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Should tap water be used to cleanse wounds? What do you think?
EXPERT COMMENT
One of my abiding memories is of a nurse sending a patient with a post-operative pilonidal sinus excision wound for a shower and then irrigating the wound with a sachet of sterile normal saline before applying a dressing. There have been many reviews of wound cleansing which demonstrate a variety of solutions, fluid volumes and delivery techniques such as syringes of differing gauges with or without a needle.
A Cochrane update (2010) reinforced its original conclusion that using tap water (straight from the tap, boiled and cooled, or distilled) in adult acute wounds does not result in more wound infection than normal saline. They also remind us that there is little “strong evidence” that cleanings per se reduces infection or affects healing rates.
Studies have focused on chronic, acute and traumatic wounds. In the community people with leg ulcers routinely have their legs washed in a lined container with many benefits to patients’ comfort, skin care and general well being. Unanswered questions include cleansing for immune-compromised patients (but they are more likely to be on antibiotics which complicates studies) and comparing showering with administration of fluids via a syringe or other delivery device. A DoH letter circulated in 2010 expressed concern about the cleanliness of taps and sinks which may warrant further investigation in bathing facilities
The major question is whether the wound needs to be cleansed at all; if the surrounding skin is managed the wound may well be best left moist and warm as long as there is not an excess of chronic wound exudate or debris in the wound bed.
Ritualistic practice arises from a lack of engagement with the literature, lack of time for practice based discussions and adherence to a procedure that is not thought through logically. Many patients could shower and if the facilities were appropriate there is scope for a great reduction in costs.
Irene Anderson is a Reader in Learning and Teaching in Healthcare Practice and Programme Tutor, Tissue Viability, University of Hertfordshire
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From Behind the Rituals
Why do you do the things you do? How much of nursing practice is based on ritual and myth and how much on sound evidence? If you have a ritual you’d like to discuss here, email nursingtimescomments@emap.com
Readers' comments (5)
Anonymous | 9-Aug-2011 3:01 pm
I agree with Irenes comment. It makes no sense to wah a wound in the shower and clean it with sterile saline
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Jacqueline Hickman | 10-Aug-2011 4:56 pm
So do I. We often use sachets of sterile saline simply to impress the patients! An awful lot of our practices are historic, simply due to patient expectations. We should apply evidence researched practice and educate our patients to accept it.
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lea coles | 10-Aug-2011 6:31 pm
I think that the cleansing must considered for its effectiveness in cleansing and with more consideration for pain management.
The pain management I feel is often not taken into account especially if the individual has barriers to effective communication.
And so the sterility of the water may not be as important as the delivery of the cleansing procedure
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lillianni | 11-Aug-2011 10:11 am
I stopped using normal saline to clean wounds many many years ago. All my patients who's wounds require cleaning have it done with tap water, I actively encourage those that are able to, to have a bath or a shower if their wound does not have a dressing on it or if they are dressing their own wounds, particularly leg ulcers. The patients appreciate this and feel it does more good than harm and I certainly have never had anybody acquire an infection through this practice.
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DesertNurse | 17-Aug-2011 7:26 am
There have been studies on this and they have found that potable tap water is as effective as normal saline. When I was a midwife we were using potable tap water to cleanse episiotomies (and that was a few years ago!)
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