11:29 AM, March 29, 2026

On March 13, 2026, the Environmental Protection Agency (“EPA”) announced amendments to the 2024 National Emissions Standards for Hazardous Air Pollutants (“NESHAP”) for ethylene oxide (“EtO”). EtO is a flammable colorless gas. While EtO has many uses, its primary and most notable use is for the sterilization of medical equipment, especially equipment that cannot withstand the heat from autoclaves or other sterilization measures. Approximately 20 billion medical devices are sterilized using the chemical. Other uses for the compound include pesticides, antifreeze, and cleaning agents. EtO plays an important role in industry, with 2.92 million metric tons of the chemical that is used annually contributed $3.5 billion in value.

A known carcinogen, EtO was first regulated in 1994. Its ability to damage DNA is the same reason it makes a great sterilizer, however. EtO has been specifically linked to lymphoma, leukemia, and breast cancer, as well as reproductive issues and neurological issues. Exposure to EtO often comes from inhalation or ingestion, especially for people who live and work near facilities using the compound. Exposure at high levels can cause respiratory and skin damage. The gas is especially dangerous to workers due to its flammable, explosive, and reactive properties.

EtO emissions are a major environmental justice concern as well. Nearly 50% of the population within 5 miles of EtO emitting facilities are people of color and more than 30% of the population near these facilities are low-income.

According to the Southern Environmental Law Center, “[i]n 2024, the EtO Commercial Sterilizer final rule was promulgated, implementing more stringent standards for EtO emissions. The rule had been shown to reduce EtO emissions by more than 90%, accordingly reducing cancer risk by 92%. Despite additional findings that the gas is 60 times more toxic than previously thought, the new EPA proposed rule plans to roll back these standards.” The Trump administration has already taken steps to slow compliance, giving presidential exemptions to 40 commercial sterilizers. These exemptions are currently being challenged by the Southern Environmental Law Center and Natural Resources Defense Council on behalf of CleanAIRE NC, Sustainable Newton, Savannah Riverkeeper, and Virginia Interfaith Power & Light.

There is little excuse for rescinding this rule. Despite its industrial use, the risks are far too high to rescind the 2024 EtO rule. While the sterilization of medical equipment is important, it is not worth the risks associated with working in and working near these industrial plants. Additionally, these risks disproportionately affect communities that often lack the power to fight back against these industries.

The rule had been shown to reduce EtO emissions by more than 90%, accordingly reducing cancer risk by 92%. Despite additional findings that the gas is 60 times more toxic than previously thought, the new EPA proposed rule plans to roll back these standards.

Importantly, there are safe alternatives to EtO. Moist heat, dry heat, radiation, and liquid chemical sterilizations are traditional alternatives, but some of these are not suitable for equipment that cannot handle high heat. However, new sterilization methods are being developed that are safe for heat sensitive devices and equipment, such as vaporized hydrogen peroxide sterilization, chloring dioxide sterilization, and nitrogen dioxide sterilization.

Environmental and community groups are preparing to fight the presidential exemptions and the new proposed EtO rule, as well as the many other protections that have been rolled back since 2025. This goes to show that an informed public is one that can advocate for itself, aspiring toward science-based limits for dangerous chemicals such as EtO.

Madison Kate Williams

Madison Kate Williams graduated from UNC Chapel Hill in 2023 with a degree in environmental science and is currently a second year law student at the University of North Carolina School of Law. She is a co-president of the Environmental Law Project and the incoming Managing Editor for the North Carolina Journal of Law and Technology. She is pursuing a career in environmental law.