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There is a controversy regarding the roles of the Normal saline and Tap water in irrigation of the wound. It has been suggested that antiseptic solution including normal saline has cytotoxic effect while tap water damages the fibroblast. There are no high level evidence to support one type of solution over other, systematic review have found no difference in wound infection between irrigation with normal saline vs tap water. There are ten randomized controlled trial comparing tap water with normal saline for irrigating wound published between 1992 to 2016. These RCT are analyzed in three systemic review and meta-analysis published on 2016, 2019, 2022, which showed that tap water and normal saline has no difference in terms of infection rate. The infection rate observed in various studies ranges from 0-11.5% in normal saline group and 0-12.6% in tap water group with no statistically significant difference.
There is a controversy regarding the roles of the Normal saline and Tap water in irrigation of the wound. It has been suggested that antiseptic solution including normal saline has cytotoxic effect while tap water damages the fibroblast. There are no high level evidence to support one type of solution over other, systematic review have found no difference in wound infection between irrigation with normal saline vs tap water. There are ten randomized controlled trial comparing tap water with normal saline for irrigating wound published between 1992 to 2016. These RCT are analyzed in three systemic review and meta-analysis published on 2016, 2019, 2022, which showed that tap water and normal saline has no difference in terms of infection rate. The infection rate observed in various studies ranges from 0-11.5% in normal saline group and 0-12.6% in tap water group with no statistically significant difference.
The published study has looked into tap water which may not be equivalent to drinking water in our setup, therefore the investigators are looking into drinking water that is bacteriologically safe. Out of published RCTs there is only one done in acute traumatic wound with good sample size and study design. This study is purposed to look into acute traumatic wound with proper randomization, allocation and concealment. Moreover, this is a non-inferiority trial, therefore if it is proven that drinking water is non-inferior to normal saline then, it will be easily available modality of wound irrigation in Low-Middle-Income country like Nepal.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Irrigating Traumatic Wound with Drinking Water | Experimental | In drinking water arm, acute traumatic wound will be cleaned with drinking water. Bacteriological safety of the drinking water will be ensured by testing water. |
|
| Irrigating Traumatic Wound with Normal Saline | Experimental | In normal saline arm, acute traumatic wound will be cleaned with normal saline. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Irrigating Traumatic Wound with Drinking Water | Procedure | Irrigating Traumatic Wound with Drinking Water and Normal Saline |
|
| Measure | Description | Time Frame |
|---|---|---|
| Comparison between drinking water and normal saline in irrigating traumatic wound: Noninferiority trial. | Difference in wound infection rates between the two randomized groups. Wound evaluation was based on the following criteria No infection:
1. Fever greater than 1000 F or pus discharge on any day 2. Erythema with serous discharge on any day | 3-7 Days |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ashis Shrestha, Fellow | Contact | 9851061846 | ashisshrestha@pahs.edu.np | |
| Sumana Bajracharya, Fellow | Contact | 9841359823 | sumanabajracharya@pahs.edu.np |
| Name | Affiliation | Role |
|---|---|---|
| Ashis Shrestha, Fellow | Patan Academy of Health Sciences | Principal Investigator |
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| Label | URL |
|---|---|
| The Effects of Wound Lavage Solutions on Canine Fibroblasts: An In Vitro Study | View source |
| The importance of lavage in wound care | View source |
| Is tap water a safe alternative to normal saline for wound irrigation in the community setting? |
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| ID | Term |
|---|---|
| D014947 | Wounds and Injuries |
| D014946 | Wound Infection |
| ID | Term |
|---|---|
| D007239 | Infections |
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| ID | Term |
|---|---|
| D060766 | Drinking Water |
| D000077330 | Saline Solution |
| ID | Term |
|---|---|
| D014867 | Water |
| D006878 | Hydroxides |
| D000468 | Alkalies |
| D007287 | Inorganic Chemicals |
| D000838 |
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Randomized, double blinded, parallel, non-inferiority trial
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|
| View source |
| Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial | View source |
| The effectiveness of cleansing solution for wound treatment A systematic review | View source |
| Comparison of wounds' infection rate between tap water and normal saline cleansing: A meta-analysis of randomised control trials | View source |
| Water for wound cleansing | View source |
| A Multicenter Comparison of Tap Water versus Sterile Saline for Wound Irrigation | View source |
| Injury, fatal and nonfatal: Sharp and cutting-edge wounds | View source |
| Wound classification | View source |
| Anions |
| D007477 | Ions |
| D004573 | Electrolytes |
| D010087 | Oxides |
| D017601 | Oxygen Compounds |
| D001628 | Beverages |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D019602 | Food and Beverages |
| D000077324 | Crystalloid Solutions |
| D007552 | Isotonic Solutions |
| D012996 | Solutions |
| D004364 | Pharmaceutical Preparations |