Thursday, November 19, 2015

The History of Sodium Hypochlorite and the Bleach Bath

Sodium hypochlorite (NaClO), the main ingredient found in laundry bleach, is a chemical compound that has a range of uses, including bleaching textiles (particularly cotton) and paper, sanitizing food preparation equipment, refining petroleum, and disinfecting water and wastewater. Sodium hypochlorite is also the sodium salt of hypochlorous acid (HOCl). Hypochlorous acid is effective against a broad range of microorganisms, and is the major strong oxidant produced by neutrophils (white blood cells). The acid works as a potent microbicidal agent within the neutrophils, and has been shown to kill large quantities of E. coli in less than 5 minutes in vitro.

In 1789, Antoine Labarraque passed chlorine gas through a solution of soda lye to obtain sodium hypochlorite. In 1843 in Boston, Oliver Wendell Holmes determined physicians and nurses carried on their hands and clothing the microbes that caused puerperal (childbed) fever in patients. One physician was observed washing his hands with sodium hypochlorite between patient visits; this doctor’s patients were reported to be unusually free of disease. This opened the gates for the use of sodium hypochlorite in the healthcare industry.

During World War I, Henry Dakin—an English Chemist—and Alexis Carrel—a French surgeon—introduced the Carrel-Dakin technique, which became the best practice in wound care by delivering Dakin solution, a solution of 0.5% sodium hypochlorite and 4% boric acid, directly to damaged tissue in deep wound beds before closure. Dakin solution’s solvent action on dead cells increased the separation of dead from living tissue, and thus expedited healing. 

Today, hypochlorite is used in hospitals as a disinfectant for equipment and environmental surfaces. For example, it is used to disinfect dialysis equipment, dental equipment, syringes and needles, linens and clothing, and manikins used in the training of mouth-to-mouth resuscitation. Sodium hypochlorite is also used to clean up blood spills and to remove all traces of nerve agent or blister agent from personal protective equipment (e.g. gloves, gown, mask, shoe covers) as personnel move into toxic areas.

Patient use of hypochlorite includes dilute bleach baths that have been used to treat moderate to severe eczema—an inflammatory skin condition that causes skin to become dry, itchy, and red. The first use of a bleach bath to treat atopic dermatitis (AD)—a common type of eczema—occurred when patients who suffered from AD started to improve after swimming in chlorinated pools during the summer months.

As a consequence, physicians started recommending the use of dilute bleach baths for their patients with AD for as young as 6 months and older. A study by JT  Huang, MD  and colleagues found that chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections.

Patients with AD are prone to bacterial infections that worsen the condition, particularly Staphylococcus aureus. Bleach baths have been shown to decolonize Staph; however, baths with sodium hypochlorite are cumbersome and bleach may not be used above the neck, thus leading to poor patient compliance. According to a study conducted by Caitriona Ryan, MD and fellow researchers, sodium hypochlorite wash is beneficial in children diagnosed with AD where Staph colonization is present.


The challenges associated with bleach baths led Azam Anwar, MD and Clay J. Cockerell, MD to invent and patent the formula for CLn® Body Wash. The family of CLn® Skin Care products was created to elevate the life quality of people with impaired skin. CLn ® BodyWash is designed to cleanse skin prone to eczema, acne, and folliculitis without irritation and aids in the reduction of body odor. For more information on CLn® Skin Care, please visit: www.CLnWash.com.



References
BleachBath.org (2015). History. Retrieved November 15, 2015, from http://www.bleachbath.com/how-it-works/history/.

Huang JT, Abrams M, Tlougan B, et al. Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity. Pediatrics 2009; 123(5): e808-814.

Rutala WA, Weber DJ. Uses of inorganic hypochlorite (bleach) in health-care facilities. Clin Microbiol Rev 1997; 10(4): 597-610.

Ryan C, Shaw RE, Cockerell CJ, et al. Novel sodium hypochlorite cleanser shows clinical response and excellent acceptability in the treatment of atopic dermatitis. Pediatr Dermatol 2013; 30(3): 308-315.

Wang, L, Bassiri M, Najafi R, et al. Hypochlorous acid as a potential wound care agent. J. Burns and Wounds. 2007. Retrieved November 15, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853323/.

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