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

  • Stephanie M. Holm
    Address correspondence to Stephanie M. Holm, MD, MPH, UCSF Division of Occupational and Environmental Medicine, 2330 Post St #460, San Francisco, CA 94115.
    University of California San Francisco Division of Occupational and Environmental Medicine, San Francisco, CA

    University of California Berkeley Division of Epidemiology, Berkeley, CA

    University of California San Francisco Benioff Children's Hospital Oakland, Oakland, CA
    Search for articles by this author
  • Victoria Leonard
    Western States Pediatric Environmental Health Specialty Unit–University of California San Francisco, San Francisco, CA
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  • Timur Durrani
    University of California San Francisco Division of Occupational and Environmental Medicine, San Francisco, CA

    Western States Pediatric Environmental Health Specialty Unit–University of California San Francisco, San Francisco, CA

    California Poison Control System, San Francisco, CA
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  • Mark D. Miller
    University of California San Francisco Division of Occupational and Environmental Medicine, San Francisco, CA

    Western States Pediatric Environmental Health Specialty Unit–University of California San Francisco, San Francisco, CA
    Search for articles by this author
Published:August 29, 2018DOI:


      • Children in childcare settings are vulnerable to environmental health risks.
      • Evidence-based guidelines are needed regarding surface disinfection in child care.
      • Currently recommended disinfectants do not disinfect against all child care–relevant organisms.
      • Peroxide products have less potential for respiratory toxicity than bleach or quats.


      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.


      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.


      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.


      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.

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