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

Samrah Mitha
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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.
使用 0.9% 普通生理盐水与自来水进行伤口冲洗:针对街头医疗和低资源提供者的综述
无家可归的病人是一个易受伤害的群体,他们承受着不成比例的皮肤病负担。急性和慢性伤口发病率高,后果严重。为了清除细胞碎片、细菌和污染物,有必要对伤口进行适当的清洁和冲洗。在资源匮乏的街头医疗环境中,医疗人员可能是无家可归的病人处理伤口的第一接触点。本综述确定了可在街头环境中用于灌洗伤口的简易灌洗技术的可行性。我们在 MEDLINE 上进行了搜索,结果包括随机对照试验、实验室研究和病例对照研究。结果发现,使用 0.9% 的生理盐水或自来水灌洗伤口时,伤口感染率和愈合率没有明显差异。具有合适冲洗压力的简易清洁装置包括用 14-18 号针头刺穿的水瓶、10 毫升注射器和 50 号注射器。研究发现,下肢和上肢伤口的感染风险较高,需要谨慎管理和清洁。街头医疗提供者应考虑权衡现场简易伤口冲洗治疗急性软组织损伤的益处和风险,尤其是在资源有限的情况下。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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