Do we know how best to disinfect child care sites in the United States? A review of available disinfectant efficacy data and health risks of the major disinfectant classes

Am J Infect Control. 2019 Jan;47(1):82-91. doi: 10.1016/j.ajic.2018.06.013. Epub 2018 Aug 30.


Background: Children in child care settings have a high infectious burden. They are frequently exposed to sanitizing and disinfecting agents, whose toxicities have not been studied in these settings. Current guidance on the preferred disinfection agents for child care is vague.

Methods: This article combines 2 different sources of information: the Environmental Protection Agency registration data on the efficacy of hospital-grade disinfectants and a review of the research on the toxicities of the most common of these disinfectants to summarize information that could be used for more evidence-based early care and education disinfection regulations and guidelines.

Results: Coverage of these organisms varied both between disinfectant classes (defined by active ingredient), as well as within classes. The 3 most common active ingredients in the database-quaternary ammonias, bleaches, and hydrogen peroxides-had 251, 63, and 31 products, respectively. Quaternary ammonias and bleaches are both known asthmagens, with the potential for toxic gas release when mixed. Quaternary ammonias may also cause reproductive toxicity. Disinfectant-grade peroxides have relatively low inhalational toxicity.

Conclusions: A clear rationale is needed to establish policies for determining preferable disinfection products for use in child care settings, based on efficacy against relevant pathogens, toxicity, ease of use, and cost. When other factors are equal, the use of peroxide-based disinfectant products is recommended to minimize inhalational toxicity.

Keywords: Bleach; Child care; Disinfection; Environmental health; Peroxide; Quaternary ammonia compounds.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.
  • Systematic Review

MeSH terms

  • Child Care / methods*
  • Child, Preschool
  • Disinfectants / adverse effects*
  • Disinfectants / pharmacology
  • Disinfection / methods*
  • Drug-Related Side Effects and Adverse Reactions / epidemiology*
  • Humans
  • Infant
  • Risk Assessment
  • United States


  • Disinfectants