ABSTRACT
Quaternary ammonium compounds are antimicrobial chemicals that provide significant public health benefits by controlling bacteria and viruses that cause infections such as colds, flu, and COVID. The benefits of antimicrobial QACs are seen in increased quality-of-life measures, such as reduced time away from work and school and reduced medical costs. As active antimicrobial agents, QACs and QAC-containing consumer and professional products are highly regulated by authorities such as the US Environmental Protection Agency and the European Chemicals Agency. A complete database of guideline safety studies, covering human and environmental health, is available and has been reviewed by multiple regulatory agencies globally. The conclusions of regulatory agencies from these studies indicate no concerns regarding reproductive effects, genotoxicity, carcinogenicity, or other systemic adverse effects. In contrast, some published academic studies provide mixed findings on lipid synthesis, reproductive effects, and asthma. However, many of these studies have been found not to be robust in design and lacked appropriate controls to support conclusions of a clear and direct association with an adverse effect. The hazard data for the QACs show that their primary critical effects are point-of-contact effects such as irritation, which exhibit a threshold and occur in a dose–response manner. This review compares toxicity information for QACs, examines human exposures, and quantifies the risks estimated from QAC product use. QACs are an important cleaning and hygiene tool, and the abundance of safety data generated for them provides assurance they can be safely used in professional and household products.
ABSTRACT
INTRODUCTION: Between early March 2020 and the end of May 2020, Italy issued strict measures to limit further spread of coronavirus disease 2019 (COVID-19) and became the first European country that imposed a lockdown on the population. The aim of this study was to assess the impact of these restricted conditions on the activity of the Poison Control Center (PCC) of Policlinico Umberto I Hospital-Sapienza University of Rome. METHODS: This was a retrospective analysis of calls received by the PCC during the lockdown period March 9, 2020 through May 31, 2020 compared to the same time period in year 2019 (reference). RESULTS: We observed a reduction in calls from hospitals and emergency departments and an increase in calls from private citizens about exposures to products or intoxications during the lockdown. There were increases in unintentional exposures and exposures to hand and surface sanitizers among household and cleaning products. There was a decrease in calls concerning medications, which were mostly from hospitals and emergency departments. We observed increases in exposures requiring clinical observations among adults and referral to the emergency department among pre-school children. CONCLUSIONS: Public health protection measures against COVID-19 to improve hygiene and maintain clean environments can increase exposures to hazardous products in the domestic environment. We observed an increase in unintentional exposures to household and cleaning products during the lockdown and an increase in ED referrals for pre-school children compared to the previous year. Our data suggest the need for improvements in public campaigns that promote safer handling of household products and prevent unnecessary exposures during a lockdown. The public health promotion activity can benefit the community after the pandemic and prepare the community for lockdowns in the future.