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Ethylene oxide (EO) is an environmental pollutant and is toxic to humans. Congress classified it as a “hazardous air pollutant,” according to the United States Environmental Protection Agency.

Multiple studies have shown that EO increases the risk of several types of cancer. The EPA classified the chemical as a human carcinogen in 2016. Despite its toxicity, the chemical is still widely used.

The American Chemical Council has called it a versatile chemical that contributes to the American economy. For example, approximately 50 percent of sterile medical devices in the U.S. are sterilized with EO, according to the EPA’s FAQ page updated September 2022. That equates to about 20 billion devices each year. Food producers also use it to sterilize some food products, including spices, dried vegetables, certain dried herbs, walnuts and sesame seeds.

In 2016, the EPA classified ethylene oxide as cancerous to humans.

There are more than 90 processing plants across the country that work with EO and chemicals made from it. Thousands of Americans work directly or indirectly with the chemical.

The Occupational Safety and Health Administration (OSHA) requires employers to monitor employee exposure to EO and provide protective equipment to keep them safe. The EPA’s National Emission Standards for Hazardous Air Pollutants regulates EO atmosphere emissions.

Exposure to EO can cause a number of acute side effects and health problems. Most people aren’t at risk of toxic levels of exposure in the environment, but factory workers, agricultural workers and some hospital workers who work with the chemical may be at risk.

Ethylene Oxide Uses

Manufacturers use EO primarily in producing other chemicals used in consumer and industrial applications. The main chemical created from EO is ethylene glycol, a chemical used in products from brake fluid to industrial solvents. Some studies have found it in e-cigarette liquids.

EO is also used to create health care products and sterilize medical devices.

Ethylene oxide uses include:
  • Adhesives
  • Agricultural insecticide
  • Antifreeze
  • Chemicals used to create fabrics for clothes, pillows and carpets
  • Cosmetics
  • Detergents
  • Fiberglass used in jet skis, bowling balls and other products
  • Herbicide
  • Household cleaners
  • Industrial cleaners
  • Medicines
  • Polyethylene terephthalate (PET) plastic resin used to make packaging and beverage containers
  • Shampoos
  • Sterilizing medical devices that are too delicate or sensitive for high-heat sterilizing, such as knee implants, bandages, electronics and devices containing plastic
  • Sterilizing spices

What Does Ethylene Oxide Kill?

Ethylene oxide can kill most viruses, bacteria, bacteria spores and fungi. It kills microorganisms by ripping apart cell membranes.

Because of this property, manufacturers often use EO to disinfect dry foods like spices and grains as well as medical devices and supplies like knee implants, catheters, syringes and surgical kits.

About 20 billion medical devices are sterilized with ethylene oxide each year.

Side Effects of Ethylene Oxide Exposure

Most people don’t experience ethylene oxide side effects because they are not exposed to high amounts of the chemical every day.

People exposed to toxic amounts of EO typically inhale it, but it may also contaminate the skin or be ingested. Potential sources of exposure include uncontrolled emissions in industrial settings, contaminated air, tobacco smoke and the on-the-job exposure.

Side effects of ethylene oxide exposure can occur up to 72 hours after acute exposure to high doses.

More severe side effects, such as fluid in the lungs that can lead to lung collapse, coma, cardiovascular collapse and respiratory paralysis, are more likely at larger doses and at longer durations of exposure.

The EPA hasn’t established a limit for safe EO exposure in the air.

Side effects of ethylene oxide exposure may include:
  • Cancer
  • Diarrhea
  • Difficulty breathing
  • Drowsiness
  • Exhaustion
  • Eye burns
  • Frostbite
  • Headache
  • Irritation of the eyes, nose, throat, skin and lungs
  • Memory loss
  • Miscarriages
  • Nausea
  • Numbness
  • Reproductive effects
  • Skin burns
  • Seizures
  • Vomiting
  • Weakness

Who Is Most at Risk?

People who work with ethylene oxide are most at risk of suffering health effects because of chronic exposure.

Examples of at-risk jobs include:
  • Agricultural workers who use ethylene oxide as an insecticide for grain bins
  • Factory workers in plants that make ethylene oxide
  • Hospital workers or technicians who sterilize medical equipment and supplies with ethylene oxide
  • Plant workers that use ethylene oxide to produce antifreeze, solvents, detergents, textiles, polyurethane foam and adhesives

What Cancers Can Ethylene Oxide Exposure Cause?

Because ethylene oxide destroys DNA, it can increase the risk of certain cancers. Studies show that long-term exposure to ethylene oxide can cause cancers of the white blood cells in humans, including non-Hodgkin lymphoma, myeloma and lymphocytic leukemia, according to the EPA. It also increases the risk of breast cancer in women.

Animal studies have shown it can cause brain, lung, connective tissue and uterine tumors.

The EPA hasn’t set limits for exposure, but the agency has said it “considers any exposure, however small, to a carcinogen to create some cancer risk.”

Treating and Preventing EO Exposure

There is no antidote to ethylene oxide poisoning, and treatment consists of decontamination as well as respiratory and cardiovascular support. People treating others who have been exposed should be wearing protective gear and HAZMAT teams should be contacted.

Because side effects of acute ethylene oxide exposure can occur up to 72 hours after exposure, anyone who suspects exposure should go to a medical facility for evaluation.

The Agency for Toxic Substances & Disease Registry has some guidelines for treating ethylene oxide exposure. They consist of decontamination and emergency care.

For more information, contact local, state or national poison control centers.

Basic Decontamination

Before being treated for serious symptoms, anyone who has been exposed will be decontaminated. For minor contamination, rescuers will remove any contaminated clothing and wash skin and hair for 3 to 5 minutes. Eyes should be flushed with saline or water for at least 15 minutes after removing any contact lenses.

Advanced Treatment

If patients are having trouble breathing, rescuers will intubate them to help them breathe. Aerosolized bronchodilators — medications that help relax the lungs and improve breathing — may be used.

People who are comatose, having seizures or exhibiting an irregular heartbeat will be rushed to the hospital and placed on advanced life support after decontamination.

Preventing Exposure

Most exposure happens in the workplace. The law requires employers to make sure employees have appropriate protective gear such as protective clothing and respirators. There are also limits in place for how long a person may work around ethylene oxide.

Protect yourself from exposure at work by:
  • Wearing protective clothing
  • Discarding clothing that may be contaminated
  • Wearing goggles and skin protection
  • Not smoking, eating or drinking while working with EO
  • Seeing a doctor if you have been exposed to EO
  • Avoiding working with EO without protective gear

Ethylene Oxide Lawsuits

The EPA sets limits for EO emissions. But sometimes workers or people that live near industrial facilities that produce or work with the chemical may be exposed because of uncontrolled emissions.

Because ethylene oxide gas is colorless and odorless, people might not know they are inhaling it. It can linger for as long as 149 days in the air in colder weather, according to the EPA.

People who developed cancer after being exposed to uncontrolled emissions are filing ethylene oxide lawsuits against corporations responsible for the exposure. Cancers that are a part of the lawsuits are: Breast cancer, lymphoid tumors, non-Hodgkin lymphoma, multiple myeloma and chronic lymphocytic leukemia.

Please seek the advice of a qualified professional before making decisions about your health or finances.
Last Modified: October 25, 2022

13 Cited Research Articles

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  1. Environmental Protection Agency. (2022, September 22). Frequent Questions about Ethylene Oxide (EtO). Retrieved from https://www.epa.gov/hazardous-air-pollutants-ethylene-oxide/frequent-questions-about-ethylene-oxide-eto
  2. Agency for Toxic Substances & Disease Registry. (2014). Medical Management Guidelines for Ethylene Oxide. Retrieved from https://www.atsdr.cdc.gov/mmg/mmg.asp?id=730&tid=133
  3. American Chemistry Council. (2019). The Economic Benefits of Ethylene Oxide. Retrieved from https://www.americanchemistry.com/EO/Ethylene-Oxide-and-the-Potential-Cost-of-Deselection.pdf
  4. American Chemistry Council. (2020). Ethylene Oxide. Retrieved from https://www.chemicalsafetyfacts.org/ethylene-oxide/
  5. Andersen Sterilizers. (n.d.). How does ethylene oxide work? Retrieved from https://www.anderseneurope.com/eto-sterilisation/ethylene-oxide/how-does-ethylene-oxide-work
  6. Centers for Disease Control and Prevention. (2019, June 21). Ethylene Oxide. Retrieved from https://www.cdc.gov/niosh/topics/ethyleneoxide/default.html
  7. Environmental Protection Agency. (2018). Ethylene Oxide. Retrieved from https://www.epa.gov/sites/production/files/2016-09/documents/ethylene-oxide.pdf
  8. Environmental Protection Agency. (n.d.). Ethylene Oxide Emissions: Frequent Questions. Retrieved from https://www.epa.gov/il/ethylene-oxide-emissions-frequent-questions
  9. Hutzler, C. et al. (2014). Chemical hazards present in liquids and vapors of electronic cigarettes. Retrieved from https://pubmed.ncbi.nlm.nih.gov/24958024/
  10. National Cancer Institute. (2018, December 28). Ethylene Oxide. Retrieved from https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/ethylene-oxide
  11. Occupational Safety and Health Administration. (2002). Ethylene Oxide. Retrieved from https://www.osha.gov/OshDoc/data_General_Facts/ethylene-oxide-factsheet.pdf
  12. Science Direct. (2016). Ethylene Oxide. Retrieved from https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/ethylene-oxide
  13. United States Department of Labor. (n.d.). Ethylene Oxide. Retrieved from https://www.osha.gov/ethylene-oxide