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Infections and Benzalkonium Solutions

Andrew E. Ogden, MD; Thomas K. Rathmell, MD
JAMA. 1965;193(11):978-979. doi:10.1001/jama.1965.03090110116044.
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To the Editor:—  Aqueous solutions of quaternary ammonium compounds, eg, benzalkonium chloride, USP, are relatively ineffective against some gram-negative bacilliincluding Pseudomonas aeruginosa. The compounds are partly inactivated when combined with protein (as of the skin) or other organic matter such as cotton pledgets.Serious infections have been reported when aqueous solutions contaminated with Pseudomonas organisms were used for preparation of the surgical field and for maintaining the sterility of surgical instruments. When used as a skin disinfectant for intravenous and intramuscular injections, a rare, fatal infection has occurred.Pseudomonas infections were reported from the use of such solutions in hospital dressing stations and operating theatres (Brit J Industr Med8:22-25 [Jan] 1951). In 1957 it was demonstrated that 1.0 gm of cotton gauze would absorb 3.7 mg of benzalkonium chloride (Zephiran) from a 1:746 solution ("Investigations on Adsorption of Benzalkonium Chloride, Arch Surg75:1036-1042 [Dec] 1957). The danger


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