PediatricsWound irrigation in children: Saline solution or tap water?☆,☆☆
Introduction
Wound repair is a common procedure in the pediatric emergency department. In 1996, approximately 11 million wounds were evaluated and treated in EDs across the United States.1, 2 Most of these traumatic wounds occur in children and represent approximately 30% to 40% of all pediatric injuries.2, 3 Wound infection is associated with a variety of factors, such as timing of wound closure, presence of foreign bodies, mechanism of injury, host immune response, bacterial inoculum, and presence of devitalized tissue.4
Wound irrigation is a critical component of wound management. Wound infections have been shown to correlate with tissue bacterial counts of more than 105 per gram of tissue.5, 6 However, bacterial counts cannot be assessed in the ED, and therefore, all wounds are irrigated copiously for decontamination.
Most authors recommend wound irrigation pressures of at least 0.35 to 0.56 kilogram-force per square centimeter (kgf/cm2) generated by using a syringe with a minimum of 100 to 300 mL of continuous irrigation.7, 8 Standard water faucet pressures are typically 3.16 kgf/cm2.9 The higher pressure associated with tap water irrigation might improve the efficiency of bacterial removal and decrease the incidence of infection.4, 5, 10, 11, 12, 13
For patients of all ages, the standard of care in the ED has been to use sterile normal saline solution with a syringe for pressure irrigation of wounds. Evidence suggests that tap water might also be adequate for wound irrigation; however, this has not been adequately studied in children.6, 14, 15
The purpose of our study was to compare, in children, the infection rate in simple wounds irrigated with sterile normal saline solution by means of standard techniques with that in wounds irrigated with running tap water.
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Materials and methods
In the immediate pre-enrollment period, the water pressures and flow rates from each faucet in the pediatric ED were measured by engineering department staff. In addition, 1-L samples of tap water were collected directly from each faucet, with the handle turned to predetermined flow positions after the water had been running for approximately 30 seconds. Each 1-L sample of tap water was passed through a 0.2-μm disposable filter. Cultures of these filters were performed by using a tripticase soy
Results
The measured tap water pressure from the faucets in the pediatric ED was approximately 3.52 to 4.22 kgf/cm2. The measured average flow rate of the tap water was 238 mL/s. On average, there was less than 1 colony-forming unit of bacteria per milliliter of water cultured. The organisms identified were Bacillus megaterium , an aerobic gram-positive spore forming bacillus and saprophytic organism widely distributed in nature, and Staphylococcus hominis , a nonvirulent gram-positive coccus
Discussion
Our results suggest that tap water might be as effective as sterile normal saline solution irrigation for simple wounds in children. The overall wound infection rate was 2.9%, with comparable rates in both irrigation groups. There did appear to be an increased risk of infection if foot wounds were irrigated with tap water, but the number of patients with foot wounds was small, and this increase in relative risk might not persist with a larger sample size.
Wound infection rates have been found to
Acknowledgements
We would like to acknowledge all members of the pediatric ED staff for their help in patient recruitment and enrollment, especially Lucille Corva, PNP, MSN, and Angela Diano, PNP, MPH, for their help with patient follow-up.
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Cited by (0)
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The authors report this study did not receive any outside funding or support.
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Address for reprints: Rene J. Forti, MD, 1W20 Jacobi Hospital, 1400 Pelham Parkway, Bronx, NY 10461; 718-918-7986, fax 718-918-7459; E-mail [email protected]