Choosing Wisely: Evidence-Based Support for the Efficacy and Safety of Tap Water Versus Normal Saline for Wound Cleansing.

Abstract

Background: Although normal saline is widely applied in wound irrigation, evidence suggests that tap water irrigation does not increase the risk of wound infection. In this study, the gap between current evidence and clinicians' awareness regarding wound care practice was examined.

Methods: A comprehensive literature search was conducted of trials published before July 2025 in the PubMed, Embase, and Cochrane Library databases. Individual effect sizes were standardized, and a meta-analysis was performed to estimate the pooled effect size through random-effects models. The primary and secondary outcomes were wound infection and healing, respectively. On the basis of the meta-analysis findings, a survey was conducted to assess the gap between current evidence and clinical practice among health care providers.

Results: This study reviewed 12 trials involving 3330 patients with 3352 wounds. The risk of wound infection did not differ significantly between the tap water and normal saline groups (risk ratio, 0.78; 95% confidence interval, 0.59-1.03). In the trial sequential analysis for wound infection, the Z curve remained within the O'Brien-Fleming boundaries, even after the 11th interim significance test. A subsequent survey indicated that many clinicians exposed to these findings remained unwilling to practice tap water irrigation.

Conclusions: Tap water irrigation does not increase the risk of wound infection. Despite widely available evidence, many clinicians remained reluctant to practice tap water irrigation. To facilitate broader acceptance of this irrigation approach, institutional guidelines, endorsement from key opinion leaders, and social media promotion are recommended.