Tap water is an adequate cleansant for minor wounds
Date First Published:
March 1, 2000
Last Updated:
November 8, 2003
Report by:
Sandy Thompson, Medical Student (Manchester Royal Infirmary)
Search checked by:
Fiona Lecky, Manchester Royal Infirmary
Three-Part Question:
In [patients with lacerations] is [wound toilet with iodine solution or sterile saline more effective than wound toilet with tap water] at [reducing rate of infection]?
Clinical Scenario:
A patient presents to the Emergency Department with a laceration to the right forearm. The wound will need cleaning and then closing. There appear to be many different cleaning solutions available - you wonder which is best.
Search Strategy:
Medline 1966-10/03 using the OVID interface on ATHENS (including Medline in progress and non-indexed citations)
Search Details:
({[exp "wounds and injuries" OR exp wounds, penetrating OR laceration$.ti,ab,rw,sh OR wound$.ti,ab,rw,sh OR cut$.ti,ab,rw,sh] AND [exp iodine OR exp iodine compounds OR exp povidone-iodine OR iodine$.ti,ab,rw,sh OR exp sodium chloride OR saline.ti,ab,rw,sh OR anti-infective agents, local OR antiseptic$.ti,ab,rw,sh] AND [clean$.ti,ab,rw,sh OR exp decontamination OR exp sterilisation OR exp disinfection OR decontaminate$.ti,ab,rw,sh OR exp irrigation OR lavage.ti,ab,rw,sh]} AND [random$.af] LIMIT to human and english and abstracts)
Outcome:
397 papers found. One citation is a cochrane review of tap water use. There are no individual published after the cochrane review. 4 other papers not included in the cochrane review of water are also included.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| water for wound cleaning fernandez r; griffiths t; ussia c 2001 (updated April 2003) Australia | A variety of patients were included in the review. 5 of the 6 trials included in the review used emergency department patients. | Meta-analysis of trials of wound cleansing. | tap water vs normal saline (2 trials) - infection rates | OR 0.52 (CI 0.28 - 0.96) in favour of tap water | Only 6 trials were included in this well conducted review. There were concerns regarding the methodological quality of several of the included trials. No trials included children. |
| distilled water or cool boiled water vs normal saline (1 trial) - infection rates | OR 0.55 (CI 0.18-1.6s NS) in favour of tap water | ||||
| A prospective trial of prophylactic povidone iodine in lacerations of the hand Roberts AH, Roberts FE, Hall RI, Thomas IH 1985 UK | 418 patients with hand lacerations. All wounds cleaned with savlodil. Experimental group sprayed with povidone-iodine |
Randomised clinical trial. | Infection rate | 4.6% (povidone-iodine) vs 5.3% (control) (NS) | Poor randomisation. No control. 96 lost to follow up. |
| Imperfect healing | 35.5% (povidone-iodine) vs 41.2% (control) (NS) | ||||
| A trial of povidone-iodine in the prevention of infection in sutured lacerations. Gravett A, Sterner S, Clinton JE, Ruiz E. 1987 USA. | 500 emergency department patients with lacerations requiring sutures. All wounds irrigated with normal saline. Experimental group irrigated and scrubbed with 1% povidone iodine. |
Randomised clinical trial. | Infection rate | 15.4% (control) vs 5.47% (povidone-iodine) | No control. 105 patients lost to follow up and 122 followed up by phone only. High control infection rate. |
| A comparison of wound irrigation solutions used in the emergency department. Dire DJ, Welsh AP. 1990 USA. | 531 patients with minor, uncomplicated soft-tissue lacerations requiring suturing. Treated with either irrigation with normal saline, 1% povidone-iodine or F-68 (Shur-Clens). |
Clinical trial | Infection rates | 6.9% (normal saline) vs 4.3% (povidone-iodine) vs 5.6% (F-68). Non significant | Not randomised. |
| Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds. Lammers RL, Fourre M, Callaham ML, Boone T. 1990 USA | 35 patients with 37 heavily contaminated wounds requiring debridement. Randomised to soaking for 10 min with either 1% povidone-iodine solution, normal saline or covering for 10 min with a dry dressing. |
PRCT | Change in bacterial counts | No change povidone-iodine group or control. Increase in saline group | Small numbers. |
Author Commentary:
It is striking that the infection rate remains 5 - 10% whatever the intervention. In this case the cheapest and most easily obtained solution should be used. The meta-analysis shows that tap water may have a beneficial effect.
Clearly the quality of water should be good (at least potable)
Clearly the quality of water should be good (at least potable)
Bottom Line:
Tap water is a safe and effective solution for cleaning recent wounds requiring closure and is the treatment of choice.
Level of Evidence:
Level 1: Recent well-done systematic review was considered or a study of high quality is available
References:
- fernandez r; griffiths t; ussia c. water for wound cleaning
- Roberts AH, Roberts FE, Hall RI, Thomas IH. A prospective trial of prophylactic povidone iodine in lacerations of the hand
- Gravett A, Sterner S, Clinton JE, Ruiz E.. A trial of povidone-iodine in the prevention of infection in sutured lacerations.
- Dire DJ, Welsh AP.. A comparison of wound irrigation solutions used in the emergency department.
- Lammers RL, Fourre M, Callaham ML, Boone T.. Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds.