Engineering optimization of ozone generation technologies for medical device sterilization: a review

Abstract Ozone is increasingly recognized as an alternative sterilization agent for medical devices, offering high oxidative potential, broad-spectrum antimicrobial activity, and residue-free decomposition. Despite these advantages, its broader adoption remains constrained by ozone’s chemical instability and sensitivity to environmental conditions, complicating consistent sterilization outcomes, particularly for heat-sensitive devices and those with complex geometries. This review provides a critical evaluation of the four main ozone generation technologies used in medical device sterilization: corona discharge (CD), dielectric barrier discharge (DBD), ultraviolet-induced generation (UV-C), and electrochemical ozone production (EOP). The analysis focuses on how environmental parameters, material interactions, and reactor configurations influence ozone stability, delivery precision, and disinfection efficacy. Comparative findings indicate that while DBD systems provide superior energy efficiency and ozone yield, they require further optimization to mitigate NO x formation and manage thermal instability. CD systems, although widely used, face similar challenges and lower overall efficiency. EOP systems offer safer, NO x -free ozone generation but are limited by low output efficiency and scalability. UV-C systems, although contributing to ozone production through photodissociation, remain best suited as adjuncts in hybrid sterilization platforms. This review highlights key engineering strategies, identifies critical knowledge gaps, and outlines future research directions to advance ozone-based sterilization toward safe, efficient, and clinically relevant applications.