Water for wound cleansing.

Area of Science:

• Wound Care and Management
• Infectious Disease Prevention
• Clinical Trials and Evidence Synthesis

Background:

• Normal saline is a standard wound cleansing solution due to its isotonic properties.
• Tap water is widely used in community settings for wound cleansing owing to its accessibility and cost-effectiveness.
• The efficacy and safety of tap water for wound cleansing remain subjects of ongoing debate.

Purpose of the Study:

• To systematically review and assess the comparative effects of water versus other solutions for wound cleansing.
• To evaluate the impact of different cleansing agents on wound infection and healing outcomes.

Main Methods:

• Conducted a comprehensive literature search across multiple databases including Cochrane Wounds Group Register, CENTRAL, MEDLINE, EMBASE, and CINAHL.
• Included randomized and quasi-randomized controlled trials comparing water with other solutions for wound cleansing.
• Assessed outcomes related to objective or subjective measures of wound infection or healing, with data extraction and quality assessment performed independently by two reviewers.

Main Results:

• Eleven trials were included, comparing water with normal saline, no cleansing, or procaine spirit.
• Tap water demonstrated effectiveness in reducing infection rates in adults with acute wounds compared to normal saline (RR 0.63, 95% CI 0.40 to 0.99).
• No statistically significant differences in infection rates were found when comparing tap water to no cleansing, or for other comparisons including chronic wounds, pediatric acute wounds, and open fractures.

Conclusions:

• Current evidence suggests tap water does not increase infection risk for acute adult wounds and may reduce it.
• There is limited strong evidence that wound cleansing itself significantly enhances healing or reduces infection.
• Boiled, cooled, or distilled water can serve as effective wound cleansing agents when potable tap water is not accessible.