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Study: Saline Water More Effective for Cleaning Wounds

Saline water is more successful than using soap and water at cleaning wounds for open fractures, according to new research.

In a study of 2,400 individuals with open arm or leg fractures, participants’ wounds were cleaned with either soap and water or a saline water solution, and 1 of 3 different levels of water pressure. Investigators monitored the patients to see which would need additional operations within 12 months due to infection or issues with their wounds healing. According to the authors, very low water pressure was an acceptable and affordable alternative to washing out open fractures. They also found that the reoperation rate was higher among the group that had used soap.

These wounds are often first by primary care practitioners outside of large urban referral centers, notes study co-author Edward Harvey, MD, MSc, FRCSC, a professor of surgery at McGill University. Harvey adds that “primary care physicians can certainly now feel better in the debridement process if an operating room and specialist is not available when initially seen, in that, after the start of antibiotics, running 6 liters of crystalloid solution through the wound is not going to harm the patient and may be of great benefit.”

This is “ever-more pertinent in under-serviced areas where the primary care practitioner may be the only care provider to deride the wound definitively,” continues Harvey. “In austere environments, there is now no problem with running fluid without soap as final care for an open fracture, whereas [the] previous standard of care was a rather expensive combination of machine-driven high pressure lavage plus soap in the solution.”

The findings have “broad applicability to primary care practitioners, who should feel confident that use of a saline solution alone, delivered to the wound by any pressure, is an acceptable standard of care,” adds Mohit Bhandari, MD, PhD, FRCSC, a professor and university scholar at McMaster University, and lead author of the study.

“The use of costly battery-operated wound irrigators and additional additives like soap are unwarranted,” says Bhandari, who is also academic chair in the division of orthopaedic surgery at McMaster. In fact, he says, this approach “may lead to greater risk of complications and harm.”

Reference
Bhandari M, Harvey E, et al. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. NEJM. 2015.

Source: Reproduced from GP Clinics Vol 6 No 12, 2016.