Ethylene Oxide Gas Sterilization: A Systematic Review of Carcinogenicity, Toxicity And Occupational Exposure.

The Operating Room Global Journal · Volume 1 · Issue 2
Systematic Review

Ethylene Oxide Gas Sterilization: A Systematic Review of Carcinogenicity, Toxicity And Occupational Exposure

Authors

Hafiza Tuba Razzaq1*; Abdul Wajid2; Asjed Sanaullah3; Muhammad Mohsin Yar4; Shafqat Abbas5

1 Lahore General Hospital, Lahore, Pakistan.

2 Punjab Institute of Neurosciences, Lahore, Pakistan.

3 Ibadat International University, Islamabad, Pakistan.

4 Gulab Devi Educational Complex, Lahore, Pakistan.

5 Chaudhry Pervaiz Elahi Institute of Cardiology Wazirabad, Pakistan.

Corresponding Author Hafiza Tuba Razzaq

Abstract

Evidence on ethylene oxide sterilization, occupational exposure, toxicity and carcinogenic risk.

Background

Ethylene oxide gas is a colourless gas used to sterilize items that are sensitive to moisture, heat and radiation. The published article notes that overexposure can have harmful effects on the central nervous system, reproductive system and peripheral nervous system.

Methodology

Web of Science, Science Direct, PubMed, Google Scholar and Scopus were used to identify articles relevant to ethylene oxide sterilization, toxicity and exposure.

Results

A total of 116 articles were initially selected. Following title and abstract review, 15 articles were retained. Subsequent assessment of the methodology, discussion and conclusion resulted in 10 articles being included as directly relevant to the review.

Conclusion

The review identifies ethylene oxide gas as an important sterilization option for surgical instruments that cannot tolerate conventional heat or moisture-based methods. At the same time, excessive exposure may affect the central nervous system and reproductive system and may contribute to carcinogenic and other serious health risks. Appropriate personal protective equipment and careful attention to safe handling are therefore important during ETO use.

Records Identified 116

Articles initially identified for review.

After Initial Screening 15

Articles retained after title and abstract review.

Included Articles 10

Articles considered directly relevant to the final review.

Databases 5

Web of Science, Science Direct, PubMed, Google Scholar and Scopus.

Ethylene Oxide
Sterilization
Toxicity of ETO
Surgical Instruments
Cancer
Neurogenic Issues

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Authors’ Contributions

Contributor Statement

Equal contributions.

Declarations

Conflict of Interest & Funding

Conflict of Interest: No conflict of interest.

Funding: No funding received by the authors.

Review Design

Systematic Review

The article reviews the use of ethylene oxide gas sterilization with particular attention to toxicity, carcinogenicity and occupational exposure associated with ETO use.

Evidence Sources

Five Databases

Web of Science, Science Direct, PubMed, Google Scholar and Scopus were used to identify articles relevant to the review.

Screening

Evidence Selection

The review began with 116 articles. Fifteen were retained after title and abstract screening, followed by further review of methodology, discussion and conclusion, resulting in 10 articles considered directly relevant to the study.

Occupational Safety

Exposure Considerations

The article emphasises safe handling, appropriate personal protective equipment and careful occupational exposure control when ethylene oxide gas is used for sterilization.

Article History

Editorial Timeline

Received 15 July 2025
Accepted 18 October 2025
Available Online 21 November 2025
Open Access

Licence & Article Record

This article is published by The Operating Room Global Journal (TORGJ) under the Creative Commons Attribution 4.0 International licence (CC BY 4.0).

Persistent DOI: 10.64573/torgj2507005

Scholarly Indexing

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Access the Published Article

Read the official full-text systematic review, access the persistent DOI record, or return to Volume 1, Issue 2.