The Case Against Liquid & Aerosolized Disinfectants,

their Danger on Public Health and Environment.

By H.E.A.L. (Health & Environment Association Lebanon)

Below is a metadata analysis of compiled scientific papers, findings and experiments all highlighting the
clear and present dangers of Quaternary Ammonium disinfectants in all of its forms and by all of its delivery
vectors (gels, liquid dispensers, sprays, nebulizers, tunnels and other).

A- Quaternary Ammonium causes Infertility. (5 studies)

B- Quaternary Ammonium and environmental toxicity. (6 studies)
C- Quaternary Ammonium causes miscarriages and malformation. (2 studies)
D- Quaternary Ammonium causes Skin and respiratory irritation. (2 studies)
E- Quaternary Ammonium toxicity when used to disinfect food and wash fruits and vegetables. (7 studies)
F- Quaternary Ammonium increases acquired antimicrobial resistance. (2 studies)

A- Quaternary Ammonium causes Infertility:

1- « Exposure to common Quaternary Ammonium disinfectants decreases fertility in mice Vanessa E. Melin,1
Haritha Potineni,1 Patricia Hunt,2 Jodi Griswold,2 Bill Siems,3 Stephen R. Werre,4 and Terry C. Hrubec1,5
Reprod Toxicol. 2014 Dec; 50: 163–170. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260154/ Pub.
2014 doi: 10.1016/j.reprotox.2014.07.071 PMCID: PMC4260154, NIHMSID: NIHMS616368, PMID: 25483128

2- « Quaternary Ammonium Disinfectants Cause Subfertility in Mice by Targeting Both Male and Female
Reproductive Processes », Vanessa E Melin 1 , Travis E Melin 2 , Brian J Dessify 2 , Christina T
Nguyen 2 Caroline S Shea 1 , Terry C Hrubec 3 PMID: 26582257 DOI: 10.1016/j.reprotox.2015.10.006

3- Murray KA, Parker NJ. « Breeding genetically modified rodents: tips for tracking and troubleshooting
reproductive performance », Lab animal. 2005;34:36–41. https://www.ncbi.nlm.nih.gov/pubmed/15806089

4- Hunt P. Lab « disinfectant harms mouse fertility. » Patricia Hunt interviewed by Brendan Maher. Nature.
2008;453:964 https://www.ncbi.nlm.nih.gov/pubmed/18563110

5- Gaskins, Audrey (2017). « Occupational use of high-level disinfectants and fecundity among nurses ». Scand J
Work Environ Health. 43 (2): 171–180. doi:10.5271/sjweh.3623. PMC 5840865. PMID 28125764.

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B- Quaternary Ammonium and environmental toxicity:

1- Sánchez-Fortún, F. Marvá, A. D’ors et E. Costas, « Inhibition of growth and photosynthesis of selected green
microalgae as tools to evaluate toxicity of dodecylethyldimethyl-ammonium bromide », Ecotoxicology, vol.
17,‎11 janvier 2008, p. 229–234 (ISSN 0963-9292 PMID: 18188698 DOI: 10.1007/s10646-007-0189-2)

2- Norbert Kreuzinger, Maria Fuerhacker, Sigrid Scharf et Maria Uhl, « Methodological approach towards the
environmental significance of uncharacterized substances — quaternary ammonium compounds as an
example », Desalination, série MEDAWATER International Conference on Sustainable Water Management,
Rational Water Use, Wastewater Treatment and ReuseJune 8–10, 2006, Marrakech, Morocco, vol. 215,‎5
septembre 2007, p. 209–222 (DOI 10.1016/j.desal.2006.10.036, lire en ligne, consulté le 19 février 2016).

3- Guohua Jing, Zuoming Zhou et Jing Zhuo, « Quantitative structure–activity relationship (QSAR) study of
toxicity of quaternary ammonium compounds on Chlorella pyrenoidosa and Scenedesmus quadricauda »,
Chemosphere, vol. 86,‎1er janvier 2012, p. 76–82 (DOI 10.1016/j.chemosphere.2011.09.021, lire en ligne,
consulté le 19 février 2016).

4- Yi Chen, Marc Geurts, Sascha B. Sjollema et Nynke I. Kramer, « Acute toxicity of the cationic surfactant C12-
benzalkonium in different bioassays: How test design affects bioavailability and effect concentrations »,
Environmental Toxicology and Chemistry, vol. 33,‎1er mars 2014, p. 606–615 (ISSN 1552-8618, DOI
10.1002/etc.2465) PMID: 24273010 DOI: 10.1002/etc.2465

5- Zhang C.; Cui F.; Zeng G.; Jiang M.; Yang Z.; Yu Z.; Zhu M.; Shen L. « Quaternary Ammonium Compounds
(QACs): A Review on Occurrence, Fate and Toxicity in the Environment. », Sci. Total Environ. 2015, 518–519,
352–362. 10.1016/j.scitotenv.2015.03.007. PMID: 25770948 DOI: 10.1016/j.scitotenv.2015.03.007

6- Ying G.-G. G. Fate, Behavior and Effects of Surfactants and Their Degradation Products in the Environment.
Environ. Int. 2006, 32 (3), 417–431. PMID: 16125241 DOI: 10.1016/j.envint.2005.07.004

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C- Quaternary Ammonium causes miscarriages and malformation:

1- Narotsky MG, Best DS, McDonald A, Godin EA, Hunter ES, 3rd, Simmons JE. « Pregnancy loss and eye
malformations in offspring of F344 rats following gestational exposure to mixtures of regulated
trihalomethanes and haloacetic acids », Reproductive toxicology. 2011;31:59–65. PMID: 20850520

2- Gaskins, Audrey (2017). « Occupational use of high-level disinfectants and fecundity among nurses ». Scand J
Work Environ Health. 43 (2): 171–180. doi:10.5271/sjweh.3623. PMC 5840865. PMID 28125764.

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D- Quaternary Ammonium causes Skin and respiratory irritation:

1- Bello, Anila; Quinn, Margaret M.; Perry, Melissa J.; Milton, Donald K. (2009). « Characterization of
occupational exposures to cleaning products used for common cleaning tasks-a pilot study of hospital
cleaners » Environmental Health. 8: 11. doi:10.1186/1476-069X-8-11. PMC: 2678109. PMID: 19327131

2- Warshaw, E. M.; et al. (2007). « Contact dermatitis of the hands: Cross-sectional analyses of North American
Contact Dermatitis Group Data, 1994-2004 ». Journal of the American Academy of Dermatology. 57 (2):
301–314. doi:10.1016/j.jaad.2007.04.016. PMID 17553593.

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E- Quaternary Ammonium toxicity when used to disinfect food and wash fruits and vegetables:

1- Tennant DR. « Estimating acute dietary intakes of chemicals. » Regulatory toxicology and pharmacology:
RTP. 1999;30:S99–102 https://www.ncbi.nlm.nih.gov/pubmed/10597621

2- Lin GH, Hemming M. « Ocular and dermal irritation studies of some quaternary ammonium compounds.
Food and chemical toxicology » An international journal published for the British Industrial Biological
Research Association. 1996;34:177–82. https://www.ncbi.nlm.nih.gov/pubmed/8606034

3- Van Miller JPaEVW. Unpublished report number 51-504. Bushy Run Research Center; Export, PA, U. S: 1988.
« Ninety-Day Dose Range-Finding Study with Alkyl Dimethyl Benzyl Ammonium Chloride (ADBAC) ».

4- Weaver EWaJPVM. Unpublished report number 51-514. Bushy Run Research Center; Export, PA, U. S: 1988.
« Two-Week Dose Range Finding Screen with Alkyl Dimethyl Benzyl Ammonium Chloride (ADBAC) ».

5- Gill MW, Hermansky SJ, Wagner CL. « Chronic Dietary Oncogenicity Study with Alkyl Dimethyl Benzyl
Ammonium Chloride (ADBAC) in Mice ». Unpublished report number 53-515. Bushy Run Research Center;
Export, PA, U. S: 1991

6- Hegstad K, Langsrud S, Lunestad BT, Scheie AA, Sunde M, Yazdankhah SP. « Does the wide use of quaternary
ammonium compounds enhance the selection and spread of antimicrobial resistance and thus threaten our
health? » Microbial drug resistance. 2010;16:91–104. https://www.ncbi.nlm.nih.gov/pubmed/20370507

7- Kendra Hammond, MD, Tiffany Graybill, Susannah E. Spiess, MD, Jenny Lu, MD, and Jerrold B. Leikin, MD « A
complicated hospitalization following dilute ammonium chloride ingestion » J Med Toxicol. 2009 Dec; 5(4):
218–222. PMCID: PMC3550414 PMID: 19876856 doi: 10.1007/BF03178271
F- Quaternary Ammonium increases acquired antimicrobial resistance:

1- Tezel U.; Pavlostathis S. G.. « Role of Quaternary Ammonium Compounds on Antimicrobial Resistance in the
Environment. In Antimicrobial Resistance in the Environment » John Wiley & Sons, Inc.: Hoboken, NJ, USA,
2011; pp 349–387. 10.1002/9781118156247.ch20. https://doi.org/10.1006/eesa.1999.1860

2- Bacterial resistance to disinfectants containing quaternary ammonium compound G.Sundheim,

S.LangsrudE.HeirA.L.Holck, Matforsk, N-1430, Ås, Norway Accepted 29 January 1998, Available online 18
September 1998. https://doi.org/10.1016/S0964-8305(98)00027-4

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In Conclusion:

Quaternary Ammonium compounds can cause countless toxic effects by all routes of exposure including
inhalation, ingestion, dermal application and irrigation of body cavities. Exposure to any diluted solutions can
cause mild to very sever irritation, exemas, blisters and other. Quaternium-15 is the single most often found
cause of allergic contact dermatitis of the hands (16.5% of all registered and hospitalized cases). Any dilutions of
quaternary ammonium compounds are corrosive and can cause burns to the skin and the mucous membranes.
They can produce systemic toxicity including liver and kidneys toxicity due to their curare-like properties. They
can also cause allergic reactions to long term repertory diseases and conditions even lung cancers.
Severe caustic burns of the skin and mucous membranes can occur depending on the agent, the concentration
and the immunological state of the victim. Other Quaternary Ammonium exposure signs can manifest in the
form of nausea, vomiting, abdominal pain, anxiety, restlessness, coma, convulsions, hypotension, cyanosis and
apnoea due to respiratory muscle paralysis; death may occur within 1 or 3 hours after exposure by
compromised infants or the very elderly. Systemic cancers, Haemolysis and methaemoglobinemia have been
also reported after exposure. Quaternary ammonium-based disinfectants (such as Virex and Quatricide) were
tentatively identified as the most probable cause of jumps in birth defects and fertility problems in caged lab
mice. The quaternary ingredients in the disinfectants include alkyl-dimethyl-benzyl-ammonium chloride (ADBAC)
and dodecyl-dimethyl-ammonium-chloride (DDAC). Similarly sanitary hospital workers and Nurses who are
exposed to Quaternary Ammonium also showed a much higher rate of infertility and birth defects in their
infants than the rest of the population. Many of this new data contradicted much older and short term hatsful
studies previously reviewed by the U.S. Environmental Protection Agency (some dating back to 1952) creating
the basis for the tobacco science that many Quaternary Ammonium still use today to promote their toxic
products under false pretexts.

Final Thoughts, Risk Assessment and Recommendations:

It is of utmost importance and of extreme urgency that all so-called disinfectant sprays, nebulizers, tunnels,
hand held gadgets and dispensers be immediately banned from being used in any way shape or form by a
decree from the Lebanese Ministry of Health given the eminent and present dangers resulting from the
continued usage of such devices and to the immeasurable toxic effect they may have on the general public and
the environment. Those substances should be strictly regulated for the exclusive use in surgical rooms under
strict conditions and protocols in the hopes that even that singular application gets discontinued and replaced.