Chronic quaternary ammonium compound exposure during the COVID-19 pandemic and the impact on human health

OBJECTIVE: This review examines a relevant, and underacknowledged, emerging global public health concern—the widespread exposure to quaternary ammonium compounds (QACs) during the COVID-19 pandemic. QACs are a widely used class of cationic surfactants with broad spectrum antimicrobial activity that serve as the active ingredients in antimicrobial products. While these compounds have been used for decades, the production and consumer use of QAC-containing products have steeply risen during the COVID-19 pandemic to control and prevent the spread of the SARS-Cov-2 virus. As a result, human exposure to QACs has also drastically increased. METHODS: This critical review was conducted by searching the key terms “quaternary ammonium compounds,” “disinfectants,” “COVID-19,” “SARS-Cov-2,” “human health,” and “human exposure” in the major search engines, including Google Scholar, PubMed and Science Direct. RESULTS: QACs are generally considered safe and effective, yet the magnitude of QAC exposure and the subsequent health effects have not been adequately investigated. Recent studies have revealed the potential for bioaccumulation of QACs in blood and tissue. Inhalation and dermal absorption of QACs are identified as the most significant exposure routes for adults, while children and infants may be significantly more vulnerable to QAC exposure and potential adverse health effects. CONCLUSIONS: QACs are an important tool to protect individual and public health, but understanding the impact of widespread QAC exposure is vital to guide best practices for QAC use and minimize the associated health risks. These pandemic era results warrant further investigation and raise additional questions about the short-term and long-term health effects of chronic QAC exposure. CLINICAL TRIAL REGISTRATION: Not applicable.