Dear Readers:

The adage “Cleanliness is next to godliness” seems to apply to wounds as well as people. Wounds have been cleansed since recorded history to remove foreign or necrotic matter, reduce odor, or more recently, to reduce bacterial burden. The evidence on cleansing, irrigation, and wound disinfection has been ably reviewed elsewhere,¹ with appropriate techniques and cleansers described. Yet, we rarely know if we are doing more harm than good when cleansing a wound. Is it wise to wash away or dilute natural growth factors^2,3 and autolytic enzymes or cool a wound during cleansing? Do we consider patient pain during the cleansing process? I recall the burning pain of sterile distilled water, our standard control solution for maximal-pain, when applied to open cantharidin blister beds used to measure wound pain in response to topical formulations. Isotonic saline solution was a soothing, zeropain control. Which is safer? For those interested in safety and efficacy of wound cleansers, the 2 recent reviews summarized in this Evidence Corner bring some issues into clearer focus, but leave many of these questions unresolved.

Evidence Supports Use of Tap Water To Cleanse Wounds

Reference: Fernandez R, Griffiths R.Water for wound cleansing. Cochrane Database Syst Rev. 2008;23(1):CD003861.

Rationale: There is an unresolved debate about safety and efficacy of the usual community practice of cleansing wounds with tap water.Acute care and other environments with ready access to other sterile cleansing solutions seem to prefer them for wound cleansing.

Objective: Assess the effects of water compared with other solutions for cleansing wounds.

Methods: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched and authors and corporations were contacted to identify and retrieve randomized or quasi-randomized controlled studies comparing healing or infection effects of water to other solutions used in wound cleansing. Derivative references from included studies were also reviewed. Two independent authors selected the references, evaluated study quality and extracted data for analysis, pooled when appropriate, using a random effects model.

Results: Of 11 randomized controlled trials (RCTs) identified, 7 compared infection and/or healing of wounds cleansed using water or saline, 3 compared tap water cleansing with no cleansing, and 1 compared infection rates of episiotomy wounds cleansed with procaine spirit or water. Analyses showed that chronic wounds have a significantly lower risk of infection if cleansed with tap water than if cleansed with saline. No other infection differences were statistically significant for cleansing solutions on acute wounds in children, for open fractures cleansed with distilled water, boiled water, or isotonic saline, or for cleansing with tap water compared to not cleansing.

Authors’ Conclusions: There is no evidence that saline wound cleansing is more effective than tap water in reducing the likelihood of a wound infection or improving healing; some evidence suggests the opposite. The evidence is insufficient to support cleansing wounds with water or saline versus no cleansing at all.