NEW YORK NURSE: May 2008
Q.: I am an emergency department (ED) nurse and clean traumatic wounds all the time. Our standard practice is to use sterile saline for this purpose. A colleague recently told me that tap water is just as good. Is this so?
A.: Tap water of high quality is just as effective as other methods of cleansing wounds and may be more cost effective. A recent Cochrane Library review (Fernandez & Griffiths, 2008) of 11 studies that compared the use of “drinkable tap water” with several cleansing regimens (including saline) found that, in adults, acute wounds cleansed with tap water showed fewer infections than those cleansed with saline. Interestingly, no difference was found in infection rate between wounds cleansed with tap water and wounds that were not cleansed at all.
The debate about which cleansing regimen is best continues. Those challenging the use of saline as a cleansing agent argue that it can “wash away” factors that promote cell growth as well as white blood cells, which are also infection fighters. Another point to consider is that saline is more expensive than tap water, and if saline does not have a beneficial effect on wound infection rate or healing of acute wounds compared to tap water (of drinkable quality or boiled and cooled), then why use it? Reading the study cited below and sharing it with your ED colleagues may provide a good opportunity for you to improve practice in your department.
Fernandez, R., Griffiths, R. (2008). Water for wound cleansing. Cochrane Database of Systematic Reviews. Issue 4. Art. No.: CD003861. DOI: 10.1002/14651858.CD003861.pub2
This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA Nursing Representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.