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Water for wound cleansingFernandez R, Griffiths R
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SummaryThe effects of water compared with other solutions for wound cleansingWater is frequently used for cleaning wounds to prevent infection. This can be tap water, distilled water, cooled boiled water or saline (salty water). Using tap water to cleanse acute wounds in adults does not increase the infection rate, however, there is no strong evidence that cleansing per se is better than not cleansing. The reviewers concluded that where tap water is high quality (drinkable), it may be as good as other methods such as sterile water or saline (salty) water (and more cost-effective), but more research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 21. 2002 AbstractBackgroundVarious solutions have been recommended for cleansing wounds, however normal saline is favoured as it is an isotonic solution and does not 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. ObjectivesThe objective of this review was to assess the effects of water compared with other solutions for wound cleansing. Search strategyRandomised and quasi-randomised controlled trials were identified by electronic searches of Cochrane Wounds Group Specialised Register (November 2007), Ovid MEDLINE (1996-October 2007), Ovid EMBASE (1980-October 2007), Ovid CINAHL (1982-October 2007) and the Cochrane Central Register of Controlled Trials (Issue 3; 2007). Primary authors, company representatives and content experts were contacted to identify eligible studies. Reference lists from included trials were also searched. Selection criteriaRandomised 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. Data collection and analysisTrial selection, data extraction and quality assessment were carried out independently by two authors and checked by a third author. Differences in opinion were settled by discussion. Some data were pooled using a random effects model. Main resultsEleven trials were included in this review. Seven trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline, three trials compared cleansing with no cleansing and one trial compared procaine spirit with water. There were no standard criteria for assessing wound infection across the trials which limited the ability to pool the data. The major comparisons were water with normal saline, and tap water with no cleansing. For chronic wounds, the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0.16, (95% CI 0.01 to 2.96). Tap water was more effective than saline in reducing the infection rate in adults with acute wounds (RR 0.63, 95% CI 0.40 to 0.99). 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). No statistically significant differences in infection rates were seen when wounds were cleansed with tap water or not cleansed at all (RR 1.06, 95% CI 0.07 to 16.50). 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. Authors' conclusionsThere is no evidence that using tap water to cleanse acute wounds in adults increases infection and some evidence that it reduces it. However there is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents. |
