A Multicenter Comparison of Tap Water versus Sterile Saline for Wound Irrigation

Abstract

Objectives: To compare wound infection rates for irrigation with tap water versus sterile saline before closure of wounds in the emergency department. Methods:The study was a multicenter, prospective, randomized trial conducted at two Level 1 urban hospitals and a suburban community hospital. Subjects were a convenience sample of adults presenting with acute simple lacerations requiring sutures or staples. Subjects were randomized to irrigation in a sink with tap water or with normal saline using a sterile syringe. Wounds were closed in the standard fashion. Subjects were asked to return to the emergency department for suture removal. Those who did not return were contacted by telephone. Wounds were considered infected if there was early removal of sutures or staples, if there was irrigation and drainage of the wound, or if the subject needed to be placed on antibiotics. Equivalence of the groups was met if there was less than a doubling of the infection rate.Results: A total of 715 subjects were enrolled in the study. Follow-up data were obtained on 634 (88%) of enrolled subjects. Twelve (4%) of the 300 subjects in the tap water group had wound infections, compared with 11 (3.3%) of the 334 subjects in the saline group. The relative risk was 1.21 (95% confidence interval = 0.5 to 2.7).Conclusions: Equivalent rates of wound infection were found using either irrigant. The results of this multicenter trial evaluating tap water as an irrigant agree with those from previous single institution trials. 1 Wound infection, while infrequent, is the most common complication of treating these lacerations, occurring in 3%-5% of cases.2 Standard care requires adequate decontamination of lacerations before skin closure to reduce wound infection rates. High-pressure irrigation (>8 psi) with sterile saline (SS) is more efficacious in removing debris and bacteria than is cleaning with antibacterial solutions. 3-5The current standard of care for simple skin lacerations is irrigation with SS using a syringe and splash shield. However, there are several potential drawbacks to this method, including cost of supplies, clinician time, and risks associated with exposure to the splatter of body fluids.6 Clinician time and the cost of supplies may be decreased with the use of tap water (TW). Additionally, in many cases, TW irrigation does not require the health care provider to be in such close proximity to the patient as is required with syringe irrigation. The ability to have a larger distance between the health care provider and the wound therefore reduces the risk of body fluid contamination due to splatter.It has been shown that 35-mL and 65-mL syringes with a 19-gauge needle are able to achieve pressures of 25-35 psi for irrigation.7 A standard water faucet has also been shown to provide sufficient pressure (about 45 psi) for adequate wound irrigation. 8 We previously compared TW with SS in an animal model and determined that bacterial decontamination of simple lacerations was not compromised and was actually improved with ...

Manejo clínico de úlceras venosas na atenção primária à saúde

“…This technique is used for the removal of foreign bodies, loose adhered tissues, in addition to maintaining the recently formed granulation tissue (15) . However, international studies indicate the use of potable water at room temperature, because it does not show significant indices of infection when compared with sterile saline solution (16)(17)(18) . The use of tap water for cleaning leg ulcers is also referred to by the protocols of Ireland and England (8)(9) .…”

Part 17: First Aid

“…Superficial wounds and abrasions should be thoroughly irrigated with a large volume of warm or room temperature potable water with or without soap [77][78][79][80][81][82] until there is no foreign matter in the wound (Class I, LOE A). Cold water appears to be as effective as warm water, but it is not as comfortable.…”

Animal‐inflicted open wounds in rural Turkey: lessons learned and a proposed treatment algorithm for uncertain scenarios

“…Therefore, the size of the wound must be taken into account during the irrigation process. Studies also report that tap water can be just as effective in the absence of saline, especially before referring to a health facility (9). Once the wound is properly irrigated with saline, Figure 6 Sixty-seven-year-old male patient suffering from an abnormally healed dog bite on his left hand in the palmar thenar area.…”