Burn wound cooling with tap water: is it safe in developing countries or not?

Dear Editors, We read the article titled ‘Cleansing of wounds by tap water? An evidence-based systemic analysis’ as well as the letter ‘Cleansing of wounds by tap water? Would it be safe to use in developing countries?’ by Huang et al. and Nagoba et al. with great interest (1,2). While we agree with Huang et al. that tap water irrigation helps reduce wound colonisation and infection rates cost-effectively, we also share Nagoba et al.’s concerns that using tap water for wound irrigation may not be safe in developing countries where water sanitation is questionable. We would like to further contribute to this discussion from another perspective. Cooling the burn wound is a widely accepted first aid treatment modality in the management of burns. Early cooling of burn wounds alleviates pain, reduces tissue damage, increases wound healing and eventually improves outcomes by decreasing thermal injury (3). Research has shown that using tap water for 20 minutes to cool burn wounds is effective in reducing tissue necrosis (4). Compared to the basic wound irrigation process, which usually takes just a few minutes, the time required to cool burn wounds with tap water is markedly longer and, depending on the size, might extend even beyond 1 hour. The longer the contact time, the more the risk of infection with contaminated water. Furthermore, the fact that the risk of burn injury is higher in underdeveloped or developing countries as compared with high-income, developed countries further increases the overall risk of infection with tap water in these countries (5). To conclude, further studies should assess whether or not it is safe to use tap water in wound as well as burn management in underdeveloped and developing countries. Acknowledgements