Bleach is often the go-to disinfectant because it has a proven history of effectiveness against a broad range of bacteria, bacterial spores, viruses, and fungi. In fact, the Centers for Disease Control and Prevention (CDC) recommends using an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant, like bleach, to kill C. auris or C. difficile (“C. diff”) spores.1,2,3 Clorox Healthcare® Bleach Germicidal Disinfectants, for example, kill over 55 pathogens, including C. auris and C. diff, and meet CDC and Occupational Safety and Health Administration (OSHA) recommendations for 1:10 bleach solutions for disinfecting healthcare surfaces. Over the years, bleach has been the subject of several tall tales and we at Clorox Healthcare believe it’s time to put some of those rumors to rest.
Myth #1: Bleach contains chlorine gas.
Bleach is not chlorine.4 In fact, there is a difference between chlorine bleach and non-chlorine bleach. Non-chlorine bleach does not have sodium hypochlorite as the active agent, instead it uses other actives like hydrogen peroxide, sodium perborate, or sodium carbonate.5 Many safety concerns stem from the misperception that chlorine bleach, or regular bleach, contains chlorine gas. Clorox Healthcare® bleach-based products do not contain chlorine gas. The term “chlorine bleach” is a misnomer and actually refers to any bleach that uses sodium hypochlorite as the active agent. Liquid chlorine bleach is, therefore, just sodium hypochlorite diluted in water. Sodium hypochlorite is derived from sodium chloride, or common table salt.
Myth #2: Bleach odor is unacceptable for staff and patients.
All Clorox Healthcare® disinfecting products meet applicable safety, environmental and labeling regulations established by the EPA as well as other regulatory bodies. Both acute and long-term exposures are considered as part of the safety assessment of a product to ensure safe short and long-term use by consumers or workers when used according to label directions. The characteristic “bleach smell,” like that found at a swimming pool, is often indicative of a disinfected environment and should not be an immediate cause for concern for adverse health effects.6,7,8 The smell is caused by the chemical reaction that occurs when bleach breaks down proteins, like those found in pathogens and body fluids.
Bleach odor can be minimized by ensuring proper use (not overuse) according to label directions and using in a well-ventilated space. Additionally, some bleach products are made with a gentle, odor-masking formula to help mitigate the smell for patients and staff.
Myth #3: Bleach causes asthma.
According to the World Health Organization (WHO), it is difficult to identify a single, direct cause linked to an increased risk of developing asthma.9 In fact, if present in high enough concentrations, any disinfectant or odor can trigger an asthma attack in people with existing asthma or be a non-allergic irritant in non-asthmatic people.5,10 In the case of product misuse and/or exposure to concentrated (undiluted) bleach, asthma-like symptoms can occur.8 However, when used as directed, sodium hypochlorite is very effective at inactivating the proteins in allergens that cause respiratory symptoms and can eliminate antigens that cause asthmatic symptoms.5,11,12 To help limit exposure to asthma triggers, a cleaning and disinfecting schedule should be followed to prevent overuse of products.10
Tips for Responsible Bleach Use:
- Wear the proper personal protective equipment (refer to the product label and/or Safety Data Sheet) and follow label directions.
- Ensure adequate ventilation in areas where bleach is used.
- Never mix bleach with anything (except water), unless specified by label directions. Certain combinations of chemicals can create toxic byproducts or gases, like the release of toxic chlorine gas when bleach is mixed with ammonia or acid (e.g., household cleaning agents).7
- Dilute concentrated products only with water, unless otherwise specified on the label. When diluting, add bleach to water, never the reverse.
Myth #4: Using bleach will damage surfaces and equipment.
Bleach is safe for use on a variety of hard, nonporous surfaces, including stainless steel, plastics, glazed ceramics, glass, porcelain, acrylics, and other materials.13 Sometimes, after use, a crystal residue may be observed on surfaces. These salt crystals are caused when sodium hypochlorite breaks down into salt and water. As the water evaporates, salt crystals remain. Surface damage may also be caused from prolonged exposure to the bleaching agent. Fortunately, these damaging effects can be managed by following label instructions, rinsing/wiping surfaces after bleach use to prevent salt build up, and using ready-to-use (RTU) formulated bleach products that contain anticorrosion agents. Facilities should also check their equipment cleaning and care guides for products and ingredients that are compatible with and approved for use on medical equipment and other hospital surfaces.
Bleach is the go-to disinfectant for a reason
As my dear colleague and expert Infection Preventionist (IP) Doe Kley said regarding bleach, “Every healthcare facility needs this sporicidal in their arsenal.”3 Bleach is an effective disinfectant, and it is important to understand how sodium hypochlorite is safely used regularly in healthcare and in our communities to help prevent the transmission of pathogens. Fortunately, education and usage experience can help dispel fears about bleach. Not only is bleach an effective disinfectant when used as directed, one-step cleaner-disinfectant bleach products are good cleaners and disinfectants. Furthermore, bleach’s odor profile can be a recognizable, and reassuring cue for patients and staff that they are in a clean and disinfected environment.
References
1. Centers for Disease Control and Prevention (CDC). Prevent the Spread of C. diff [Internet]. [Cited 2023 Mar 20]. Available from https://www.cdc.gov/cdiff/prevent.html
2. Centers for Disease Control and Prevention (CDC). Infection Prevention and Control for Candida auris [Internet]. [Cited 2022 Oct 21]. Available from https://www.cdc.gov/fungal/candida-auris/c-auris-infection-control.html.
3. Why Every Healthcare Facility Needs this Sporicidal in their Arsenal. [Internet Blog]. [Cited 2023 Mar 20]. Available from https://www.cloroxpro.com/blog/why-every-healthcare-facility-needs-this-sporicidal-in-their-arsenal/
4. ATSDR Public Health Statement About Chlorine [Internet]. [Cited 2023 Mar 20]. Available from https://wwwn.cdc.gov/TSP/PHS/PHS.aspx?phsid=683&toxid=36#:~:text=OSHA%20set%20a%20legal%20limit,worker’s%20exposure%20exceed%20this%20limit.&text=EPA%20established%20a%20maximum%20contaminant,free%20chlorine%20in%20drinking%20water.
5. The Difference Between Chlorine and Non-Chlorine Bleach [Internet]. [Cited 2023 Mar 23]. Available from: https://www.clorox.com/learn/difference-between-chlorine-and-non-chlorine-bleach/
6. Infection Control Today [Internet]. [Cited 2023 Mar 20]. Available from https://www.infectioncontroltoday.com/view/dispelling-myths-about-bleach-odors
7. Centers for Disease Control and Prevention (CDC). Chemical Disinfectants [Internet]. [Cited 2023 Mar 20]. Available from https://www.cdc.gov/infectioncontrol/guidelines/disinfection/disinfection-methods/chemical.html#:~:text=The%20most%20prevalent%20chlorine%20products,)%2C%20usually%20called%20household%20bleach.
8. Common Misconceptions About Bleach & Asthma [Internet]. [Cited 2023 Mar 20]. Available from https://www.cloroxpro.ca/wp-content/uploads/2020/08/clorox-healthcare-bleach-asthma-brochure-2015.pdf
9. World Health Organization (WHO). Asthma [Internet]. [Cited 2023 Mar 28]. Available from https://www.who.int/news-room/fact-sheets/detail/asthma
10. Centers for Disease Control and Prevention (CDC). Common Asthma Triggers [Internet]. [Cited 2023 Mar 25]. Available from https://www.cdc.gov/asthma/triggers.html
11. Matsui, E., Kagey-Sobotka, A., Chichester, K., Eggleston, P.A. 2003. Allergic potency of recombinant Feld 1 is reduced by low concentrations of chlorine bleach. Journal of Allergy Clinical Immunology, 111:396-401.
12. Chen, P., Eggleston, P.A. 2001. Allergenic proteins are fragmented in low concentrations of sodium hypochlorite. Clin Exp Allergy 31:1086-1093.
13. Surface Compatibility Resource Guide [Internet]. [Cited 2023 Mar 25]. Available from https://www.cloroxpro.com/resource-center/surface-compatibility-resource-guide/
