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14 www.NationalNursesUnited.org Sterilization method Advantages Disadvantages Glutaralde hyde · Numerous use studies published · Relatively inexpensive · Excellent material compatibility · Respiratory irritation from glutaralde- hyde vapor · Pungent and irritating odor · Relatively slow mycobactericidal activity (unless other disinfectants added such as phenolic, alcohol) · Coagulates blood and fixes tissue to surfaces · Allergic contact dermatitis HP · No activation required · May enhance removal of organic matter and organisms · No disposal issues · No odor or irritation issues · Does not coagulate blood or fix tissues to surfaces · Inactivates Cryptosporidium · Use studies published · Material compatibility concerns (brass, zinc, copper, and nickel/silver plating) both cosmetic and functional · Serious eye damage with contact OPA · Fast-acting high-level disinfectant · No activation required · Odor not significant · Excellent materials compatibility claimed · Does not coagulate blood or fix tissues to surfaces claimed · Stains protein gray (eg, skin, mucous membranes, clothing, and environmen- tal surfaces) · Limited clinical experience · More expensive than gluteraldehyde · Eye irritation with contact · Slow sporicidal activity · Anaphylactic reactions to OPA in patients with bladder cancer with repeated exposure to OPA through cystoscopy Peracetic acid · Standardized cycle (eg, Liquid Chemical Sterilant Processing System using Peracetic Acid, rinsed with extensively treated potable water) · Low temperature (50°C-55°C) liquid immersion sterilization · Environmental friendly byproducts (acetic acid, O2, H2O) · Fully automated · Single-use system eliminates need for concentration testing · May enhance removal of organic material and endotoxin · No adverse health effects to operators under normal operating conditions · Compatible with many materials and instruments · Does not coagulate blood or fix tissues to surfaces · Sterilant flows through scope facilitating salt, protein, and microbe removal · Rapidly sporicidal · Provides procedure standardization (constant dilution, perfusion of chan- nel, temperatures, exposure) · Potential material incompatibility (eg, aluminum anodized coating becomes dull) · Used for immersible instruments only · Biological indicator may not be suitable for routine monitoring · One scope or a small number of instru- ments can be processed in a cycle · More expensive (endoscope repairs, operating costs, purchase costs) than high-level disinfection · Serious eye and skin damage (concen- trated solution) with contact · Point-of-use system, no sterile storage · An AER using 0.2% peracetic acid not FDA cleared as sterilization process but HLD Table 3: Excerpted from Rutala & Weber (2016) Summary of advantages and disadvantages of chemical agents used as chemical sterilants or as high-level disinfectants