Monday 8 August 2022

Advantages of quaternary ammonium compounds

Healthcare‐associated infections present a serious and ever-present source of morbidity and mortality. Within the hospital setting, the risk needs to be addressed through an effective infection control strategy, which must include surface cleaning and disinfection, glove disinfection, and hand sanitisation. These measures should be observed by healthcare professionals for the personal hygiene, decontamination of the ward and for treating equipment and surfaces in-between patients. With the latter step, this is additionally important since many patients will be asymptomatic carriers of infectious agents. While many of the microorganisms against which these measures are targeted will not pose a risk to the general populace under normal circumstances, risks exist should these organisms enter the blood or tissues and there are enhanced concerns with immunocompromised patients.

Central to the infection control strategy is the selection and use of an appropriate disinfectant.1 An ideal disinfectant will have a broad spectrum of activity and a relatively short contact time.2 A suitable disinfectant, which meets these objectives, is a blend of quaternary ammonium compounds. As an additional advantage, formulations can be supplemented with detergents to improve cleanability.

Quaternary ammonium compounds (QAC) are a type of disinfectant common to a range of healthcare settings, including hospital environments, as described in the US Centers for Disease Control and Prevention (CDC) ‘Guideline for Disinfection and Sterilization in Healthcare Facilities’.3 These compounds have a strong bactericidal action through the inactivation of bacterial cell enzymes, the denaturation of essential cell proteins, and disruption of the cell membrane (this includes bactericidal efficacy against organisms like multidrug-resistant Staphylococcus aureus, vancomycinresistant Enterococcus, and Pseudomonas aeruginosa).4 In addition, QAC products are effective against fungi5 and viruses6 (including the coronavirus responsible for COVID-19). 

This review article considers the use and application of QACs in healthcare facilities, at the hospital ward level, and provides an overview of the mode of action together with some of the technical challenges presented by this type of disinfectant.


Sandle, T. (2022) Advantages of quaternary ammonium compounds, The Clinical Services Journal, 20 (1):


Posted by Dr. Tim Sandle, Pharmaceutical Microbiology Resources (

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