Irrigating methicillin‐resistant Staphylococcus aureus‐colonised and ‐infected chronic wounds – why use tap water?

Abstract

International Wound JournalVolume 12, Issue 5 p. 605-605 LETTER TO THE EDITOROpen Access Irrigating methicillin-resistant Staphylococcus aureus-colonised and -infected chronic wounds – why use tap water? Basavraj S Nagoba PhD, Corresponding Author Basavraj S Nagoba PhD Department of Microbiology MIMSR Medical College Latur, Indiadr_bsnagoba@yahoo.com; bsnagoba@gmail.comSearch for more papers by this authorSohan P Selkar MPhT, Sohan P Selkar MPhT Department of Physiotherapy MIP College of Physiotherapy Latur, IndiaSearch for more papers by this authorJitendra B Mule MSc, Jitendra B Mule MSc Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, IndiaSearch for more papers by this author Basavraj S Nagoba PhD, Corresponding Author Basavraj S Nagoba PhD Department of Microbiology MIMSR Medical College Latur, Indiadr_bsnagoba@yahoo.com; bsnagoba@gmail.comSearch for more papers by this authorSohan P Selkar MPhT, Sohan P Selkar MPhT Department of Physiotherapy MIP College of Physiotherapy Latur, IndiaSearch for more papers by this authorJitendra B Mule MSc, Jitendra B Mule MSc Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, IndiaSearch for more papers by this author First published: 19 September 2013 https://doi.org/10.1111/iwj.12150Citations: 2AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Dear Editors, We read with great interest a letter entitled, ‘Irrigating methicillin-resistant Staphylococcus aureus-colonised and -infected chronic wounds with tap water’, by Li et al. 1. In this study, the use of tap water, which was 2°C higher than individual body temperature, has been suggested to irrigate chronic wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) for 5 minutes, twice a day. A significant improvement in the condition of the chronic wound after 2 weeks of irrigation with tap water has been reported, showing two impressive clinical photographs before and after warm tap water irrigation. It is not clear whether tap water irrigation was the only treatment modality used for the treatment of wound or some other local or systemic antibacterial agent was also used to eliminate MRSA from the wound site. We do agree that daily wound irrigation with requisite pressure can decontaminate wound and eliminate bacterial colonies, preventing subsequent liberation of multiple toxins that may incite an ongoing inflammatory response that retards the process of wound healing; however, complete elimination of most noxious and most difficult bacteria such as MRSA from chronic wound site by using tap water irrigation alone appears to be difficult. Another important issue is why use tap water? Although use of tap water is a very economical option because of its wide availability, it is comparatively better than normal saline in reducing infection rates 2 and is also superior to antibacterial solutions in removing debris and bacteria present at wound site, thereby creating a better healing environment, when an irrigation pressure of greater than 8 psi is used 3. It is risky to use tap water because it may contain potentially pathogenic bacterial flora that may lead to further addition of infectious material to the already infected wound. Hence, tap water that is 2°C higher than individual body temperature is not always a better option for wound irrigation. Instead of tap water, bacteria-free boiled water, distilled water or packed mineral water would be a better option for irrigation of chronic wounds. Hence, irrigation with boiled water, distilled water or packed mineral water that has a pressure of about 45 psi would be a superior alternative to detach bacteria and debris from the wound, thus serving the purpose of irrigation and simultaneously not adding any potentially pathogenic microbial flora to the wound. Basavraj S Nagoba, PhD1, Sohan P Selkar, MPhT2 & Jitendra B Mule, MSc3 1Department of Microbiology MIMSR Medical College Latur, India dr_bsnagoba@yahoo.com; bsnagoba@gmail.com 2Department of Physiotherapy MIP College of Physiotherapy Latur, India 3Sunrich Aqua (Packaged Drinking Water Plant) Maharashtra Industrial Development Corporation Latur, India References 1Li TS, Choong MY, Wu SF, Chen KJ. Irrigating methicillin-resistant Staphylococcus aureus—colonized and infected chronic wounds. Int Wound J 2013; 10: 359. Wiley Online LibraryPubMedWeb of Science®Google Scholar 2Bansal BC, Wiebe RA, Perkins SD, Abramo TJ. Tap water for irrigation of lacerations. Am J Emerg Med 2002; 20: 469– 72. CrossrefPubMedWeb of Science®Google Scholar 3Stone S, Carter W. Wound preparation. In: JE Tintinalli, G Kelen, J Stapczynski, editors. Emergency medicine: a comprehensive study guide, 5th edn. New York: McGraw-Hill, 2000: 284– 7. 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