Tap Water vs. Sterile Saline for Irrigation of Traumatic Soft-Tissue Wounds in the ED

Traumatic wounds are a common presentation in EDs and are routinely irrigated to reduce infection risk. Sterile saline (SS) is traditionally used, though tap water (TW) may offer advantages in cost, availability, and environmental sustainability. A narrative review was conducted using PubMed and Google Scholar (August 2025) to identify systematic reviews, randomized controlled trials, observational studies, and guidelines comparing TW and SS for traumatic wound irrigation in emergency settings. Outcomes assessed included infection rates, cost, environmental impact, workflow efficiency, and accessibility. Evidence from randomized trials and a recent systematic review demonstrates no significant difference in infection rates between TW and SS, with some studies favoring TW. These findings, combined with the considerable reductions in cost and environmental impact, along with the greater practicality of TW, suggest it is a safe and effective alternative when potable water is available. Remaining concerns relate mainly to water quality and clinician acceptance, particularly in regions where water quality is variable. Additional multicenter high-quality studies are needed to clarify any absolute infection differences and to explore TW implementation across diverse clinical and resource contexts.