Knowledge, attitudes, and practice of medical students towards the use of benzalkonium chloride in hand sanitization from the perspective of environmental sustainability

Control measures for disinfectant pollution and related anthropogenic behaviors are required. Benzalkonium chloride (BAC) with widespread use especially in hand sanitization is highlighted as a representative disinfectant emerging contaminant. This cross-sectional survey was conducted to assess the knowledge, attitudes, practice regarding BAC use for hand hygiene among medical students from the perspective of environmental sustainability. Of the 703 responding students, only 3.7% had never used hand sanitizer products containing BAC. But few students paid attention to the "environmental friendliness" property of products when consumption. Mean knowledge test score was 1.90 out of 5, suggesting poor knowledge regarding BAC use. Most students had positive attitudes toward source control of BAC pollution and strong intentions to learn more about environmental knowledge related to BAC and other disinfectants. Data indicated that medical students had positive attitudes but lacked knowledge and practices towards eco-friendly disinfectant use, thus further training and practice standards are required.