Non-surgical wound cleansing : a comparison of tap water and sterile normal saline

Abstract

Background Various solutions are available for wound cleansing, however, normal saline is widely used since it is isotonic, and thus, leaves the healing process intact. Tap water is easily accessible, and widespread, but there exists a debate on whether or not it should be used for wound cleansing. Research Question Is tap water a safe alternative to sterile normal saline for non-surgical wound cleansing? Population: Males and females over one year of age, presenting themselves at a healthcare care setting, requiring acute or chronic wound cleansing. Intervention: Wounds, lacerations or ulcers are irrigated or cleansed using tap water. Comparison: The wounds, lacerations or ulcers are cleansed or irrigated with sterile normal saline solution. Expected Outcome: Tap water is safe for wound cleansing, cleansing is more effective, costs are reduced and wound infection rates post-cleansing with tap water are comparable to that of sterile normal saline. Search Strategies and Outcomes Studies were included if they exclusively compared tap water to normal saline, and not any other solution. Both acute and chronic wounds were considered, however, post operative and surgical wound cleansing were excluded. Studies adding a bactericidal during or after cleansing were also excluded. One Systematic Review, four Randomised Controlled Trials, and two Quasi randomised controlled trials were retrieved using electronic searches of five databases. Methods of Appraisal The Critical Appraisal Skills Programme (CASP) was used as as guideline for critical analysis of the literature. Results There was no statistically significant differences between tap water and normal saline in terms of wound infection rates in five out of the six experimental studies. Costs were estimated to be decreased when using tap water as an alternative to normal saline. Conclusion There is no evidence that using tap water instead of normal saline to cleanse both acute and chronic wounds increases infection. As a result tap water of high quality (potable) might be a safe alternative to sterile normal saline. Implications and Recommendations Tap water is safe to use as an alternative to normal saline in acute wounds. Furthermore, it might contribute to a decrease in hospital stay, if patients are educated on self-wound cleansing at home. Further research should be undertaken and emphasis should be on testing tap water and sterile normal saline in similar conditions.