Bleach baths in patients with skin infections

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

Bleach baths are recommended in patients with frequent skin infections to reduce skin colonisation by pathogenic bacteria, particularly Staphylococcus aureus.

Skin infections

Staphylococcal skin and soft tissue infections are common, especially in children, and can be serious. Despite treatment, more than 20% of patients with skin and soft tissue infections have recurrence within 3 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 antimicrobial action.

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.

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)

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 child-proof top and make sure young children are not able to open it.

Ingestion of small volumes may lead to:

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

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