Sterility is required for medical devices use in invasive medical procedures, and for some situations in the food industry. Sterilization of heat-sensitive or porous materials or devices, such as endoscopes, porous implants, liquid foodstuff, and liquid medicine, poses a challenge to current technologies. There has been a steady interest in using high-pressure carbon dioxide as a process medium for new sterilization technology. Among the potential advantages are that CO2 may sterilize at low temperatures. This paper is a review of the technical and patent literature, including analysis of the microorganisms studied, important operating parameters, and deactivation mechanisms. The current research status and challenges are summarized at the end of this paper. (c) 2006 Elsevier B.V. All rights reserved.