The present report is a review of uses of quaternary ammonium cations (QACs) as free monomers or immobilized in micelle-clay complexes in bacteria removal from water. The removal of bacteria from water by filtration through a bed of a granulated QAC-clay micelle was improved by minute concentrations of QAC that were released from the complex during filtration, which exerted biostatic or biocidal effects on the bacteria that emerged from the filter. The relationships between antibacterial activity (minimum inhibition concentration, MIC; minimum lethal concentration, MLC) and structural parameters of the QACs (head group size and alkyl chain length) are discussed. The antibacterial activity of QACs in aqueous phases is mainly due to the free monomeric species. Bacterial inactivation is enhanced by QACs with longer alkyl chains. In most recorded cases, however, minimum MIC and MLC values occurred at n = 14–16 and mostly at n = 16, where n is the number of C atoms in the alkyl chain. This outcome is explained by the combination of two antagonistic effects: (i) An increase in alkyl chain length (i.e., QAC hydrophobicity) enhances QAC binding, penetration, and destabilization of bacterial membranes; and (ii) an increase in alkyl chain length lowers the critical micelle concentration (CMC) of QACs and, thus, reduces QAC monomer concentrations, which more efficiently inactivate bacteria than the micelles. The octadecyltrimethylammonium (ODTMA, n = 18) MLC value (0.25 µm) for the cyanobacterium genus Aphanizomenon is significantly lower than the CMC (300 µm) value. Hence, a test to determine the minimum MLC value at n = 16 is of interest. Removal of bacteria from water by filtration is expected to be made more efficient by small increases in the ODTMA/clay ratio in the complex, which will act to increase the concentrations of ODTMA cations released during filtration.