Is tap water a safe alternative to normal saline for wound irrigation in the community setting? Pulsatile lavage for the enhancement of pressure ulcer healing: a randomized controlled trial.
This double-blind randomised controlled trial compared the effects of tap water and normal saline on the healing and infection rates of acute and chronic wounds.
                The trial was conducted in two metropolitan community health centres in New South Wales, Australia. Thirty-five patients with 49 acute or chronic wounds were randomised to receive wound irrigation with either normal saline or tap water.
                Statistical analysis demonstrated there was no significant difference between the infection and healing rates in wounds irrigated with normal saline or tap water.
                Although the small sample size is a limitation of this study, the researchers conclude that drinkable tap water appears to provide a safe alternative to normal saline for wound cleansing and may be preferred by some patients. Pressure ulcer development is a common, serious complication after spinal cord injury (SCI). Although many biophysical agents are available for treatment, few randomized controlled trials of their efficacy have been done.
                The study objective was to examine the efficacy of low-pressure pulsatile lavage treatment for stage III and IV pressure ulcers in people with SCI.
                This study was a randomized controlled trial. Participants and assessors were unaware of intervention assignments.
                This study was conducted in an SCI tertiary care center inpatient unit.
                Participants were 28 people with SCI and stage III and IV pelvic pressure ulcers; 14 participants each were randomly assigned to treatment and control (sham treatment) groups.
                Daily low-pressure pulsatile lavage treatment with 1 L of normal saline at 11 psi of pressure was applied to the treatment group along with standard dressing changes. The control group received only sham treatment and standard dressing changes.
                Linear and volume measurements of pressure ulcer dimensions were obtained weekly for 3 weeks.
                Statistical analysis with the t test revealed no statistically significant difference in demographics between groups. Random-coefficient models for analysis of linear and volume measurements revealed improvements over time for both groups. Time trend analysis revealed greater measurement decreases for the treatment group. Differences in rates of change (with 95% confidence intervals) for treatment and control groups, respectively, were: depth, -0.24 (0.09 to -0.58) cm/wk; width, -0.16 (0.06 to -0.39) cm/wk; length, -0.47 (0.18 to -1.12) cm/wk; and volume, -0.33 (0.13 to -0.80) cm(3)/wk.
                Study limitations were small sample size and inclusion of only one site. Additionally, participants were not queried about their group assignments.
                Pulsatile lavage enhanced stage III and IV pelvic pressure ulcer healing rates in people with SCI relative to standard pressure ulcer treatment alone.
We identified three small studies addressing cleansing of pressure ulcers. One reported a statistically significant improvement in pressure ulcer healing for wounds cleansed with saline spray containing Aloe vera, silver chloride and decyl glucoside (Vulnopur) compared with isotonic saline solution, a further study reported no statistically significant change in healing was seen when wounds were cleaned with water was compared with saline. A final study compared pulsatile lavage with sham and found a significantly greater reduction in ulcer volume at the end of the study period in the lavage group compared with the sham group. The authors conclude that there is no good trial evidence to support use of any particular wound cleansing solution or technique for pressure ulcers.