The EPA identified 23 sterilization facilities with EtO emissions linked to an increased risk of cancer for nearby residents, described as “elevated cancer risk at or above 100 additional cases per million people exposed.”

These high-risk facilities include:

1. Ardmore, OK: LEMCO Ardmore
2. Athens, TX: Steritec, Inc.
3. Añasco, PR: Edwards Lifesciences
4. Columbus, NE: Becton Dickinson Pharmaceutical Systems
5. Erie, PA: Cosmed Group LLC/Erie
6. Farjado, PR: Customed, Inc.
7. Franklin, NJ: Cosmed Group Inc. (Cosmed of NJ)
8. Groveland, FL: International Sterilization Laboratory
9. Hanover, MD: Elite Spice, Inc.
10. Henrico, VA: Sterilization Services of Virginia
11. Jackson, MO: Midwest Sterilization Corporation
12. Jessup, MD: Elite Spice, Inc.
13. Lakewood, CO: Terumo BCT Sterilization Service, Inc.
14. Laredo, TX: Midwest Sterilization Corporation
15. Linden, NJ: ETO Sterilization-Plant #2 (Cosmed)
16. Memphis, TN: Sterilization Services
17. New Tazewell, TN: DeRoyal Industries
18. Salinas, PR: Steri-Tech, Inc.
19. Salisbury, MD: Trinity Sterile, Inc.
20. Sandy, UT: BD Medical
21. Taunton, MA: Professional Contract Sterilization, Inc. (PCS)
22. Villalba, PR: Medtronic PR Operation Co.
23. Zelienople, PA: American Contract Systems Inc.

Several companies operate multiple high-risk sterilization facilities:

• American Contract Systems: 2 facilities
• Becton Dickinson: 3 facilities
• Boston Scientific: 3 facilities
• Cosmed Group: 3 facilities
• Elite Spice: 3 facilities
• Medtronic: 5 facilities
• Midwest Sterilization: 2 facilities
• Sterigenics: 7 facilities
• Sterilization Services: 2 facilities
• Steris: 5 facilities

Numerous facilities have faced legal and regulatory actions due to EtO emissions and their health impacts. Some notable cases include:

Facilities with Regulatory Violations

• Cosmed: In 2005, paid $1.5 million for failing to report and control EtO emissions at multiple locations between 1998 and 2003.

Facilities Temporarily or Permanently Closed

• Medline Industries, Waukegan, IL: Voluntarily shut down in 2019 to comply with new emissions standards.
• Sterigenics, Atlanta, GA: Temporarily closed in 2019 for emission reduction construction.
• Sterigenics, Willowbrook, IL: Permanently closed in 2019 following regulatory actions and public outcry.

Civil Lawsuits and High-Profile Actions Related to Ethylene Oxide Emissions

• B.Braun Med Inc, Allentown, PA: In February 2022, around three dozen individuals filed lawsuits against the B.Braun facility, alleging they developed leukemia and other cancers after living or working near the plant.
• Baxter International, Mountain Home, AR: In 2021, Baxter Healthcare Corp reached a confidential settlement with plaintiffs who claimed harm from EtO emissions at its Arkansas facility, which had the third-highest EtO emissions in 2020.
• BD (Becton Dickinson) and Sterigenics, Georgia: In 2020, multiple lawsuits were initiated against BD in Covington and Sterigenics in Cobb County. Plaintiffs alleged they developed breast or blood cancers due to emissions from these sterilization plants.
• KPR (Kendall Patient Recovery), Augusta, GA: In 2021, over twenty lawsuits were filed against the KPR plant, with claims of cancer and miscarriages from individuals who lived or worked within a five-mile radius of the facility.
• Sterigenics, Santa Teresa, NM: In January 2021, the New Mexico Attorney General filed a lawsuit against Sterigenics, citing increased cancer risks for residents due to EtO emissions from the Santa Teresa facility.
• Sterigenics, Vernon, CA: In August 2022, local officials, including the Los Angeles County Supervisor, called for the closure of the Sterigenics plant in Vernon after the South Coast Air Quality Management District labeled it a “high-risk” facility.
• Sterigenics, Willowbrook, IL: In September 2022, a jury awarded $363 million in damages to a woman who developed breast cancer after living near the Willowbrook facility. Over 700 lawsuits have been filed against Sterigenics following an EPA report indicating residents within 1.5 miles of the plant were ten times more likely to develop cancer.
• Terumo BCT Facility, Lakewood, CO: By 2022, at least a dozen lawsuits were pending against the Terumo BCT plant due to its EtO emissions. A trial involving twelve plaintiffs is set for July 2023.

The EPA's website comprehensively lists all commercial sterilization facilities and their emissions. This list includes nearly 100 facilities in 32 states and Puerto Rico, underscoring the widespread concern over EtO emissions and their potential health impacts.