What is the preferred solution for wound cleansing, normal saline (NS) or sterile water?

Wound Cleansing: Normal Saline vs. Sterile Water

Both normal saline and sterile water are acceptable for wound cleansing, with no significant difference in infection rates or healing outcomes between the two solutions. 1

Evidence-Based Recommendations for Wound Cleansing

Primary Solution Selection

• First-line option: Normal saline (0.9% sodium chloride)

  • Isotonic solution that doesn't interfere with normal healing process
  • Widely available in clinical settings
  • Considered standard of care in many healthcare facilities 2

• Acceptable alternative: Tap water

  • Particularly useful in community settings
  • Cost-effective and easily accessible
  • Evidence shows comparable infection and healing rates to normal saline 1, 3

Clinical Decision Algorithm

1. For clean wounds and routine cleansing:

   • Use normal saline or tap water based on availability 2, 1
   • Both options show similar outcomes for wound infection and healing rates

2. For contaminated wounds:

   • Use copious irrigation with either solution
   • Apply with sufficient pressure to remove debris and contaminants
   • Pressure irrigation with saline may be more effective than standard irrigation (OR 0.35; 95% CI 0.19–0.65) 4

3. For infected wounds:

   • Consider antimicrobial cleansers rather than saline or water
   • Antimicrobial solutions may be more effective at reducing bioburden 5, 6

4. For specific wound types:

   • Human and animal bite wounds: Copious irrigation with either water or saline 4
   • Eye exposure to toxins: Tap water is beneficial for immediate irrigation 4

Application Techniques

• Irrigation method: Apply sufficient volume (100-1000 mL) to effectively remove contaminants 2
• Pressure consideration: Gentle pressure irrigation may be more effective than standard irrigation 4
• Temperature: Consider using warmed solution to reduce pain during cleaning 4

Important Caveats and Pitfalls

1. Avoid antiseptic agents like povidone-iodine or hydrogen peroxide for routine wound cleansing as they can damage healthy tissue and impair healing 2

2. Solution sterility matters less than technique: The cleansing technique is often more important than the solution used 1, 7

3. Context-specific considerations:

   • In resource-limited settings, tap water is a practical and cost-effective alternative 3
   • In healthcare facilities with readily available sterile solutions, normal saline remains standard practice

4. Evidence limitations: Most studies comparing wound cleansing solutions show low or very low certainty evidence 1, suggesting that the choice between normal saline and water may not significantly impact outcomes

Follow-up Care

• After cleansing, cover superficial traumatic abrasions with a clean occlusive dressing to keep the wound moist and prevent drying 4, 2
• Monitor for signs of infection regardless of cleansing solution used
• Change dressings when soiled or wet 2

The evidence suggests that the traditional preference for normal saline may be based more on convention than superior clinical outcomes, as tap water has demonstrated similar safety and efficacy in multiple studies 1, 3, 7.