Does wound irrigation in the pre-hospital environment affect infection rates? – A review of the literature

Abstract

Introduction Historically it has been shown in the military combat setting that early irrigation of open wounds/fractures effectively assists in the prevention of infection. The objective of this study was to determine whether wound irrigation alone in the civilian prehospital environment affects wound infection rates.

Methods A literature search of the electronic medical databases CINAHL, Cochrane Collaboration, EMBASE and Medline was conducted. The databases were reviewed from January 1950 until the end of March 2015. An existing prehospital search filter was applied to each database with additional search terms “wound”, “traumatic wound”, “simple wound”, “irrigation”, “fluid irrigation”, and “infection rate”. Articles of any study design were included if they reported on the effect of wound irrigation and wound infection rates. Reference lists of included articles were also reviewed. Articles were excluded if they were not written in English, involving animals, or were from the military setting.

Results A total of 1,648 articles were identified in the search with eight meeting the inclusion criteria. The eight articles were from the military combat setting were excluded. There were no civilian prehospital specific articles identified in the search therefore hospital ED and military data was used as a substitute to investigate the effectiveness of wound irrigation in decreasing wound infection rates.

Conclusion Evidence from the civilian prehospital setting does not clearly prove that irrigation alone prevents infection, nor does it prove that removing irrigation from wound care increases wound infection rates. Extrapolation of data from the military and hospital setting is inconclusive. Therefore wound irrigation should remain part of civilian prehospital wound care until further high-level studies can be undertaken.