title: Water for wound cleansing.
abstract: BACKGROUND
  Although various solutions have been recommended for cleansing wounds, 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.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of water compared with other solutions for wound cleansing.
  
  
  METHODS
  For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 9 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 8, 2011); Ovid EMBASE (2010 to 2011 Week 44); and EBSCO CINAHL (2010 to 4 November 2011).
  
  
  METHODS
  Randomised 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.
  
  
  METHODS
  Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.
  
  
  RESULTS
  We included 11 trials in this review. We identified seven trials 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). We identified no statistically significant differences in infection rates 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.
  
  
  CONCLUSIONS
  There 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.
authors.affiliation: School of Nursing, Midwifery and Indigenous Health, University of Wollongong, Kogarah, Australia.ritin.fernandez@sesiahs.health.nsw.gov.au
authors.forename: Ritin
authors.initials: R
authors.lastname: Fernandez
authors.forename: Rhonda
authors.initials: R
authors.lastname: Griffiths
mesh_terms: D060766:Drinking Water; D006801:Humans; D006875:Hydrotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012883:Skin Ulcer / Q000628:therapy; D012965:Sodium Chloride / Q000627:therapeutic use*; D007507:Therapeutic Irrigation / Q000379:methods; D014946:Wound Infection / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000628:therapy*
chemical_list: D060766:Drinking Water; D012965:Sodium Chloride