Beyond quaternary ammonium compounds: Evaluating the harms of non-QAC disinfectant agents in healthcare and industry

Quaternary ammonium compounds (QACs) account for approximately 35% of the U.S. disinfectant market, but mounting concerns about their links to occupational asthma, reproductive toxicity, and antimicrobial resistance as well as their allergic potential have driven increased adoption of non-QAC chemical disinfectants, which comprise the remaining 65% of the market. This review critically examines the health, environmental, and material compatibility profiles of these non-QAC agents, including alcohols, chlorine compounds, hydrogen peroxide, peracetic acid, and phenolics. While many of these agents reduce certain risks associated with QACs, they present new challenges such as respiratory irritation, corrosiveness, systemic toxicity, and ecological persistence. Hydrogen peroxide and peracetic acid show favorable biodegradability but may impair wastewater systems or damage sensitive equipment. Among emerging technologies, ultraviolet-C (UV-C) disinfection stands out for its high antimicrobial efficacy, absence of chemical residues, and strong environmental profile. A risk-balanced, evidence-based approach to disinfectant selection is essential, and greater integration of UV-C and other non-chemical technologies may support safer and more sustainable infection control practices.