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A teacher on the West Coast wrote to us inquiring about laws/regulations that prohibit the use of disinfectants particularly harmful to use in sensitive areas like classrooms and playgrounds:
Q: Hello! I hope you can help me and or possibly direct me in regards to a product that my employer is requiring us to use multiple times a day in the classroom and on playground equipment (when students are not around).
It contains Quaternary Ammonium ("Quats").
I want to convince the head of school and administration to consider a product on the N list that is green or environmentally friendly as this is harsh for the students and staff. Those required use this Quaternary Ammonium chemical have received chemical burns when it inadvertently touches the skin, which leads me to believe that it is not diluted properly.
All my research says that EPA and CDC "recommend" environmentally friendly disinfectants for schools and daycare centers but I need to know is there any law or act that forbids quaternary compound use in school classrooms and playgrounds.
Thank you so very much for your expertise.
- To reduce the risk of asthma-related to disinfecting, programs should aim to select disinfectant products on the EPA List N with asthma-safer ingredients (hydrogen peroxide, citric acid, or lactic acid)
- Avoid products that mix these ingredients with peroxyacetic acid, sodium hypochlorite (bleach), or quaternary ammonium compounds, which can cause asthma
Use disinfectants labeled to be effective against emerging viral pathogens, following label directions for appropriate dilution rates and contact times."
A: Based on Beyond Pesticides' "avoid" guidance for Safer Disinfectants and Sanitizers:Holm, S.M., Leonard, V., Durrani, T. and Miller, M.D., 2019. Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes. American journal of infection control, 47(1), pp.82-91.
Some quaternary ammonium compounds (QACs or quats) are mutagenic and have been shown to damage animal DNA and DNA in human lymphocytes at much lower levels than are present in cleaning chemicals (as low as 0.3 mg/L),82 although carcinogenicity has not yet been shown. Mice whose cages were cleaned with QACs had very low fertility rates.83 Also, genes have been discovered that mediate resistance to QACs. There has been an association of some of these genes with beta lactamase genes, raising concern for a relationship between disinfectant resistance and antibiotic resistance.84 One quat, benzalkonium chloride, has also been associated with dermatitis (34% of people reacted to exposure to 7.5% benzalkonium).85
Quats also increase the risk for asthma and allergic sensitization. There is evidence from occupational exposures for increased risk of rhinitis (OR 3.2, CI 1.42-7.22) and asthma with exposure to quats (OR 7.5, CI 1.84-31.05; RR 2.16, CI 1.03-4.53),28, 58,86 and surveillance data in France suggest that the number of work-related asthma cases attributable to quat exposure has increased over 2001-2009,86 thought to be related to increased use of quats, largely in the medical sector.28 A case series of people with asthma symptoms during cleaning tasks found that more reacted to a controlled exposure to quats (10/44) than any other chemical.87 Quats are on the Association of Occupational and Environmental Clinics list of asthmagens88 and may be a more potent asthmagen than bleach, given the apparent higher odds of asthma with quat exposure than with bleach. Thus quats have potential mutagenicity and reproductive toxicity and are known to increase the risk of asthma.
Lipinska-Ojrzanowska, A. and Walusiak-Skorupa, J., 2014. CZWARTORZEDOWE ZWIAZKI AMONIOWE-NOWE ZAGROZENIE W SRODOWISKU PRACY/QUATERNARY AMMONIUM COMPOUNDS-NEW OCCUPATIONAL HAZARDS. Medycyna pracy, 65(5), p.675.
Quaternary ammonium compounds (QACs, quats) belong to organic ionic chemical agents which display unique properties of both surfactants and disinfectants. Their wide distribution in the work environment and also in private households brings about new occupational hazards. This paper reviews reports about the health effects of QACs. QACs could play a role of sensitizers and irritants to the skin and mucous membranes. It is suspected that particular QACs can display an immunologic cross-reactivity between each other and with other chemical compounds containing ammonium ion, such as muscle relaxants widely used in anesthesia. They may promote the development of airway allergy, however, the background mechanisms are still unclear and need to be further investigated. Until now, a few cases of occupational asthma induced by QACs have been described and their involvement in contact dermatitis has been documented. The possibility of anaphylaxis due to QACs cannot be excluded as well.
Chemical and Engineering News: Do We Know Enough About the Safety of Quat Disinfectants?
- Human Exposure: " Among workers like janitors or nurses who routinely handle concentrated disinfectant solutions, the occupational health risks associated with using quats are well established, including dermal irritation, skin sensitization, and occupational asthma."
For more information, please check out Beyond Pesticides' factsheet on Quaternary Ammonium Compounds.