A Reader Responds to “Should We Use Saline or Tap Water for Cleansing Wounds?”

To the Editor:

Finally there is some plain common sense in the ways of cleansing acute wounds.[1] I've used both tap water and saline, and honestly saw no appreciable difference other than the cost. I ran a rural health clinic in northern California for 5 years and had no budget to pay for sterile normal saline solution for the irrigation of wounds. Having no running water at my facility for the first couple of years, I had to haul creek water that I had collected to treat traumatic wounds. I stored it in 50-gallon olive barrels and, once full, added a quarter cup of chlorine bleach to kill any pathogens. I had absolutely no increase in the rates of infection.

In any irrigation of wounds I used the principle of “hydraulics” for irrigation, using a large syringe and an intracatheter to push the water through. This gave good mechanical debridement when needed, especially with dirty wounds. Granted, to have ingested it (drinking it) could have caused illnesses such as giardiasis, but this was never the case.

In past years (learned from previous protocols with patients who had cancer), we instilled warmed tap water intra-abdominally with patients who had multiple peritoneal metastases (as in ovarian cancer) and left the water in the peritoneal cavity about 30 minutes. We used the same protocols in the follow-up surgeries. Three months later, those treated with warmed tap water had far less remaining metastases than those treated with warmed saline, and their survival was statistically better! The tap water lysed the cells, and I simply figured that it would also do a better job of lysing bacterial cells because it is hypotonic (as compared to using an isotonic solution). It just made sense!

I am a physician and secondary science teacher, and I have always demonstrated to my students the effects of cellular lysis when subjecting various types of cells to hypotonic water. For plain tap water, the chlorine is actually a benefit in helping bring about cellular death from bacteria (think of bleach and how it is used to kill things as virulent as the HIV virus). I would expect the amount of negligible “drugs” in the water to not be a problem as one physician implied it would be.

I hope this tidbit of information may be of some assistance.