Irrigation of traumatic lacerations in the ED: Evidence on tap water as an alternative to Sterile Saline - A scoping review

Wound irrigation in the Emergency Department is essential for preventing infection in traumatic lacerations. While sterile saline is widely considered to be the standard solution of choice, tap water may offer a safe, cost-effective, and resource-conscious alternative. We conducted a scoping review following PRISMA-ScR guidelines. Searches of PubMed, Embase, CINAHL, and Scopus through October 2024 identified 913 records; 27 studies met inclusion criteria (RCTs, observational studies, systematic reviews). Across included studies, infection rates did not differ significantly between tap water and sterile saline (pooled risk difference of -0.3% [95% CI: -1.2 to +0.6; p = 0.62]). High-pressure and large-volume irrigation were consistently associated with reduced infection risk, regardless of solution type. Cost analyses estimated potential annual savings of $65.6 million with tap water use. Variability in irrigation techniques and limited data in vulnerable populations remain key gaps. Tap water appears to be a safe, effective, and economical alternative for irrigating uncomplicated lacerations in ED settings. Future research should prioritize standardized protocols, controlled trials, and implementation strategies to optimize wound care and reduce resource burden.