Original ContributionsTap water for irrigation of lacerations*,**,★
Section snippets
Methods
The study was undertaken at a large urban pediatric hospital with an annual census through the ED of over 100,000 visits. Approval was obtained by the Institutional Review Board. Patients were randomized to receive either sterile normal saline or tap water wound irrigation. The investigator and treating physicians were blinded to the form of irrigation used. Patients were recruited during a 15-month period from June 1999 through August 2000. Eligible patients were between 1 and 18 years of age
Statistical methods
Data were summarized using means and standard deviations (age) and numbers with percentages for categorical data. The 2 groups were compared using Student's t test for independent groups (age) and with Chi-square contingency table analysis of Fisher's Exact test, as appropriate, for the categorical measurements. Because postrepair infection rates is the only clinically pertinent variable, a sample size to prove a difference would have to be extremely large.
Results
During the study period, a total of 46 patients were consented and enrolled in the study and 44 returned for follow-up. The remaining 2 patients were contacted by telephone. Patients ranged from 2 to 16 years of age. Table 1 illustrates the patient and wound characteristics for both the tap water and normal saline groups.Description Tap Water Group Normal Saline Group Total (%) P Value Male 12 16 28 (62) .727 Female 9 8 17 (38) Age range (years) 4-15 2-13 2-15 Mean injury (+/− SD)
Discussion
Fortunately, serious complications from laceration repair are relatively uncommon events. However, this makes safety and efficacy studies comparing a change in standard care (normal saline irrigation), with a new method (tap water irrigation) a difficult task. When postrepair infection rates are the measurable adverse event, small numbers are expected and a statistically valid study is difficult to attain. Children have been found to have fewer postrepair infections than adults.6, 14, 25 This
Summary
Further validation of safety and efficacy of tap water as an irrigation solution for wound cleansing and debridement is necessary before widespread recommendation for use can be made. Our study suggests that tap water may serve as a cost-saving alternative to normal saline for irrigating simple lacerations before repair. Higher pressures and more prolonged and effective irrigation may be delivered at less cost.
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Cited by (63)
Biting the hand that feeds you: Management of human and animal bites
2022, InjuryCitation Excerpt :Administration of local anaesthesia is recommended to allow sufficient irrigation and debridement [2,46]. Copious use of plain water to irrigate laceration wounds has been shown to be non-inferior to saline; however, bite wounds are often excluded in these trials and as such, no evidence specific to bite wounds has been found for inclusion in this review [94–96]. A tetanus booster is recommended if over ten years have elapsed since tetanus vaccination [97].
High-Risk Chief Complaints III: Abdomen and Extremities
2020, Emergency Medicine Clinics of North AmericaCitation Excerpt :Irrigation procedure: normal saline or tap water can be used to irrigate the laceration. There have been several studies that have examined infection rates in patients whose lacerations were irrigated with sterile normal saline versus tap water and repeatedly infection rates have been found to be similar in both groups.81,82 Pressurized irrigation has been found to lead to decreased bacterial contamination in wounds; however, the optimal pressure has been debated.
Wound irrigation and the lack of evidence-based practice
2018, Journal of Plastic, Reconstructive and Aesthetic SurgeryWhat does Postoperative Fever Mean?
2018, Abernathy's Surgical Secrets: Seventh EditionPearls in Pediatric Wound Management
2017, Clinical Pediatric Emergency MedicineCitation Excerpt :Historically, sterile technique was recommended for wound management. However, several studies have questioned the utility of sterile technique in laceration repairs demonstrating that nonsterile techniques, including the use of nonsterile gloves and tap water, do not increase the risk of wound infection.14-16 Irrigation may be more important than the use of sterile preparatory materials.
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Supported by funds from the Sarah M. and Charles E. Seay Distinguished Chair in Pediatric Medicine, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
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Address reprint requests to Robert A. Wiebe, MD, UT Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd., Dallas, TX. 75390-9063. E-mail: [email protected]
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