Ethylene Oxide (ETO) Sterilization: Features and Limitations

Ethylene oxide (ETO) has been widely used as a low-temperature sterilant. ETO is a colorless gas that is flammable and explosive but it is liquid at temperatures below 10.8°C.

ETO is an effective sterilizing agent for heat and moisture-sensitive materials in hospitals, industries, and laboratories. Bacterial spores show little resistance to destruction by this agent. It is effective at relatively low temperatures and does not damage materials exposed to it.

ETO sterilization equipment
ETO sterilization machine

It has high penetrating power and passes through and sterilizes large packages of materials, bundles of cloth, and even certain plastics.

Mode of action

Alkylation reactions with organic compounds such as enzymes (eg inactivation of enzymes having sulfhydryl group) and other proteins.


Ethylene oxide is used to sterilize spices, biological preparations, soil, plastics, certain medical preparations, and contaminated laboratory equipment.


The main disadvantages associated with ETO are:

  1. Its comparatively slow action up on microorganisms. ETO is not used often because it requires a lengthy processing and aeration time (e.g., 12 hours).
  2. Higher cost
  3. Sterilization chamber is small
  4. ETO mixed with air at a ratio of at least 3% EtO gas, forms an explosive mixture. ETO cartridges should be stored in a flammable liquid–storage cabinet.
  5. Potential hazards to patients and staff (occupational hazards). ETO should be considered a known human carcinogen. Acute exposure to ETO may result in irritation and central nervous system depression. Chronic inhalation has been linked to the formation of cataracts, cognitive impairment, neurologic dysfunction, etc. Occupational exposure in healthcare facilities has been linked to hematologic changes, increased risk of spontaneous abortions, and various cancers.
  6. ETO is absorbed by many materials. For this reason, following sterilization, the item must undergo aeration to remove residual ETO.


  1. Compatible with most medical materials. It can sterilize heat- or moisture-sensitive medical equipment without deleterious effects on the material used in the medical devices.
  2. Equipment is simple to operate and monitor
  3. Penetrates packaging materials and device lumens
  4. Single-dose cartridge and negative-pressure chamber minimize the potential for gas leak and ETO exposure

Further Reading:

  1. CDC: Guideline for Disinfection and Sterilization in Healthcare Facilities

Acharya Tankeshwar

Hello, thank you for visiting my blog. I am Tankeshwar Acharya. Blogging is my passion. As an asst. professor, I am teaching microbiology and immunology to medical and nursing students at PAHS, Nepal. I have been working as a microbiologist at Patan hospital for more than 10 years.

Recent Posts