Cleansing of wounds by tap water? Would it be safe to use in developing countries?

Dear Editors, We read with great interest a letter entitled ‘Cleansing of wounds by tap water? An evidence based systemic analysis’ by Huang et al. (1), commenting on the safety of tap water irrigation in wound cleansing. The tap water irrigation has been reported to reduce colonisation of wounds and infection rates significantly (2,3). It has also been found that the rate of infection and outcome of wounds cleansed with tap water are similar to wounds cleaned with normal saline (4–8). Moreover, the tap water therapy has been considered as more cost-effective as compared with normal saline solution (4–8). Although use of tap water is a cost-effective option because of its wide availability and although it yields equally good results as compared with normal saline, would it be safe to use for the purpose of wound irrigation in developing countries? where the tap water bodies may be grossly polluted rendering the quality of tap water unsafe. All the six articles used in their study for the review and to develop a specific recommendation are from developed countries such as America (03 articles), and one article each from Sweden, Britain and Australia where the quality of tap water is excellent and is as good as like mineral water with least or no contamination with pathogenic microorganisms. As compared to this, the quality of tap water in developing countries is not at par with the developed countries, and it may contain potentially pathogenic bacterial flora, and hence the tap water irrigation may further add potential pathogens to the already infected wound, making it more and more difficult to heal. Hence, tap water irrigation is not a safer option in developing countries. As suggested in our earlier letter (9), in developing countries where the quality of tap water is not safe, use of pathogen-free boiled water, distilled water or mineral water would be a better and safer option for tap water for the purpose of cleansing of wounds. The studies on tap water for wound irrigation from developing countries regarding the effectiveness and safety of tap water would be helpful to achieve more useful and concrete conclusion regarding the safety of tap water for wound irrigation purpose in developing countries. At this stage, we safely conclude that it is unsafe to use tap water for wound irrigation in developing countries where the quality of tap water is a questionable issue.