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Bleach baths in patients with skin infections

Author: Kevin Zheng, Medical Student, University of Auckland, New Zealand; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, August 2015.


Bleach baths in patients with skin infections — codes and concepts
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Introduction

Bleach baths are recommended in patients with frequent skin infections to reduce skin colonisation by pathogenic bacteria, particularly Staphylococcus aureus. Bleach baths have been reported to reduce the severity of atopic dermatitis and to reduce the need for topical steroids and antibiotics. 

Skin infections

Staphylococcal skin and soft tissue infections are common, especially in children, and can be severe. Despite treatment, more than 20% of patients with skin and soft tissue infections have a recurrence within three months. Primary staphylococcal skin infections include:

Secondary staphylococcal infections include:

Predisposing factors for skin and soft tissue infections include:

How can skin be decolonised?

Attempts to reduce S. aureus by decolonisation of the skin include combinations of:

What is a bleach bath?

Bleach baths are dilutions of household bleach with water in a bath. The concentration of chlorine is similar to that of a swimming pool. It has an antimicrobial action.

  • The active compound in commercial household bleaches is sodium hypochlorite (NaOCl).
  • Bleach contains 3–6% available chlorine (Cl2), approximately 0.5–1.5% sodium hydroxide (NaOH) as a stabiliser, small quantities of surfactants, and perfume.
  • At pH 11–13, it is an alkaline aqueous solution with major oxidising properties.
  • Sodium hypochlorite 0.0006% is also available as a convenient wash suitable to use in a shower.

Why use a bleach bath?

In conjunction with other methods of decolonisation, bleach baths reduce rates of recurrent primary and secondary skin and soft tissue infections.

Bleach baths have a broad spectrum of action against:

No microbial resistance has been reported to sodium hypochlorite. The effect of bleach baths on decolonising the patient's skin is only temporary, so must be repeated regularly.

Bleach baths also seem to reduce inflammation and itching in eczema.

How to use a bleach bath

Mix 2 ml of 2.2% household bleach for every 1 litre of water to make a 0.005% solution. Brands vary strength, so check the label. If the concentration is higher, use less bleach, and if the concentration is lower, use more bleach.

Bath TypeUsual CapacityMillilitres (mL) of 2.2% Bleach required
Baby bath 15 litres of water 30 ml (approx. two tablespoons)
Full-sized bath 80 litres of water (for 10 cm deep) 160 ml (approx. half a cup)
  • Soak trunk and limbs in the bath for 10–15 minutes. Do not submerge head.
  • Rinse off with warm tap water and pat dry with a towel. Avoid sharing towels.
  • Apply topical steroid and moisturisers if prescribed.
  • Bleach baths are recommended at least twice a week.
  • Keep bleach out of reach from children.
Bleach for a bleach bath

What are the adverse effects of a bleach bath?

Exposure to bleach baths can lead to:

These symptoms are often due to added perfumes or detergents in the bleach. If troublesome, try another brand. Do not apply the bleach directly to the skin.

Toxicity or poisoning is rare but potentially very serious. It is usually due to ingestion of undiluted solution. Keep bleach in its original container with a child-proof top and make sure young children are not able to open it.

Ingestion of small volumes may lead to:

  • Irritation of the oropharynx,
  • Burning sensation in the mouth and throat
  • Thirst
  • Nausea
  • Vomiting
  • Haematemesis (vomiting blood).

Ingestion of large amounts or more concentrated solutions can lead to:

  • Corrosion of the mucous membranes
  • Chest and abdominal pain
  • Watery diarrhoea
  • Melaena (blood in faeces)
  • Ulceration or perforation of the oesophagus or stomach
  • Haemorrhage and shock.

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Related information

 

References

  • Maarouf M, Shi VY. Bleach for Atopic Dermatitis. Dermatitis. 2018
    May/Jun;29(3):120-126. doi: 10.1097/DER.0000000000000358. PubMed PMID: 29762205. PubMed.
  • Christine H. Smith MB BS Ran D. Goldman MD FRCPC. Staphylococcus aureus decolonization for recurrent skin and soft tissue infections in children Canadian Family Physician. Le Médecin de famille canadien. Vol 58: December 2012. PubMed.
  • Tanya M Barnes and Kerryn A Greive. Use of bleach baths for the treatment of infected atopic eczema. Australasian Journal of Dermatology (2013) 54, 251–258. PubMed.
  • Stephanie A. Fritz, MD, MSCI, Bernard C. Camins, MD, MSCR, Kimberly A. Eisenstein, BS, Joseph M. Fritz, MD, Emma K. Epplin, BS, Carey-Ann Burnham, PhD, Jonathan Dukes, MPH, and Gregory A. Storch, MD. Effectiveness of Measures to Eradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft Tissue Infections: A Randomized Trial Infect Control Hosp Epidemiol. 2011 September ; 32(9): 872–880. doi:10.1086/661285. PubMed.
  • Bleach bath instruction handout — Starship Hospital, Auckland

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