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NEPI » Emergency Medicine » Clinical case discussions
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wound irrigation
Clinical Scenario:
A 20 year old presents to ED after sustaining a simple laceration on his left thigh. The wound edges are not mangled and it does not appear dirty. There is nothing suggestive of a nerve/tendon/vascular injury. He also does not suffer from diabetes, bleeding disorders etc. In other words, he has an otherwise clean bill of health!!! You feel that this needs sutures. What kind of fluid would you use for iirigation of this wound? Is it sterile water or tap water?
Several RCTs have been done, mainly in the western world. They find their tap water to be good enough for irrigation. How about our tap water. Can our water boards provide us clean enough water? How about bottled water? Is bottled (mineral) water cheaper than the same volume of sterile water?
Mind you the issues here are
1 Should reduce the chances of infection comparable to sterile water
2 Cost
Have any studies been done in our sub-continent? Or else, it could be a good topic for some research... volunteers please....
Edited by maroju on 10-11-2007 15:09
I haven't heard of any formal studies on this.

But I know the ED in CMC vellore was using tap water to wash
grossly contaminated wounds and their microbiology dept showed no
increase in infection rates compared to normal saline.

If you plan to use tap water, I think you need to go see where it is
coming from (The tanks must not be full of algae and arthropods!)
Did the team from CMC publish their study? It would be interesting to review. Anyone from CMC, who was involved wants to comment please!!!
Edited by maroju on 11-11-2007 21:13
I think the studies done by these people are checking the cost efficiency and the complications of both tap water and normal saline.I personally think as long as the liquid is sterile i would't mind to use any(Tap water/Distilled water/Normal Saline).
So Stemlyn, have you ruled out the possibility of using 'tap water' when you say you would use any sterile liquid??
However if anyone is interested in some studies, listed a few refs... there are a lot more but none in the Indian context...

1.Tap water for irrigation of lacerations.
The American Journal of Emergency Medicine, Volume 20, Issue 5, Pages 469-472
B. Bansal et al

2. New concepts in wound management.
Clinical Pediatric Emergency Medicine, Volume 5, Issue 4, Pages 239-245
R. Schremmer et al

3. A multicenter comparison of tap water vs sterile saline for wound infection, AEM
Moscati RM et al
Haaaaaaaaaaa I don't have anything against tap water and it think the tap water is nearly as sterile as the sterile saline and i very much support using tap water.
It depends on how much reliable is the tap water source and think sterile liquid applies to the tap water as well but depends on the water supply and most of the water treatment plants do use chemical sterilization which is as good as ionisation technique used to sterilise the so called sterile saline/water used in hospitals.
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