Tap Water or Sterile Saline for Acute Laceration Irrigation?
Search strategy: Wound repair is an intervention, so you turn first to the Cochrane database using the search term “wound irrigation” which produces 4 citations. A 2008 Cochrane review provides all of the selections below.
Angie, a 14-year old freshman taking industrial arts at her high school suffered a laceration to her left hand while operating the saw today. She presents to your ED with a 3-cm laceration over the thenar eminence with no obvious tendon or arterial injury. After quickly reassuring Angie and her mother, you begin to plan your repair.
Your attending suggests a simple interrupted closure of the wound after irrigation with tap water. Surprised, you ask “Tap water? I was always taught to manage traumatic lacerations with sterile saline irrigation and sterile gloves.” You are instructed to perform a quick literature search for tap water irrigation of wounds.
Population: ED patients with traumatic lacerations Intervention: Tap water irrigation
Intervention: Tap water irrigation
Comparison: Sterile saline irrigation
Outcomes: Wound infection, pain scores, cosmetic appearance, cost
Article 1: A Multicenter Comparison of Tap Water Versus Sterile Saline for Wound Irrigation Acad Emerg Med 2007; 14: 404-410
Article 2: Wound Irrigation in Children: Saline Solution or Tap Water? Annals Emerg Med 2003; 41: 609-616
Article 3: Tap Water for Irrigation of Lacerations Am J Emerg Med 2002; 20: 469-472
Article 4: Water for wound cleansing, Cochrane Database of Systematic Reviews 2008: Issue 1, Art No.: CD003861, DOI: 10.1002/14651858. CD003861.pub2.
In adults, tap water may prevent infection of acute lacerations compared with SS, though this is likely due to the temperature, pressure flow, and volume of irrigation fluid used. In children, TW and SS irrigation of acute lacerations offer similar infection rates. In one analysis based upon the worst-case scenario (upper limit of 95% CI infection rate with all infections treated with Keflex), the use of tap water for acute traumatic lacerations would save $65million/year in the US alone. Future trials ought to be multi-center and include non-first world settings while controlling for wound severity, water quality, irrigation pressure, volume, and temperature in adults and children. Additionally, future research should ascertain patient expectations which may be an important, unmeasured impediment (http://pmid.us/17967963) to routinely using tap water rather than sterile saline, although in children one might surmise that tap water (“the sink”) is far less anxiety-provoking than sterile saline (“the syringe which means a shot”).