Is it advisable to clean wounds with salt water?

Is Cleaning Wounds with Salt Water (Saline) Still Advisable?

Yes, cleaning wounds with salt water (sterile saline) remains advisable and is supported by current guidelines, though tap water is equally effective and more practical in most settings. 1

Primary Recommendation

It is reasonable to use either running tap water or sterile saline solutions for wound irrigation—both are equally safe and effective, and both are superior to antiseptic agents like povidone-iodine. 1

Key Evidence Supporting This Recommendation

• The 2024 American Heart Association and American Red Cross guidelines explicitly state that tap water and sterile saline have similar infection rates when used for wound irrigation 1
• Multiple studies demonstrate no significant difference in wound infection rates between tap water and sterile saline cleansing 2, 3
• The IWGDF (International Working Group on the Diabetic Foot) recommends cleaning ulcers regularly with either clean water or saline 1

Practical Approach to Wound Cleansing

Step 1: Irrigate Thoroughly

• Superficial wounds and abrasions must be thoroughly irrigated until no obvious debris or foreign matter remains in the wound 1, 4
• Simple rinsing may not provide adequate irrigation pressure to remove bacterial contamination 1

Step 2: Choose Your Irrigation Solution

• Use running tap water or sterile saline—whichever is more readily available 1, 4
• Tap water is safe, cost-effective, and widely accessible 5, 6
• One high-quality study actually found lower infection rates with tap water (5.4%) compared to sterile saline (10.3%) 7

Step 3: Apply Appropriate Dressing

• After cleaning, cover clean superficial wounds with an occlusive dressing to promote healing 1, 4
• Occlusive dressings maintain a moist wound environment and result in better healing than dry dressings 1, 8

When to Avoid Routine Cleansing and Seek Immediate Care

Wounds contaminated with human or animal saliva should be evaluated in a medical facility as soon as possible, regardless of irrigation method 1, 4, 8

Common Pitfalls to Avoid

Don't Use Antiseptics Routinely

• Avoid using povidone-iodine or other antiseptic agents for routine wound irrigation—they offer no advantage over tap water or saline 1, 4, 8
• Several studies show no benefit of povidone-iodine in addition to irrigation 1

Don't Assume Sterile Saline is Always Necessary

• The fear of wound colonization from tap water (particularly Pseudomonas from plumbing systems) is not supported by evidence 5
• No bacterial species grown from tap water has been subsequently grown from infected wounds 7

Don't Skip Monitoring for Infection

If redness, swelling, foul-smelling drainage, increased pain, or fever develops, remove the dressing, inspect the wound, and obtain medical care 1, 4, 8

Cost-Effectiveness Considerations

• Tap water is significantly more cost-effective than sterile saline, particularly in community settings 5
• The 2022 Cochrane review found the cost-effectiveness of tap water compared to saline is uncertain due to limited data, but available studies suggest substantial cost savings 2

Special Wound Types

Diabetic Foot Ulcers

• Clean regularly with clean water or saline, maintaining a warm, moist environment 1

Surgical Wounds

• Evidence for saline irrigation of incisional wounds before closure to prevent infection is insufficient 4

Chemical Eye Injuries

• Use continuous, large volumes of clean water (not saline specifically) for chemical eye injuries 4

Bottom Line

The evidence strongly supports that both tap water and sterile saline are safe, effective options for wound cleansing, with tap water being more practical and cost-effective in most settings. The critical factor is thorough irrigation to remove debris and contaminants, not the specific type of water used. 1, 2, 7