Water for wound cleansing

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Abstract
Various solutions have been recommended for cleansing wounds, however normal saline is favoured as it is an isotonic solution and is less likely to interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective, however, there is an unresolved debate about its use. The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Randomised and quasi‐randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Register (June 2004), MEDLINE (1996‐2004), EMBASE (1980‐2004), CINAHL (1982‐2004), and the Cochrane Controlled Trials Register (Issue 2, 2004). Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched. Randomised and quasi‐randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing. Trial selection, data extraction and quality assessment were carried out independently by two reviewers and checked by a third reviewer. Differences in opinion were settled by discussion. Some data were pooled using a fixed effects model. Five trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline; three compared cleansing with no cleansing and one compared cleansing with procaine spirit with water. There were no standard criteria for the assessment of wound infection across the trials which limited the ability to pool the data. The major comparisons were water vs normal saline, and tap water vs no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water tap compared with normal saline was 0.16, 95 % CI 0.01 to 2.96. Use of tap water to cleanse acute wounds in adults was associated with a lower rate of infection than saline (RR 0.55, 95 % CI 0.31 to 0.97). The use of tap water to cleanse acute wounds in children was not associated with a statistically significant difference in infection, when compared to saline (RR 1.07, 95 % CI 0.43 to 2.64). Similarly no statistically significant differences in infection rates were seen when wounds were cleansed with tap water vs not cleansed at all (RR 0.81, 95 % CI 0.31 to 2.12). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. In the absence of drinkable tap water, boiled and cooled water as well as distilled water can be used as cleansing agents.