Health Security

Volume 18, Number 6, 2020 ª Mary Ann Liebert, Inc.

DOI: 10.1089/hs.2020.0104

Commentary

Are Disinfectants for the Prevention

and Control of COVID-19 Safe?
Downloaded by 103.10.230.85 from www.liebertpub.com at 01/03/21. For personal use only.

Fatin Samara, Rina Badran, and Sarah Dalibalta

Keywords: COVID-19, Disinfectants, Health effects, Decontamination, Exposure, Risk communication

W ith the deteriorating situation caused by the

severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2), which causes novel coronavirus disease
Although all of these products should be used with the
manufacturers’ recommended precautions, the utmost care
must be used with some due to their potentially high level
2019 (COVID-19), it is not surprising that there has been a of toxicity and risk to human health.7
tremendous rise in the purchase and use of disinfectants.
The virus spreads by human-to-human interactions and
exposure to coughing, sneezing, respiratory droplets and Risk of Disinfectant Use on Health
aerosols from an infected person, in addition to, interac-
tions with contaminated surfaces.1,2 On contaminated According to Chang et al,7 the National Poison Data
surfaces such as metal, glass, and plastic, human cor- System reported a substantial increase in cases of disinfec-
onaviruses can survive from several hours up to 9 days, tant poisoning during the present COVID-19 outbreak.
highlighting the need to disinfect surfaces effectively.2 Notably, cases related to poisoning exposure showed that
Hence, there is a wide range of marketed disinfectants such bleach products (62.1 %) accounted for the largest per-
as household bleach, alcohol, and hand sanitizers that can centage of poisoning prior to and during COVID-19,
be used to prevent and control the spread of the virus. followed by nonalcohol disinfectants (36.7%) and hand
Although disinfectants can be effective, if misused, they can sanitizers (36.7%). The main route of exposure reported
also be hazardous to humans as well as to the environment.3 was by inhalation, which increased substantially by 35.3%
The active biocidal ingredients of these products range during the first few months of the COVID-19 pandemic.7
from natural materials such as ethanol, L-lactic acid, citric Commonly known bleach (chlorine) is a surface disin-
acid, and hydrogen peroxide to synthetic substances such as fectant made of sodium hypochlorite. It is recommended
sodium hypochlorite, hypochlorous acid, quaternary am- for use at a concentration of 0.1% or 1,000 parts per
monium compounds, octanoic acid, peroxyacetic acid, and million (1 part of 5% strength household bleach to 49 parts
glycolic acid at different concentrations.3,4 Table 1 presents of water). Alcohol at 70% to 90% strength can also be used
some of the most widely used natural and synthetic surface for surface disinfection.8 However, these are also known to
and hand disinfectants approved by the Environmental cause irritation of the skin and eyes, irritation to the re-
Protection Agency for the prevention of SARS-CoV-2.4 spiratory tract, and asthma in some individuals.3 Moreover,

Fatin Samara, PhD, is an Associate Professor of Environmental Sciences, and Sarah Dalibalta, PhD, is an Associate Professor of
Biology; both in the Department of Biology, Chemistry, and Environmental Sciences, College of Arts and Sciences, American
University of Sharjah, Sharjah, United Arab Emirates. Rina Badran is an Undergraduate Student, Department of Biological Sciences,
Colleges of Arts, Sciences, and Education, Florida International University, Miami, FL.

496
 SAMARA ET AL

Table 1. Commonly Marketed Disinfectants Against SARS-CoV-24-6

Exposure Occupational
Area of Concentration Time Exposure Health Effects from
Product Active Ingredient Application (%) (minutes) Limita (ppm) Prolonged Exposure
Household Sodium hypochlorite Surfaces 5.25-6.15 1-10 0.5 (per 15-minutes) Skin, ocular irritation,
Bleach and gastric burns
Hypochlorous acid Surfaces 0.017-0.046 10 0.5 (per 15-minutes)
Glycolic acid Surfaces 11.185 10 Not found Chemical burns to respiratory track
Peroxyacetic acid Surfaces 2.38-15 1 0.4 (per 15-minutes)b Burns of the skin and eyes
Quaternary Ammonium Surfaces 0.05-0.2 0.5-10 Not found Mild to severe irritation of the
compounds (quats) skin and mucous membranes
Octanoic acid Surfaces 0.099-3.05 2 Not found Skin irritation, scales, and scabs
Alcohol Ethanol Surfaces 60-80 0.5-1 1,000 Irritation of the respiratory tract
and effects on the central
nervous system
L-lactic acid Surfaces 0.19-1.77 5-10 Not found Eye and skin irritation
Citric acid Surfaces 2.5-4.9 5 5 mg/m3 Eye and skin irritant
Hydrogen peroxide Surfaces 0.39-27.5 5 1 Burns of the skin and eyes
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Hand Benzalkonium Hands 0.12< 3-10 Skin irritation if prolonged contact

sanitizer chloride (quats)
Hand Ethanol Hands 60-95 0.5-1 1,000 Irritation of the respiratory tract
sanitizer and effects on the central
nervous system
a
The National Institute for Occupational Safety and Health recommended exposure limits for up to a 10-hour time weighted average.
b
American Conference of Governmental Hygienists.
Abbreviation: ppm, parts per million.

the use of bleach results in the formation of toxic haloge- permanent damage to the nervous system, or death.12 In
nated volatile organic compounds in the indoor air including Canada, hand sanitizers have been recalled because they
carbon tetrachloride, chloroform, 1,1-dichloroethene and contain industrial-grade ethanol, which is not authorized
1,1-dichloroethane, and chlorobenzene.9 The concentrations for use on hands.13 In the United Arab Emirates, hand
of these chemicals detected in the air 30 minutes after ap- sanitizers have been recalled due to low alcohol content
plication were higher than those detected before application, (£60% alcohol), which is considered ineffective for fighting
indicating that the use of bleach may be an important source viruses.14
of inhalation exposure for these compounds.9 Additionally, there are concerns that using antibacterial
Hand disinfection (sanitizers) has been considered crit- hand sanitizers can contribute to antibiotic-resistant bac-
ically important, as SARS-CoV-2 can be transmitted by teria as well as the loss of a barrier to protect against the
touch and last on hands from 10 min up to 2 hours.10 The coronavirus.15 It is, therefore, clear that there is a need to
Centers for Disease Control and Prevention recommends formulate safe and effective disinfectants and raise consumer
that a minimum of 60% ethanol can maintain hand hy- awareness to potential health hazards. The ideal disinfectant
giene and effectively reduce the number of pathogens should have a low toxicity profile with short- and long-term
present in the hands. Alternatively, some hand sanitizers exposure. Since the majority of the disinfectants are able to
contain benzalkonium chloride (or quats), a quaternary kill or inactivate a wide range of microorganisms, it is crucial
ammonium compound that can irritate the skin and re- to understand the exposure time needed to target specific
spiratory system and may induce asthma in some individ- pathogens of interest with minimal risks.
uals.10,11 Unsurprisingly, hand sanitizer use has been at a
peak during this pandemic. While people have been using
hand sanitizers on a daily basis, often multiple times a day, Conclusions
it is important to investigate whether those chemicals are
safe at that level of exposure, especially for pregnant women In summary, disinfection is crucial in the prevention and
and children. What has also been evident is that consumers spread of COVID-19; however, disinfection should be
have been inadvertently exposed to hand sanitizers that can carried out with appropriate precautions to reduce exposure
be highly detrimental to health. For example, the US Food to harmful byproducts. A compound recently added to the
and Drug Administration has recalled many sanitizers Environmental Protection Agency’s list5 is thymol, a nat-
containing methanol, which can cause vomiting, head- ural phenolic compound obtained from thyme oil. Such
aches, blurred vision, permanent blindness, seizures, coma, alternative measures can include the use of less toxic

Volume 18, Number 6, 2020 497

 SAFETY OF COVID-19 DISINFECTANTS

chemical disinfectants such as naturally occurring sub- 8. World Health Organization. Cleaning and disinfection of
stances, which include thymol, ethanol, and hydrogen environmental surfaces in the context of COVID-19. Pub-
peroxide, to limit risks to humans and the environment. lished May 16, 2020. Accessed August 5, 2020. https://www.
Since these substances are used in low concentrations or who.int/publications/i/item/cleaning-and-disinfection-of-
decompose rather rapidly, they leave no toxic residues.16 environmental-surfaces-inthe-context-of-covid-19
9. Odabasi M. Halogenated volatile organic compounds from
Moreover, appropriate personal protective equipment
the use of chlorine-bleach- containing household products.
should be worn to avoid inhalation, and careful consider- Environ Sci Technol. 2008;42(5):1445-1451.
ation must be given to chemical use, concentrations, room 10. Kampf G, Karamer A. Epidemiologic background of hand
ventilation, and application technique.17 In the case of hygiene and evaluation of the most important agents for
hand disinfection, nonirritating soaps and alcohol-based scrubs and rubs. Clin Microbiol Rev. 2004;17(4):863-893.
hand sanitizers should be used instead of detergents and 11. Lakind JS, Goodman M. Methodological evaluation of
hand sanitizers containing benzalkonium chloride, which human research on asthmagenicity and occupational cleaning:
can exacerbate skin damage and irritation.10 Use of hand a case study of quaternary ammonium compounds (‘quats’).
sanitizers, though, should be limited, as they can raise the Allergy Asthma Clin Immunol. 2019;15(1):1-14.
risk of infection by disrupting the normal flora and irri- 12. US Food and Drug Administration (FDA). FDA advises
tating the skin, which normally acts as a barrier to harmful consumers not to use hand sanitizer products manufactured
by Eskbiochem. Updated June 29, 2020. Accessed August 5,
agents. Although no safe chemicals exist, there is a con-
2020. https://www.fda.gov/drugs/drug-safety-and-availability/
tinued need to enhance consumer awareness and develop
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fda-advises-consumers-not-use-hand-sanitizer-products-
disinfectants that are less harmful to humans and the manufactured-eskbiochem
environment. 13. Slaughter G. Health Canada recalls six hand sanitizers con-
taining industrial-grade ethanol. CTV News. June 6, 2020.
Last updated June 10, 2020. Accessed August 5, 2020.
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against-sars-cov-2 Fatin Samara, PhD
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Wkly Rep. 2020;69(16):496-498. Email: fsamara@aus.edu

498 Health Security