Background: Numerous solutions such as tap water and sterile saline are available for wound cleansing, yet the evidence for these interventions is complex across the literature.
Objectives: To compare the difference between tap water and saline for wound cleansing through an overview of systematic reviews.
Methods: We searched MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews in March 2016. Systematic reviews that examined adults receiving wound cleansing were included. Two reviewers independently screened the literature, abstracted data, and assessed study quality using the AMSTAR tool (A MeaSurement Tool to Assess systematic Reviews).
Results: Six systematic reviews were included after screening and three were systematic reviews without a meta-analysis. Overall, 83% of the included reviews were rated as being of high quality (AMSTAR score ≥ 8). For pressure ulcers, two studies reported no statistically significant change in healing when wounds were cleaned with water compared with saline. For chronic wounds, two studies showed there was no increase in infection or in wound healing rates between patients whose wounds were cleaned with tap water or sterile saline. Finally, three studies showed that the use of tap water to cleanse acute wounds in adults and children was not associated with a statistically significant difference in infection rate when compared to saline.
Conclusions: The high-quality evidence indicates that using tap water to cleanse wounds is not significant different with regard to increases or reductions in infection when compared to saline. The AMSTAR scale can useful to evaluate the quality of systematic reviews. However, most studies were consistent across all outcomes throughout the literature. Clinicians and nurses rarely use the results for wound cleansing. The gap between what we know and what we do remains a challenge for the discipline and the professions. Evidence-based medicine has emphasized the fact that often decisions are valued and partiality sensitive. To do the best for the individual patient, clinicians need to evaluate patient’s values, especially with shared decision-making.