Proper cleansing is perhaps the key component for acute and chronic wound management. Cleansing methods differ among health care providers and institutions, and many times is based on an individual’s experience and preference. Many cleansing solutions exist today. In this research, the author focused on the use of tap water versus sterile cleansing solutions such as Normal Saline and sterile water. Many cleansing solutions are safe and have been proven to provide effective results, whereas others may damage the tissue, destroy cells, increase infection rates and delay the healing process.
Normal saline is regarded as the most appropriate and preferred cleansing solution by health care providers because it is nontoxic, isotonic solution that does not damage healing tissue. However, tap water is most commonly used among people, especially those that are discharged home and ordered to continue wound care at home. Tap water is cost effective and easily available, therefore of interest as a cleaning solution. Tap water showed to be as effective as any sterile solution in acute and chronic wound care. As an emergency and trauma nurse, I am often involved in the care of acute traumatic wounds and chronic wounds as well.
Water is the most important molecule that exists on the Earth. Without water living beings would not be able to live. Water is used for an immeasurable number of things. There are many properties of water, which makes this molecule so unique. One which people overlook is hardness. Hardness is defined in the Chemistry: The Central Science by Prentice Hall's as being "water that contains a ...
Many practitioners prefer the use of a sterile isotonic solution, such as Normal saline while irrigating and cleansing wounds. After many years working with traumatic and chronic wounds, I have wonder if there is significant evidence to argue the following PICO question: When caring for patients in need of wound care, does sterile isotonic saline reduce infection rate and shorten healing time when compared to tap water? The following research will give us a better understanding on the use of sterile water versus tap water in the treatment of acute and chronic wounds from the emergency room perspective.
Patients with acute or chronic wounds that present to the ER for wound care. I- Using tap water for wound care. C- Using a sterile solution, such as Normal Saline (an isotonic solution) for wound care. O- Infection rate and differences in healing time. When caring for patients in need of wound care, does sterile isotonic saline reduce infection rate and shorten healing time when compared to tap water? Article #1. Water for Wound Care. A level 2 research study. Reference Fernandez, R, Griffiths, R, Ussia, C. (2008).
Water for wound cleansing.
Cochrane Database of Systematic Reviews. Issue 1. Art. No:CD003861. DOI: 10. 1002/14651858. CD003861. pub2. Normal saline has been the favored isotonic solution used for acute and chronic wound care, since it does not interfere with the normal healing process. However, tap water is commonly used for cleansing wounds because it is easily accessible, efficient and cost effective. For this study, a randomized and quasi-randomized controlled trial was identified by electronic searches of Cochrane Wounds Group Specialized Register and the Cochrane Central Register of Controlled Trials.
Eleven trials were included in this review. Seven trials 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. 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 .
In Sprakes and Tyrer’s (2010) research article entitled “Improving Wound and Pressure Area Care in a Nursing Home”, the effectiveness of wound and pressure ulcer management was examined. The rate of wounds and pressure ulcers in a nursing home is often an indicator of the quality of care received as these injuries can lead to illness and a decreased quality of life (Sprakes & Tyrer, 2010). ...
Tap water was more effective than saline in reducing the infection rate in adults with acute wounds (0. 63).
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 (1. 07 from 0. 43-2. 64).
No statistically significant differences in infection rates were seen when wounds were cleansed with tap water or not cleansed at all. When caring for patients in need of wound care, does sterile isotonic saline reduce infection rate and shorten healing time when compared to tap water?
Article #2 Water is Safe and Effective. A level 3 research study. Reference Weiss, E. (2012).
Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomized, and controlled clinical trial. British Medical Journal. http://bmjopen. bmj. com/content/3/1/e001504. full DOI: 10. 1136/bmjopen-2012-001504. This was a single centre, prospective, randomized, double-blind controlled trial. The wound solution type was computer randomized and allocation was done on a sequential basis.
The patients were older than 1 year of age, who presented to the emergency room with a soft tissue laceration requiring repair. The primary outcome measure was the difference in wound infection rates between the two randomized groups. During the 18 month study period, 663 consecutive patients were enrolled, but only 631 were used for the study. From the 631, 318 were randomized into the Tap Water (TW) group and 313 into the Sterile Saline (SS).
There were a total of 20 infections (6. 4%) in the SS group compared to 11 infections (3. 5%) in the TW group.
Indicating that there is no difference in infection rate of wounds irrigated with either TW or SS solution, with clinical trends towards fewer wound infections in the TW group, making it easy to conclude that tap water is a safe and cost effective alternative to sterile saline for wound irrigation. When caring for patients in need of wound care, does sterile isotonic saline reduce infection rate and shorten healing time when compared to tap water? Article #3. Cleansing chronic wounds with tap water or saline: a review. A level 4 systematic reviews research. Reference
Staphylococcal infections are communicable conditions caused by specific bacteria. Infections from Staphlococcus frequently cause the formation of abscesses. Staph is the leading cause of nosocomial (hospital-acquired) infections in the United States. Staph exists on the skin and/or in the nostrils of 20-30% of healthy people. It is also sometimes found in the breast tissue, the mouth, and also in ...
Ljubic, A. (2013).
Cleansing chronic wounds with tap water or saline: a review. Journal Of Community Nursing. 27(1), 19-21. Some practitioners advocate that cleansing with tap water is better than with saline for healing and has economic benefits; others say there is no difference in the infection rates or healing with either solution.
A literature search was undertaken of the electronic databases for relevant systematic reviews, randomized control trials (RCT) and other evidence based literature using the key words chronic wound, wound cleansing, tap water, saline, infection. No evidence suggesting the use of tap water instead of saline was inappropriate was found. Four studies of 14 RCTs comparing infection rates in wound cleansing with tap water and normal saline in adults and children were identified. The studies evaluated patients in hospitals emergency departments. The trial was a comparison of the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds.
The researchers concluded that there was no significant difference between the infection and healing rates in wound cleansing with normal saline and tap water, and that tap water appears to be a safe alternative. The limitations of this review is that sparse evidence is available to support that the practice of using tap water is a viable option for wound cleaning. Much of the evidence on wound cleansing appears to be based on expert opinion rather than scientific studies, and published studies are not always of good quality.
Summary Despite a significance progress in technology for wound care during the last decades, little attention has been directed to wound cleansing. Most providers tend to practice according to experience rather than to evidence based practice when it comes to this subject. Even though there has not been a lot of research done in this area, a few research studies suggest that there’s no significant difference in the patient outcomes when using tap water instead of normal saline, whether is used to cleanse an acute or chronic wound.
There is no difference in the infection rate of wounds irrigated with either tap water or saline solution, with a clinical trend towards fewer wound infections in the tap water group, making it a safe and cost-effective alternative to saline solution for wound irrigation. However, there’s not enough evidence to suggest that cleansing wounds per se increases healing or reduces infection either. Some recommendations for this practice have been made: is water is used; it should be at body temperature as it can take 40 minutes for a wound to return to normal temperature after cooling.
A wound may be described in many ways; by its aetiology, anatomical location, by whether it is acute or chronic1, by the method of closure, by its presenting symptoms or indeed by the appearance of the predominant tissue types in the wound bed. All definitions serve a critical purpose in the assessment and appropriate management of the wound through to symptom resolution or, if viable, healing. A ...
Nurses must be able to identify the most appropriate solution to use. However, the decision to use tap water for cleansing wounds should take into consideration the quality of tap water, comorbidities that compromise immune function of the patient, and the extent and nature of the wound. But it is safe to say that, in absence of portable water, boiled and cooled water as well as distilled water can be used as wound cleansing agents. Appropriate wound cleansing will continue to be a debate within practitioners until more research is available.
The review by Fernandez, “Water for wound cleansing” (2008), provides some clarity about the comparative benefits of these cleansing solutions in wound care. In order to implement this study in the area I practice, I would implement an experimental study, using a random amount of emergency room patients with acute and chronic wounds. I wound implement the random use of tap water for some as well as normal saline for others and keep track of their wound healing process.
I would make sure the candidates are aware of the trial and document my findings after executing a random selection of a large sample. I would focuse on healing time for both, saline and tap water participants, as well as for any infection or complications. The results would be shared with the staff during a staff meeting or in-service in order to apply evidence based findings to our practice. In conclusion: patients with acute or chronic wounds, wound cleansing with tap water does not differ from no cleansing or wound cleansing with sterile normal saline for rates of healing and infection.