Wound Irrigation Using Normal Saline 0.9% Versus Tap Water: A Review for Street Medicine and Low-resource Providers

Abstract

Patients experiencing homelessness are a vulnerable cohort who suffer from disproportionate skin disease burden. Acute and chronic wounds represent high morbidity conditions with severe consequences. Adequate management in the form of cleansing and irrigation is necessary for removing cellular debris, bacteria and contaminants. Providers in low-resource street medicine settings may be the first point of contact in the management of wounds encountered by unhoused patients. This review determines the feasibility of improvised irrigation techniques that can be used in street settings to irrigate wounds. A MEDLINE search was conducted and yielded randomized controlled trials, laboratory studies and case-control studies. No significant difference in wound infection and healing rates was found when normal saline 0.9% or tap water was used in wound irrigation. Improvised cleansing devices with suitable irrigation pressure included water bottles punctured with 14-18-gauge needles, 10-mL syringes and 50-syringes. Lower and upper extremity wounds were found to be at higher risk of infection, requiring judicious management and cleaning. Street medicine providers should consider weighing the benefits versus risks of on-site, improvised wound irrigation for acute soft tissue injuries, especially in the setting of limited resources.