TABLE OF CONTENTS Sterilisation agents that predictably and reproducibly kill all micro-organisms from viruses to spores, are amazing magic bullets but their use is not without complications, limitations, and precautions. Many alternatives that are recommended may not penetrate certain plastics and mated surfaces, and even fail to demonstrate good microbiocidal kinetics.
New or alternative sterilisation processes like hydrogen peroxide, chlorine dioxide, sodium hypochlorite, peracetic acid, ozone, microwaves, pulsed light, and plasma and sporicide, performic acid can have limitations. Oxidising processes such as hydrogen peroxide or peracetic acid/plasma, ozone, sodium hypochlorite, chlorine dioxide for example, can t even sterilise paper or cellulostic materials without preferential absorption and reaction, (e.g., bleaching, deterioration), and they also oxidise aluminum. Many single use devices need paper for directons for use (DFU) inserts. Not every hospital has alternative sterilisers for reprocessing, but they do have steam sterilisers and possibly dry heat ovens. Also some devices and packages may not be penetrated by the alternatives. For example, 6 mg/l of H 2O 2 at a concentration of 58% can be used because the exposed surfaces remain treated. This peroxide vapour cannot sterilise all long lumens or cellulosic materials.
Others sterilants, (e.g., glutaraldehyde), cannot be considered for terminal sterilisation processes because they deviate from normal sterilisation kinetics or they do not typically sterilise devices within a barrier to protect them from post sterilisation contamination. One exception is the use of terminal end filters as a barrier that allows the liquid aldehyde to be flushed out without allowing microbes in.
