ADVANCEMENT OF THE PRACTICE
Open Access
THE PRACTITIONER’S TOOL KIT
Reevaluating Quaternary Ammonium Compounds
Robert W. Powitz, MPH, PhD, RS, CP-FS, DABFET, DLAAS James J. Balsamo, Jr., MS, MPH, MHA, RS, CP-FS, CSP, CHMM, DEAAS Nancy Pees Coleman, MPH, PhD, RPS, RPES, DAAS
Brian Collins, MS, REHS, DLAAS Gary P. Noonan, CAPT (Retired), MPA, RS/REHS, DEAAS Vincent J. Radke, MPH, RS, CP-FS, CPH, DLAAS Charles D. Treser, MPH, DEAAS
Field Experiences Several unseemly occurrences and timely articles recently have come together to make us question the use, and unfortunately the misuse, of many commonly encountered disinfectants and sanitizers. Most notable of these are quaternary ammonium compounds (QACs). They make up more than 50% of disinfectants and sanitizers on the market and account for an estimated $3 billion-a- year industry. Ever since the COVID-19 pan- demic, information and aggressive advertis- ing through mass media and popular press have advocated for wide use of these biocidal agents. Their dramatic increase in use and ubiquitous presence in homes and businesses should give us pause and prompt us to ques- tion potential health risks. QACs are the primary active ingredients in widely disparate products such as air sanitiz- ers, aerosols, wipes (including children’s toy wipes), wettable powders, soluble concen- trates, and pressurized liquids, among the more than 2,000 pesticide products contain- ing QACs. They also appear in personal care, beauty, and hygiene products, including eye drops, toothpaste, alcohol-free hand sanitiz- ers, and fabric fresheners. We were already awash with QACs in retail food establishments and in food pro- duction facilities. Their increased use came about due to legislation; the rise in reported Listeria and other enteric infections; uni- versal use of sanitizer buckets; and new dis- pensing systems used for foam application, sanitizing rinses, janitorial station propor- tioning, and automated CIP (clean in place) equipment and systems. And the list goes on. Even with all this automation, we still
Editor’s Note: The National Environmental Health Association (NEHA) strives to provide relevant and useful information for environmental health practitioners. In a recent membership survey, we heard your request for information in the Journal that is more applicable to your daily work. We listened and are pleased to feature this column from a cadre of environmental health luminaries with over 300 years of combined experience in the environmental health field. This group will share their tricks of the trade to help you create a tool kit of resources for your daily work. The conclusions of this column are those of the authors and do not necessarily represent the official position of NEHA, nor does it imply endorsement of any products, services, or resources mentioned.
A few caveats before we tackle this top- ic. First, we recognize the absolute need for sanitization and disinfection. We champion safe and proper use of all sani- tizing and disinfecting agents and methods. They are essential to preventing foodborne, waterborne, and fomite-contact diseases. Sec- ond, our concerns about more toxic micro- biocidal agents come from our field practice, both anecdotal and direct observation. Most of what we encountered is not recorded, but it provides insight into potential risks of ill- ness, injury, and environmental harm. The unintentional instances described in this column are not isolated, but because they are not catastrophic, people often overlook them as insignificant. Third, we have a professional duty to minimize health and safety hazards by using scientific methods to identify potential hazards, assess risk, and evaluate environmen- tal exposures, while finding suitable substi- tutes that are harmless or less harmful.
We therefore urge everyone to explore the many lesser and nontoxic biocidal agents and methods recently developed to achieve an acceptable level of microbiological safety. In other words, we support the sci- ence of “extreme green cleaning” and hope you will join us in learning more about this emerging approach to sanitation. The lat- est additions to low- to no-toxicity systems and chemicals include steam and steam/ vacuum, electrolyzed water (hypochlorous acid [HOCl]), peroxyacetic acid (aka per- acetic acid [CH 3 CO 3 H]), hydrogen peroxide (H 2 0 2 , in several forms), chlorine dioxide (ClO 2 ), citric acid (C₆H₈O₇), and ozonated water. These systems and chemicals are the most recognizable, but there are many oth- ers worth exploring. Lastly, though it should not have to be repeated, it is critical to read and follow the directions for the use of a sanitization or disinfectant product.
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Volume 89 • Number 4
https://doi.org/10.70387/001c.173650
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