Advocating for Safe and Effective Disinfectants at work and schools

Alright! Below is the email I sent to Stella’s school advocating for non-toxic disinfectants after inquiring and hearing they used bleach more frequently due to pandemic guidelines. I have been concerned with many of the Back to School Guidelines from the CDC released in May 2020 with recommendations for the pandemic. I discuss all of these in episode 192 of The Naturally Nourished podcast, Keeping our Kids Safe. This blog focuses on the issue of the toxic disinfectants used in the schools wrecking havoc on respiratory and immune health with many of them driving neurological and hormonal harms. Increased sanitization alone has many risks and we will be discussing bacterial resistance, superbugs, the problems of sterility and importance of a diverse microbiome on the Naturally Nourished podcast episode 198 coming up. Then following with episode coming on 199 on the Respiratory system covering the health risks of inhalants and how to support the respiratory system. Stay tuned for that, but for now, here is my letter that you can copy and adjust as desired to share with your school system to advocate for EFFECTIVE AND SAFE sanitary policy that meets current guidelines but will be least harmful to our children and teachers. The best part is, my recommendation for hydrogen peroxide is cheap too! This letter can be used for back to work as well.

I have written countless letters of medical necessity for clients that I am supporting on their fertility journey as many of them are high risk miscarriage and disinfectants such as quats (quaternary ammonium ingredients such as dimethyl benzyl ammonium saccharinate) commonly found in Lysol have been seen to significantly impair fertility or negatively impacting birth outcomes including miscarriage, low birth weight, and neural tube defects (4, 5).

As we go forward with navigating this pandemic we need to be mindful of 3 things:

1. Do not expose the body to unnecessary toxins with known harmful effects to neurological, reproductive, and immunological health.
2. Do not eliminate connection, collaboration, community, sharing and touch. These are very important elements of developing trust, compassion, empathy and keeping the body in a parasympathetic (safe) place which ultimately impacts mental and immune health. Touch is necessary for our developing virome in charge of managing viral activity in our body and our separation or sheltering destroys our exposure and diversity. Also touch provides necessary neurotransmitter and hormone boosts such as serotonin, dopamine, and oxytocin.
3. We can not run or hide from nature. We will not “Beat” or “Kill” this thing, we will become immune and resilient to it. This is done by supporting a robust microbiome (not sterilizing it!), getting out in nature and sunlight, managing blood sugar, supporting detoxification, and regulating inflammatory response in the body.

As comorbidities of obesity, diabetes, and hypertension as well as inflammatory conditions are seen with more severe symptoms of COVID and higher mortality rates, focus now on metabolic health!

1. Prioritize getting insulin and blood sugar levels under control by using a low-carb diet with a healthy serving of protein per meal (this is priority for kiddos too!) as well as healthy whole food fats. Check out The Anti-Anxiety Diet or my ebooks for a resource to jumpstart.
2. Layer in anti-inflammatory berries, roots, and greens as well as antioxidant rich produce such as cruciferous veggies (cauliflower, broccoli, brussels, cabbage, etc.), onions, garlic, leeks that support detoxification and glutathione status!
3. Consider supplementation to further enhance the body such as Probiotics, Cellular Antiox (with glutathione and NAC), Vitamin D, and Bio-C Plus. Check out immune protocol here!And check out the 10-day Detox protocol and supplement packs if you have or are being exposed to these toxic disinfectants!

I have been giving Stella 1 Bio-C Plus, 2 Multiavail Kids chews, 2 KidsBiotic chews daily and 1 Cellular Antiox + 1 mL Vitamin D Balanced Blend 3-4x/wk.

 

Ok here we go:

I’d love to advocate for the use of an equally effective but less toxic option to bleach: Hydrogen peroxide. I’ve gone ahead to do the legwork for your team to confirm that it is on the guidelines of CDC and EPA approved as a disinfectant in childcare settings but has significantly less volatile fumes and health hazards. Hydrogen Peroxide can be purchased as a concentrate and diluted or in already diluted formulas. I have included direct links to childcare guidelines as well as the product recommendation, Bona STL aka Bona PowerPlus Antibacterial Hard-Surface Floor Cleaner. The concerns for chronic exposure to bleach are in the respiratory, immunology, and inflammatory processes of the body. Unfortunately its popular cleaning chemical counterpart quaternary ammonia, has been shown to have DNA damaging, neurotoxic, infertility, and respiratory impact. Both bleach and quaternary ammonia have been shown to deplete glutathione levels in the body which are a significant risk factor for severity of symptoms and mortality with this pandemic (2, 3). 

I have attached a recent review from the American Journal of Infection Control. I found it to be very thorough and it concludes Hydrogen Peroxide as the best option for schools and daycare.  

I want to make this something that is a happy choice for all and you all benefit in a less toxic environment as well, not a burden. If this is something you would consider and there is a variance of cost that is significant I would be happy to look at it with other parents and fund it for the school. I’d also love to purchase a HEPA air filter for the classroom Stella is in if that would be welcomed. 

I am grateful for your time, energy, and consideration on how we can do the best we can for our future ones!

With Gratitude,

Ali Miller, RD, LD, CDE

 

Here is the link for Texas Childcare Centers Guidelines during pandemic, on pages 9 and 10 of the document are the guidelines for sanitization which goes to the next links by the CDC:

https://open.texas.gov/uploads/files/organization/opentexas/OpenTexas-Checklist-Child-Care-Centers.pdf

 

Here is a link to the CDC guidelines on disinfecting your building or facility with COVID-19:

https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html

 

When you click on the link for approved disinfectant products you will get to this link:

https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19

 

If you scroll down on the table it has listed Hydrogen Peroxide and identifies the product Bona STL disinfectant cleaner. I have screenshot the table for ease, located in the 4th row:

 

Here is a direct link to the product that is referenced in this document:

https://us.bona.com/products/bona-powerplus-hard-surface-antibacterial-floor-cleaner.html?gclid=EAIaIQobChMI58Wov6Gq6gIVjcDACh1SRg3_EAAYASAAEgI6OPD_BwE

Per our discussion, this product is pre-mixed, approved, safe, effective, and it does have a pleasant non-toxic odor which will help the staff feel confident it is working!

 

Here is another alternative product that uses the hydrogen peroxide at necessary concentration: https://www.greenbuildingsupply.com/All-Products/Cleaners-Household/Core-Products-HydrOxi-Pro-Concentrated-Cleaner?matrix=3711&gclid=EAIaIQobChMIjYDFtqan6gIVS77ACh1LJgGPEAQYAyABEgJq5fD_BwE

 

I am grateful for your openness to use a product that is BOTH Safe and Effective! My concerns for the use of bleach are from clinical research studies demonstrating:

 

Here are some highlights:

A large, multicenter study of domestic use of bleach and infections in children showed that passive exposure to bleach in the home may even have adverse effects on school-age children’s health by increasing the risk of respiratory and other infections. 13

Obviously the priority is to protect the children and staff from the respiratory pandemic not weaken them and make them more susceptible.

 

Lower level long-term exposure to bleach is now recognized as another cause of respiratory effects. In controlled adult exposure studies, acute exposure to 0.4 ppm bleach in people with chronic exposure can cause a sustained bronchospasm (drop in FEV1), and exposure to 1 ppm chlorine gas can create bronchospasm in those without chronic exposure. 54,55 

These levels are consistent with those seen during disinfecting, because measured airborne levels during real-world disinfection tasks show chlorine levels that are always detectable, with median levels up to 0.4 ppm and spikes as high as 1.3 ppm. 56  

Unfortunately airborne levels of the recommended dilution of bleach in childcare setting can create bronchospasms and respiratory stress. It has been shown volatile compounds from bleach cleaning as recommended can maintain hazardous compounds in the air for 20-30 minutes.  

 

Animal studies have also shown that bleach causes allergic sensitization, with bleach-exposed mice showing more TH2 response and more inflammatory cytokines. 57

This is concerning as the inflammatory response of COVID severe infection includes a cytokine storm which could greatly be exacerbated. 

 

There is also substantial evidence from occupational studies for effects of long-term bleach exposure. Workers who perform cleaning with bleach have increased risk of asthma (RR 2.16, 95% CI 1.03-4.53).58 Cleaners who already have asthma are more likely to have lower respiratory symptoms on days they worked with bleach (with reported OR 3.5 and 1.4).59,60 

Similar to findings in rodent studies, some workers show allergic sensitization, with positive skin prick test results for chloramine and formaldehyde which are by-products of bleach with neurlogically toxic effects. This is interesting as Stella has been exhibiting an abdominal rash after school which looks similar to chlorine rash yet occurs when she has been at school recently vs. in a pool. 

 

Quaternary ammonia and other quats are NOT a safer alternative:

Overall, quats have potential mutagenicity or ability to damage DNA and reproductive toxicity and are known to increase the risk of asthma.

 

Some quaternary ammonium compounds (QACs or quats) are mutagenic and have been shown to damage animal DNA and DNA in human lymphocytes at much lower levels than are present in cleaning chemicals (as low as 0.3 mg/L). 82

This is an increased risk for tumors and cancer

 

Mice whose cages were cleaned with QACs had very low fertility rates. 83

There are endocrine disruptive effects from this compound that have been linked to miscarriage and infertility which can impact both the children and the young teaching staff.  

 

One quat, benzalkonium chloride, has also been associated with dermatitis (34% of people reacted to exposure to 7.5% benzalkonium).85

Quats also increase the risk for asthma and allergic sensitization. There is evidence from occupational exposures for increased risk of rhinitis (OR 3.2, CI 1.42-7.22) and asthma with exposure to quats (OR 7.5, CI 1.84-31.05; RR 2.16, CI 1.03-4.53),28,58,86 and surveillance data in France suggest that the number of work-related asthma cases attributable to quat exposure has increased over 2001-2009. 86

A case series of people with asthma symptoms during cleaning tasks found that more reacted to a controlled exposure to quats than any other chemical.87 Quats are on the Association of

Occupational and Environmental Clinics list of asthmagens 88 and may be a more potent asthmagen than bleach, given the apparent higher odds of asthma with quat exposure than with bleach. 

Skin irritation and asthma can be caused from quat exposure.

 

The EPA’s Design for the Environment Antimicrobial Pesticide Pilot Project was initiated to provide the public with information on safer antimicrobials, and, in line with our review, they have also identified peroxide as one of the safer active ingredients when comparing to bleach or quats (such as quaternary ammonium). The Antimicrobial Pesticide Pilot Project also certifies specific products as safer. To qualify, manufacturers must have submitted their entire list of ingredients, including inactive ingredients, and those ingredients “cannot be listed carcinogens, mutagens or reproductive or developmental toxicants, or persistent, bio-accumulative and toxic chemicals”; they also try to minimize any other human health effects.

 

Link to article:  

https://www.sciencedirect.com/science/article/abs/pii/S0196655318307314

 

References: 

Direct reference:

Stephanie M.Holm MD, MPH, Victoria Leonard RN, PhDd, Timur Durrani MD, MPH, Mark D. Miller MD, MPH. 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. American Journal of Infection Control Volume 47, Issue 1, January 2019, Pages 82-91

 

Citations noted above by number:

13. Casas L, Espinosa A, Borras-Santos A, Jacobs J, Krop E, Heederik D, et al. Domestic use of bleach and infections in children: a multicentre cross-sectional study. Occup Environ Med 2015;72:602-4.

 

54. D’Alessandro A, Kuschner W, Wong H, Boushey HA, Blanc PD. Exaggerated responses to chlorine inhalation among persons with nonspecific airway hyper- reactivity. Chest 1996;109:331-7.

 

55. Sastre J, Madero MF, Fernandez-Nieto M, Sastre B, del Pozo V, Potro MG-D, et al. Airway response to chlorine inhalation (bleach) among cleaning workers with and without bronchial hyperresponsiveness. Am J Ind Med 2011;54:293-9.

 

56. Medina-Ramon M, Zock J-P, Kogevinas M, Sunyer J, Torralba Y, Borrell A, et al. Asthma, chronic bronchitis, and exposure to irritant agents in occupational domestic cleaning: a nested case-control study. Occup Environ Med 2005;62:598-606.

 

57. Kim S-H, Park D-E, Lee H-S, Kang HR, Cho S-H. Chronic low dose chlorine expo- sure aggravates allergic inflammation and airway hyperresponsiveness and acti- vates inflammasome pathway. PLoS ONE 2014;9:e106861.

 

58. Mirabelli MC, Zock J-P, Plana E, Anto J-M, Benke G, Blanc PD, et al. Occupational risk factors for asthma among nurses and related healthcare professionals in an international study. Occup Environ Med 2007;64:474-9.

 

59. Medina-Ramon M, Zock J-P, Kogevinas M, Sunyer J, Basagan~a X, Schwartz J, et al. Short-term respiratory effects of cleaning exposures in female domestic cleaners. Eur Respir J 2006;27:1196-203.

 

60. Vizcaya D, Mirabelli MC, Gimeno D, Anto J-M, Delclos GL, Rivera M, et al. Cleaning products and short-term respiratory effects among female cleaners with asthma. Occup Environ Med 2015;72:757-63.

 

61. Lipinska-Ojrzanowska AA, Wiszniewska M, Walusiak-Skorupa JM. Work-related asthma among professional cleaning female workers. Arch Environ Occup Health 2017;72:53-60.

 

82. Ferk F, Misík M, Hoelzl C, Uhl M, Fuerhacker M, Grillitsch B, et al. Benzalkonium chloride (BAC) and dimethyldioctadecyl-ammonium bromide (DDAB), two com- mon quaternary ammonium compounds, cause genotoxic effects in mammalian and plant cells at environmentally relevant concentrations. Mutagenesis 2007;22:363-70.

 

83. Melin VE, Potineni H, Hunt P, Griswold J, Siems B, Werre SR, et al. Exposure to common quaternary ammonium disinfectants decreases fertility in mice. Reproduct Toxicol 2014;50:163-70.

 

84. Fraise AP. Susceptibility of antibiotic-resistant cocci to biocides. J Appl Microbiol 2002;92(Suppl):158S-62S).

 

85. Basketter DA, Marriott M, Gilmour NJ, White IR. Strong irritants masquerading as skin allergens: the case of benzalkonium chloride. Contact Derm 2004;50:213-7.

 

86. Paris C, Ngatchou-Wandji J, Luc A, McNamee R, Bensefa-Colas L, Larabi L, et al. Work-related asthma in France: recent trends for the period 20012009. Occup Environ Med 2012;69:391-7.

 

87. Vandenplas O, D’Alpaos V, Evrard G, Jamart J, Thimpont J, Huaux F, et al. Asthma related to cleaning agents: a clinical insight. BMJ Open 2013;3, e003568-8.

 

88. Culver A, Geiger C, Simon D. Safer Products and Practices for Disinfecting and Sanitizing Surfaces. City and County of San Francisco: SF Environment 2014:1- 58. Available from: https://sfenvironment.org/sites/default/files/fliers/files/ sfe_th_safer_products_and_practices_for_disinfecting.pdf Accessed September 30, 2016.

 

2. Chapman, J.S., Diehl, M.A. & Lyman, R.C. Biocide susceptibility and intracellular glutathione inEscherichia coli . Journal of Industrial Microbiology 12, 403–407 (1993). https://doi.org/10.1007/BF01569672
3. Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients. Alexey Polonikov. ACS Infectious Diseases Article ASAP DOI: 10.1021/acsinfecdis.0c00288
4. Melin VE, Potineni H, Hunt P, et al. Exposure to common quaternary ammonium disinfectants decreases fertility in mice. Reprod Toxicol. 2014;50:163-170. doi:10.1016/j.reprotox.2014.07.071
5. Lawson CC, Rocheleau CM, Whelan EA, et al. Occupational exposures among nurses and risk of spontaneous abortion. Am J Obstet Gynecol. 2012;206(4):327.e1-327.e3278. doi:10.1016/j.ajog.2011.12.030