Benzalkonium Chloride—Source of Hospital Infection with Gram-Negative Bacteria

QUATERNARY ammonium compounds (QAC) have been in common use for more than a decade because of their wetting and antibacterial properties. As disinfectants they have many useful attributes and have been recommended for cold sterilization of instruments which cannot be autoclaved.¹ However, since 1957 several reports have stressed the risks of using QAC for skin disinfection.^2-5 It has been shown that aqueous solutions of these compounds lose most of their antibacterial properties if stored with cotton fibers or protein. After accidental contamination of QAC solutions, some organisms, particularly gram-negative bacteria, may survive and even multiply and may then be applied with cotton to the patient's skin prior to needle puncture.⁵ Despite this published experience, cotton pledgets stored in QAC continue to be used for skin cleansing. This report is presented to emphasize the dangers inherent in the use of these compounds in hospital wards and to