Bleach vs. Bubbles: Assessing the Impact of the Bathroom Environment on Eczema
Condition: Eczema; Atopic Dermatitis; Atopic Dermatitis and Related Conditions
MeSH terms: Dermatitis, Atopic; Dermatitis; Eczema
Study type: Interventional

Summary: 
      Purpose: Evaluate the impact of cleaning the bathroom environment on the severity of eczema.
      Determine if part of the efficacy of bleach baths may be in cleaning the bathroom. Record
      data on the process in order to improve future interventions.

      Participants: Patients and families with eczema

      Procedures (methods):

        -  Obtain baseline eczema severity scores and bacterial cultures from bathtubs

        -  Randomize subjects to receive (1) a bathtub culture alone; (2) a culture and bathroom
           cleaning; and (3) a culture, cleaning, and bleach baths.

        -  Measure changes in eczema severity scores over 4 weeks

        -  Qualitatively evaluate the process by participants and investigators
    

Detailed description: 
      The study will evaluate the effect of two interventions.

        1. At the start of the study, two-thirds of the patients (40 patients) will be randomized
           to have a culture taken from their bathtub with subsequent cleaning of all of their
           bathrooms (intervention arm) versus one-third (20 patients) only obtaining a culture
           taken from their bathtub with no cleaning (control arm).

        2. After cleansing the bathrooms in the intervention arm, this group will be randomized
           again so that half of this group (20 patients) receives instructions on performing twice
           weekly bleach baths and the other half (20 patients) does not.

        3. When the intervention period ends at 4 weeks, the placebo arm will be offered a bathroom
           cleaning.

      There will be four quantitative assessment phases:

        1. Upon entry into the study the investigators will obtain basic demographic information
           (insurer, age, race/ethnicity), a history of skin infections and allergic diseases, an
           eczema severity score (POEM score), an eczema area and severity index score (EASI
           score), and record the participant's level of eczema therapy (weak-moderate topical
           steroids, strong topical steroids, or systemic immunomodulators).

        2. The investigators will obtain a culture from the bathtub used by every study subject.
           This will be prior to cleaning the bathroom if the participant is in the cleaning
           intervention arm.

        3. The investigators will obtain a POEM score over the phone 1 week after obtaining the
           cultures.

        4. After 4 weeks, the investigators will obtain a POEM score over the phone as well as
           document whether the participant received any antibiotics or had any visits to medical
           providers for atopy flares over the last 4 weeks. The investigators will also re-record
           the participant's level of eczema therapy (weak-moderate topical steroids, strong
           topical steroids, or systemic immunomodulators).

      There will be one qualitative assessment:

      Additionally, the study team will keep field notes documenting perceptions and experiences
      during the cleaning process. These qualitative documents will be used for process evaluation
      to improve home hygiene interventions and studies. Domains that the investigators will assess
      in field notes include:

        1. Environment: The general appearance of the exterior of the home and neighborhood,
           cleanliness and order within the home and bathrooms, the hospitality and dynamics of
           interacting with the family. The investigators will also take pictures of the bathroom
           before and after each cleansing.

        2. Work difficulty: Description of activities performed and any physical, mental, and
           emotional toil related to the labor with suggestions for improving the work experience.

        3. Assessment of usefulness to the family: Did the family find the intervention useful? Did
           the family mention ways to make the cleaning intervention better? If given bleach bath
           instructions, did the family appear receptive and willing to do bleach baths? Did it
           appear that the family would clean their bathroom regularly after the intervention?
    

Intervention name(s): Bubbles; Bleach and Bubbles
Intervention type(s): Other; Other
Intervention description(s): All bathrooms with showers or bathtubs will be cleansed with simple products (dilute bleach, dilute white vinegar, baking soda, and dilute Dawn dish soap); All bathrooms with showers or bathtubs will be cleansed with simple products (dilute bleach, dilute white vinegar, baking soda, and dilute Dawn dish soap).
Other intervention name(s): cleaning; cleaning; bleach bath
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: atopic dermatitis; eczema; bleach bath; bacteria; bathroom; cleaning