use of bleach baths to decrease recurrent skin infections

1000 healthy kids aged 3 months to 18 yrs with probable community-associated staph aureus skin/soft tissue (SSTI) or invasive infection randomized to daily hygiene vs that with 2x/week bleach baths for 3 months (see skin infections beach bath clin ID 2014 in dropbox, or DOI: 10.1093/cid/cit764). basically,

--recurrence of SSTI common: about 50%   
--bleach bath consisted of adding 5ml of bleach (regular bleach, 6.0% hypochlorite) to every gallon of bath water, and bathing in that for 15 min 2x/week, for 3 months. 12-month followup. dilute bleach solutions known to kill staph.
--colonization cultures were obtained from nares, pharynx, groin. 56% were colonized with s. aureus at minimum of 1 site (most common = groin in 38%, nares 22%, throat 17%). MRSA (methicillin-resistant) more common in groin and throat, MSSA (methicillin-sensitive) in nose. more colonization in younger ages, esp <2yo
--rate of "medically-attended" recurrent infection: 17% with bleach bath and 20.9% with regular hygiene (not significant, but arguably too small a trial: needed around 1000 kids to detect 50% reduction with 90% power). no diff between MRSA and MSSA infections (though most infections were MRSA). higher rates of infection with more colonization sites culture-positive
--not adverse effects found, other than dry skin in a few kids and burning eyes in 1 patient only.

so, obviously a small study at least in terms of outcomes, only with kids, short-term (3 months of baths, with 12 month follow-up) and not powered to get significant results. but, besides that, pretty intriguing... recurrent staph infections really common in kids and adults. seems like a pretty benign therapy (esp given the alternatives of recurrent courses of antibiotics, need for frequent ER visits, etc -- ie alternatives not great). and by my quick and dirty (?) measurements in my bathtub, 6"deep water would require 4 ounces of bleach. so, might be reasonable to try in people with documented recurrent infections???? i checked out the Am Acad of Dermatology website for hidradenitis, and they suggested bleach bath as one approach (1/2 cup non-scented bleach to 1/2 full bathtub of water), noting that it works sometimes.

-----------------------------

From: Orlander, Jay D
Sent: Wednesday, March 12, 2014 11:44 AM
To: Geoff A. Modest, M.D.
Subject: RE: use of bleach baths to decrease recurrent skin infections
I had a relative with 5+ recurrent MRSA skin absecess whose dermatologist treated him in this manner.  None since, clean for 2+ years now.

 -------------------------------
From Rick Bird:
This raises some concern about handling bleech carefully since it has no immediate warning due to relatively low water solubility doesn't cause immediate burning of the eyes, nose and throat, but can burn the lungs, particularly w/repeated use, leading to reactive airway dysfunction syndrome.  Many of my patients clean weekly or more often pouring pure bleech into the tub and toilets then scrubbing, w/varying dilution, wondering why they have persisting dry coug

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