Water for wound cleansing
Editorial Group: Cochrane Wounds Group
Published Online: 15 FEB 2012
Assessed as up-to-date: 14 DEC 2011
Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD003861. DOI: 10.1002/14651858.CD003861.pub3.
- Publication Status: Edited (no change to conclusions), comment added to review
- Published Online: 15 FEB 2012
Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and does not interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost effective; however, there is an unresolved debate about its use.
The objective of this review was to assess the effects of water compared with other solutions for wound cleansing.
For this fourth update we searched the Cochrane Wounds Group Specialised Register (searched 9 November 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); Ovid MEDLINE (2010 to October Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, November 8, 2011); Ovid EMBASE (2010 to 2011 Week 44); and EBSCO CINAHL (2010 to 4 November 2011).
Randomised and quasi randomised controlled trials that compared the use of water with other solutions for wound cleansing were eligible for inclusion. Additional criteria were outcomes that included objective or subjective measures of wound infection or healing.
Data collection and analysis
Two review authors independently carried out trial selection, data extraction and quality assessment. We settled differences in opinion by discussion. We pooled some data using a random-effects model.
We included 11 trials in this review. We identified seven trials that compared rates of infection and healing in wounds cleansed with water and normal saline; three trials compared cleansing with no cleansing and one trial compared procaine spirit with water. There were no standard criteria for assessing wound infection across the trials, which limited the ability to pool the data. The major comparisons were water with normal saline, and tap water with no cleansing. For chronic wounds, the risk of developing an infection when cleansed with tap water compared with normal saline was 0.16, (95% CI 0.01 to 2.96) demonstrating no difference between the two groups. The use of tap water to cleanse acute wounds in adults and children was not associated with a statistically significant difference in infection when compared to saline (adults: RR 0.66, 95% CI 0.42 to 1.04; children: RR 1.07, 95% CI 0.43 to 2.64). We identified no statistically significant differences in infection rates when wounds were cleansed with tap water or not cleansed at all (RR 1.06, 95% CI 0.07 to 16.50). Likewise, there was no difference in the infection rate in episiotomy wounds cleansed with water or procaine spirit. The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected.
There is no evidence that using tap water to cleanse acute wounds in adults or children increases or reduces infection. There is not strong evidence that cleansing wounds per se increases healing or reduces infection. In the absence of potable tap water, boiled and cooled water as well as distilled water can be used as wound cleansing agents.
Plain language summary
The effects of water compared with other solutions for wound cleansing
Water is frequently used for cleaning wounds to prevent infection. This can be tap water, distilled water, cooled boiled water or saline (salty water). Using tap water to cleanse acute wounds in adults does not increase the infection rate; however, there is no strong evidence that cleansing per se is better than not cleansing. The reviewers concluded that where tap water is high quality (drinkable), it may be as good as other methods such as sterile water or saline (salty) water (and more cost-effective), but more research is needed.
就此第4次更新我們搜尋了考科藍創傷群組專業註冊(搜尋至2011年11月9日)；考科藍對照試驗註冊(CENTRAL) (考科藍圖書館2011年第4期)；Ovid MEDLINE (2010年到2011年10月第4周)；Ovid MEDLINE (In-Process & Other Non-Indexed Citations，2011年11月8日)；Ovid EMBASE (2010年到2011年第44周)；與EBSCO CINAHL (2010 年到2011年11月4日)。
此審閱中我們採用了11個試驗。我們找出7個試驗，比較清水與生理鹽水清洗傷口的感染與癒合率；3個試驗比較有洗清與無洗清，而一個試驗比較procaine spirit與清水。沒有標準準則可在所有試驗評估傷口感染，這限制了集合數據的能力。主要比較是水與生理鹽水，以及自來水與無清潔。就慢性傷口而言，發展出感染的風險在自來水清潔與生理鹽水相比時為0.16，(95% CI 0.01 to 2.96)顯示兩群組間無差異。成人與兒童身上使用自來水來洗清急性傷口與生理鹽水比較時，並無發生感染的統計上顯著差異(成人：RR 0.66, 95% CI 0.42 to 1.04；兒童：RR 1.07, 95% CI 0.43 to 2.64)。自來水洗清與完全無洗清相比時我們在感染率中找出統計上顯著差異， (RR 1.06, 95% CI 0.07 to 16.50)。 同樣的，在外陰切開術中以清水或procaine spirit清潔傷口的感染率上無差異。使用等滲壓鹽水、蒸餾水、滾水在清潔開放性骨折上，也沒有在受感染的骨折數中顯示出統計上的顯著差異。
由 East Asian Cochrane Alliance 14th December, 2011 翻譯
翻譯由 台灣衛生福利部/台北醫學大學實證醫學研究中心 資助
Plain language summary
voda za čišćenje rana
Učinci vode u usporedbi s drugim otopinama za čišćenje rana
Kako bi se spriječila infekcija, voda se često koristi za čišćenje rana. To može biti voda iz slavine, destilirana voda, ohlađena flaširana voda ili fiziološka otopina (slana voda). Korištenje vode iz slavine za čišćenje akutnih rana u odraslih osoba ne povećava učestalost infekcija, međutim nema čvrstih dokaza da je čišćenje rana samo po sebi bolje od nikakvog čišćenja. Autori Cochrane sustavnog pregleda, nakon analiziranja 11 kliničkih pokusa, zaključuju da pitka voda može biti jednako dobra kao i druge metode za čišćenje rana, kao što su sterilna voda i fiziološka otopina (a uz to je i jeftinija). Ako nije dostupna pitka voda iz slavine, za čišćenje rana može se koristiti kuhana i flaširana voda, kao i destilirana voda.
Translated by: Croatian Branch of the Italian Cochrane Centre