One innovation, the Sterrad hydrogen peroxide plasma sterilizers, offers many advantages compared with EtO sterilization techniques. I have witnessed firsthand the changeover from EtO to plasma sterilization. 90% of the items sterilized in EtO made the switch to plasma sterilization without any modification other than packaging. The rapid turnaround time permitted me to schedule the same tray for three or four surgeries in a day compared with the 16 to 36 hours turnaround time when the tray is processed by EtO. This alone was cost-justification for adding the plasma sterilizers. No perfect sterilization technique exists, and some EtO sterilizable items cannot be sterilized with plasma sterilization. For some of these items, suitable replacements exist, for others EtO remains the only practical alternative. With both EtO and plasma sterilizers available, I found over a year's time, that 97% of my low temperature sterilization loads were plasma sterilization, and 3% were EtO sterilization.
Gamma Irradiation sterilization may well become more common. After the Sept. 11 catastrophe in New York and the anthrax sent through the mail, sterilizing mail in Washington D.C. by Gamma Irradiation was introduced. If this mail sterilization becomes a wide spread practice, I foresee medical devices being processed through the same sterilizers. Because Gamma Irradiation sterilizers are always 'on', i.e., the gamma rays are continuously emitted, they are most cost effective if the conveyer belt carries items through the sterilizer 24 hours a day. Using the same sterilizer for food, medical devices, and postal mail might make economic sense, if the sterilizers for mail are to be installed anyway. If I had Gamma Irradiation sterilization available, I could remove the EtO sterilizers from my department.
Safety concerns about this flammable, explosive, carcinogenic, mutogenic, etc., sterilant make me want to remove EtO completely from the healthcare setting, but material compatibility and the ability to penetrate long narrow lumens makes me keep the EtO sterilizers. Other innovative sterilization techniques in development, such as Ozone sterilization, may further diminish our reliance on EtO sterilizers.
I believe any EtO machine purchased today will serve into the future as a low temperature sterilizer long enough to be a viable, cost effective option. If I could only choose one in-house low-temperature sterilization method today, I would strongly consider using only plasma sterilization supplemented with outsourcing the items requiring EtO sterilization.
Regards, Pete Bobb
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