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Am Fam Physician. 2004;69(1):177-183

Traumatic wounds are common in children, and wound irrigation is an important initial treatment component to reduce bacterial counts. The use of a sterile normal solution with a syringe is standard practice for irrigation in the emergency department. Tap water irrigation has been suggested as a better way to remove bacteria because of the higher pressure involved. Valente and associates compared the infection rate in children in wounds irrigated with sterile normal saline solution by means of standard techniques with that of wounds irrigated with running tap water.

Simple wounds requiring repair in children who presented to the emergency department within eight hours of injury were irrigated with either normal saline or tap water. The treatment methods were used on alternate days. Children who required antibiotic prophylaxis or who had complicated lacerations were excluded. In the normal saline solution group, wounds were irrigated using a minimum of 100 mL of normal saline solution with a syringe. Tap water irrigation was performed for a minimum of 10 seconds with tap water taken directly from the faucet or from an acetate tube. All of the wounds were then repaired using either sutures, staples, or skin glue. Patients were evaluated for evidence of infection within 48 to 72 hours, at return for suture removal, or were contacted by telephone to determine the outcome. More than 250 patients were included in each group.

A total of 14 wound infections were equally divided between patients in the two groups, with no differences based on the method of repair. There was, however, a significantly increased risk of infection in foot wounds irrigated with tap water.

The authors conclude that tap water might be as effective in preventing bacterial infection as sterile normal saline solution for simple wounds in children. The overall wound infection rate was 2.9 percent, which is comparable with other studies. There is an assumption that tap water is free of any significant pathogenic bacterial counts. Other potential advantages of tap water irrigation include the following: (1) decreased cost, (2) ready availability, (3) reduction in biohazard risk to health care workers, and (4) decreased patient anxiety because of the absence of a syringe from the procedure. The increased risk of foot infections in the group irrigated with tap water has uncertain significance and might not persist in a larger trial.

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