Bleach Baths for Staph Pimples
Bleach baths can be considered as part of a decolonization strategy for recurrent staphylococcal skin infections (including staph pimples), but they should be combined with nasal mupirocin rather than used alone, and are only recommended when patients have multiple recurrent infections despite good hygiene measures. 1
When to Consider Bleach Baths
Bleach baths are appropriate in two specific scenarios for staphylococcal skin infections:
Recurrent infections: When a patient experiences recurrent skin and soft tissue infections (typically defined as 2 or more discrete episodes at different sites over 6 months) despite optimizing wound care and hygiene measures 1
Ongoing household transmission: When transmission is occurring among household members or close contacts despite proper hygiene 1
Important caveat: Bleach baths should NOT be used as monotherapy. The Infectious Diseases Society of America guidelines explicitly recommend combining nasal mupirocin (twice daily for 5-10 days) with topical body decolonization using bleach baths, rather than using bleach baths alone. 1
Proper Preparation and Dosing
The concentration is critical to avoid skin irritation while maintaining antimicrobial efficacy:
Concentration: 1 teaspoon of bleach per gallon of bathwater, or equivalently ¼ cup of bleach per ¼ tub (approximately 13 gallons) of water 1, 2
Critical safety instruction: Provide clear dilution instructions to patients, as inadequate dilution can cause significant skin irritation 1
Evidence Base and Limitations
The recommendation for bleach baths in staphylococcal infections has important limitations:
No direct clinical trial evidence: There are no published clinical trials evaluating bleach baths specifically for recurrent MRSA or MSSA skin infections 1
Extrapolated evidence: The recommendation is based on in vitro data showing that sodium hypochlorite at appropriate concentrations kills community-acquired MRSA after 5 minutes of exposure 1, 2
Bundled interventions: Effectiveness data comes from community outbreak settings where bleach baths were used as part of bundled interventions with other measures 1
Mixed research findings: A 2016 randomized controlled trial in atopic dermatitis found that bleach baths did not reduce S. aureus colonization more than water baths alone over 4 weeks 3, and a 2019 Cochrane review found insufficient evidence to support bleach baths for reducing S. aureus burden 4
The Complete Decolonization Strategy
When decolonization is indicated, implement all components together:
Nasal mupirocin: Apply twice daily for 5-10 days to both nares 1
Bleach baths: As detailed above, twice weekly for up to 3 months 1
Hygiene reinforcement: Cover infected skin and draining wounds, avoid sharing personal items, clean frequently-touched surfaces daily with commercial cleaners 1
Household evaluation: Assess close contacts for evidence of S. aureus infection if household transmission is suspected 1
Safety Considerations
Age restriction: While not explicitly contraindicated, exercise caution in very young children; some guidelines suggest avoiding antiseptics in infants under 2 months 1
Skin irritation risk: The primary adverse effect is skin irritation from inadequate dilution 1
Ventilation: Ensure adequate bathroom ventilation to prevent inhalation of fumes 2
Never mix with other products: Particularly avoid mixing with ammonia-containing products, which creates toxic gases 2
Post-bath care: Apply moisturizer immediately after patting skin dry to maintain skin barrier function 2
What NOT to Do
Do not use bleach baths as first-line treatment for acute staph pimples—these require appropriate wound care (incision and drainage for abscesses) and systemic antibiotics when indicated 1
Do not use bleach baths alone without nasal mupirocin for decolonization attempts 1
Do not routinely use bleach baths in patients without recurrent infections or documented colonization 1
Do not perform screening cultures before decolonization if at least one prior infection was documented as MRSA 1