Table 4.

Summary of advantages and disadvantages of disinfectants used as low-level disinfectants

Disinfectant Active	Advantages	Disadvantages
Alcohol	•Bactericidal, tuberculocidal, fungicidal, virucidal •Fast acting •Noncorrosive •Nonstaining •Used to disinfect small surfaces, such as rubber stoppers on medication vials •No toxic residue	•It is not sporicidal. •It is affected by organic matter. •It is slow acting against nonenveloped viruses (eg, norovirus). •It has no detergent or cleaning properties. •It is not EPA registered. •It damages some instruments (eg, harden rubber, deteriorate glue). •It is flammable. (Large amounts require special storage.) •It evaporates rapidly making contact time compliance difficult. •It is not recommended for use on large surfaces. •Outbreaks are ascribed to contaminated alcohol.33
Sodium hypochlorite	•Bactericidal, tuberculocidal, fungicidal, virucidal •Sporicidal •Fast acting •Inexpensive (in diluted form) •Not flammable •Unaffected by water hardness •Reduces biofilms on surfaces •Relatively stable (eg, 50% reduction in chlorine concentration in 30 d)34 •Used as the disinfectant in water treatment •EPA registered	•There is a reaction hazard with acids and ammonias. •It leaves a salt residue. •Corrosive to metals (some ready-to-use products may be formulated with corrosion inhibitors) •It is unstable when active. (Some ready-to-use products may be formulated with stabilizers to achieve longer shelf-life.) •It is affected by organic matter. •It discolors/stains fabrics. •A potential hazard is production of trihalomethane. •It has an odor. (Some ready-to-use products may be formulated with odor inhibitors.). It is irritating at high concentrations.
Improved HP	•Bactericidal, tuberculocidal, fungicidal, virucidal •Fast efficacy •Easy compliance with wet-contact times •Safe for workers (lowest EPA toxicity category, IV) •Benign for the environment •Surface compatible •Nonstaining •EPA registered •Not flammable	•It is more expensive than most other disinfecting actives. •It is not sporicidal at low concentrations.
Iodophors	•Bactericidal, mycobactericidal, virucidal •Not flammable •Used for disinfecting blood culture bottles	•It is not sporicidal. •It is shown to degrade silicone catheters. •It requires prolonged contact to kill fungi. •It stains surfaces. •It is used mainly as an antiseptic rather than disinfectant.
Phenolics	•Bactericidal, tuberculocidal, fungicidal, virucidal •Inexpensive (in diluted form) •Nonstaining •Not flammable •EPA registered	•It is not sporicidal. •It is absorbed by porous materials and irritates tissue. •Depigmentation of skin is caused by certain phenolics. •It can cause hyperbilirubinemia in infants when phenolic is not prepared as recommended.
Quaternary ammonium compounds (eg, didecyl dimethyl ammonium bromide, dioctyl dimethyl ammonium bromide)	•Bactericidal, fungicidal, virucidal against enveloped viruses (eg, HIV) •Good cleaning agents •EPA registered •Surface compatible •Persistent antimicrobial activity when undisturbed •Inexpensive (in diluted form)	•It is not sporicidal. •In general, it is not tuberculocidal and virucidal against nonenveloped viruses. •High water hardness and cotton/gauze can make less microbicidal. •A few reports documented asthma as a result of exposure to benzalkonium chloride. •It is affected by organic matter. •Multiple outbreaks ascribed to contaminated benzalkonium chloride.33
Peracetic acid/HP	•Bactericidal, fungicidal, virucidal, and sporicidal (eg, Clostridium difficile) •Active in the presence of organic material •Environmental friendly byproducts (acetic acid, O2, H20) •EPA registered •Surface compatible	•It lacks stability. •It has potential for material incompatibility (eg, brass, copper). •It is more expensive than most other disinfecting actives. •The odor may be irritating.

If low-level disinfectant is prepared on-site (not ready to use), document correct concentration at a routine frequency.

Abbreviations: EPA, Environmental Protection Agency; HIV, human immunodeficiency virus; HP, hydrogen peroxide.

Adapted from Rutala WA, Weber DJ. Selection of the ideal disinfectant. Infect Control Hosp Epidemiol 2014;35:855–65; and Rutala WA, Weber DJ. Disinfection and sterilization in healthcare facilities. In: Han J, editor. SHEA practical healthcare epidemiology. University of Chicago Press.