OSHA’s outdated standards endanger American workers by failing to limit ethylene oxide exposure.
Across the United States, employees working in sterilization facilities, medical supply warehouses, and industrial operations are inhaling a toxic substance that could threaten their long-term health. Ethylene oxide (EtO) plays a crucial role in sterilizing approximately half of the nation’s medical equipment. Its importance to modern healthcare is undeniable, yet the escalating health risks associated with exposure can no longer be dismissed.
Although research spanning decades has linked EtO to life-altering illnesses, the Occupational Safety and Health Administration (OSHA) has not revised its worker exposure limits since the early 1980s. Government agencies understand the severity of the threat. Still, the safety standards remain locked in the past.
EtO is particularly valuable because it helps sterilize medical equipment that cannot be treated with high heat or steam. In many cases, it has replaced other methods such as gamma radiation, electron beam processing, X-ray sterilization, and hydrogen peroxide plasma. The efficiency, however, carries a steep human cost.
The U.S. Environmental Protection Agency (EPA) identifies EtO as a known human carcinogen, and even small, repeated exposures over time can cause cell DNA damage. Moreover, short-term contact with concentrated EtO emissions may trigger breathing difficulties, headaches, and neurological problems. Both the Centers for Disease Control and Prevention and EPA acknowledge links between long-term workplace exposure and cancers, including leukemia, non-Hodgkin lymphoma, multiple myeloma, and breast cancer. Its inhalation carcinogenicity in humans is highlighted in an EPA evaluation from 2016 that underpins all modern EPA cancer-risk estimates for EtO.
Communities across the country are already living with the consequences. In Willowbrook, Illinois, risk modeling data from 2018 showed cancer dangers more than 4.8 times higher than acceptable levels near a Sterigenics sterilization facility that uses EtO. The plant was closed in 2019, but right before, an EPA report acknowledged cancer risks of up to 500 to 1000 per 1 million at the site.
In Laredo, Texas, and Jackson, Missouri, the same projection map revealed cancer risk 18 times and 11 times higher, respectively, than EPA’s threshold for acceptable risk near Midwest Sterilization Corporation facilities. Other pollution projection data revealed several EtO facilities in California with elevated cancer risks around neighboring communities.
Even if these data are a few years old, they remain relevant because many of the cancers associated with EtO exposure have long latencies, spanning even 15 years after the initial exposure.
According to a 2023 study, 31 out of 654 EtO-emitting facilities in the United States have an estimated cancer risk of over 100 per 1 million. Despite this alarming evidence, many facilities continue to operate within OSHA’s outdated regulatory framework.
OSHA’s standards are stuck in the last century. OSHA’s permissible exposure limit for EtO has not changed since 1984, a time when the full extent of its toxicity was not understood. EPA now considers the chemical up to 60 times more dangerous than previously estimated, and recently adopted stricter controls intended to achieve a 90 percent reduction in hazardous EtO emissions. The agency also signaled its intention to reduce allowable workplace exposure levels to 0.1 parts per million by 2035.
Yet, OSHA’s current limit for an eight-hour workday remains at 1 part per million, 10 times higher than what other federal environmental regulators believe is safe. This disconnect leaves people closest to the hazard—such as warehouse technicians, sterilization line operators, and maintenance workers— without adequate protection.
EPA has made the first move, but if OSHA continues to delay updating its regulations, responsibility falls on state governments, labor organizations, and environmental justice advocates to demand stronger protection.
Workers deserve exposure limits supported by modern science and real-time monitoring of emissions inside and outside sterilization facilities. Thanks to the new EPA regulations, we should see more impact studies and projections that were previously halted after 2018, when EPA released its National Air Toxics Assessment.
Furthermore, companies should be required to install effective ventilation and leak detection systems, provide comprehensive protective gear, and ensure that employees undergo regular medical evaluations. These are not radical requests. The technology exists, the data are clear, and the stakes are measured in human lives.
OSHA must recognize that safeguarding workers is its core mission and not an optional set of policies. No individual should have to decide between financial security and personal health. The nation relies on a steady supply of sterile medical equipment, but that need must never justify preventable illness among those who help produce it.
The crisis is already unfolding. Now is the time to move worker protections into the modern era and ensure that the people supporting our health care system are not sacrificing their health in the process.
