Cleansing of wounds by tap water? An evidence-based systemic analysis.

Dear Editors, Tap water therapy has been used for several decades (1) in wound cleansing for the treatment of many conditions, such as lacerations, incisions, open fractures and episiotomy (2–5). The infection rate and outcome of wounds cleansed with tap water are commonly believed to be the same as those cleaned with normal saline solution (2–5). Even though this alternative treatment is considered safe, a contrary opinion has always existed. There is still no evidence-based consensus on the contribution of tap water therapy to the treatment of wound cleansing and treatment results have not always achieved patient satisfaction. Thus, the aim of this study is to explore the safety of tap water irrigation in wound cleansing and to develop a specific recommendation based on the review of medical literature. PubMed data up to May 2013 was searched for studies in English evaluating the outcome of tap water therapy in wound cleansing. The words used in the search were ‘tap water’, ‘running water’, ‘normal saline solution’, ‘irrigation’ and ‘wound’. Reference lists of obtained articles were searched as well. Studies including any laboratory values were excluded from this data analysis. One investigator selected the articles for inclusion. Two investigators independently extracted data from all eligible studies using a standardised Excel file. These authors retrieved data on study design, study period, study size, patient demographics and treatment outcome. Relevant studies were assigned a level of evidence according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence. The search performed in May 2013 yielded six articles pertinent to the topic (Table 1) – five randomised controlled trials (RCTs, level I evidence) (1–5), and one case series (level IV evidence) (6). Four RCTs showed that the infection rates and status of wound healing in tap water therapy were similar to the normal saline solution group (P > 0·05) and the culture results from the wounds in both groups showed no significant finding in colony counts (P > 0·05). Furthermore,