Cleansing of acute traumatic wounds: tap water or normal saline?

Acute traumatic wounds occur when the body is subjected to a force that exceeds the strength of the skin or underlying tissue (Whiteside and Moorehead, 1993), and can be caused by a variety of mechanisms (Holt, 2000). Healing of acute wounds involves a complex, wellorchestrated series of events, resulting in a healed wound in a timely and orderly manner (Enoch and Leaper, 2005). All acute traumatic wounds are considered contaminated and therefore require cleansing to reduce the risk of infection and to promote an optimum environment for healing (Riyat and Quinton, 1997). Wound cleansing has been described as often ritualistic, not evidence-based and inconsistent (Young, 1995; Towler, 1995; Lawrence J, 1997; Watret and Armitage, 2002; Magson-Roberts, 2006) with significant variability in the irrigation techniques and fluids employed (Dulecki and Pieper, 2005). Two commonly used irrigation fluids in wound cleansing are normal saline (NS) and tap water (TW) of drinkable quality. NS is often used to irrigate wounds and is isotonic, safe and available in most emergency departments; however, it does have an associated cost per bag, comes with a shelf life and requires administration by a healthcare professional. TW as an irrigation fluid is certainly costeffective, can be patient-delivered and a feeling of wellbeing has been reported by patients who were allowed to shower their own surgical wounds (Neues and Haas, 2000). TW of drinkable quality appears safe to irrigate wounds; studies of acute wounds either exposed to TW or kept dry, have found no significant difference in infection rates (Fernandez et al, 2001). Looking more closely at pathogen risk, Riyal and Quinton (1997) analysed the bacterial content of TW samples in a UK accident and emergency department, referred to here as emergency department (ED). They reported that no pathogens were isolated and that TW of drinking quality was safe for the irrigation of open traumatic wounds (Riyat and Quinton, 1997). Concern regarding the regular use of TW for wound cleansing has been raised by some research, proposing that diffusion could remove the dissolved substances that aid healing from the intracellular fluid, such as growth factors and chemokines (Young, 1995). However, no strong evidence exists to support these concerns, nor any to suggest that