INTRODUCTION
Dealing with wounds outside the controlled environment of a hospital presents significant challenges, especially for ordinary individuals who may lack the necessary knowledge, tools, or resources. Disinfecting wounds is a critical step in preventing infections and ensuring proper healing. However, achieving adequate disinfection outside the hospital setting can be particularly challenging for the general public. The primary issue is a lack of knowledge about proper wound care techniques. Many individuals do not know how to cleanse wounds with appropriate solutions or follow specific procedures to expedite healing.
For many, the financial aspect of managing wounds outside a hospital setting presents a significant barrier. The costs of purchasing wound care supplies, including antiseptics, sterile dressings, bandages, gloves, and other essential items, can accumulate rapidly. While over-the-counter wound care products are readily available, they often carry a price tag that may be prohibitive for individuals or families with low incomes. Moreover, those in need of specialized products for chronic or severe wounds may encounter even higher expenses.
Recent studies have reported that using tap water for wound disinfection yields results comparable to those obtained with normal saline. According to a Cochrane review, there is no significant difference in wound infection rates or healing outcomes between tap water and sterilized water [
1]. In the author’s practice, patients are typically instructed to wash their wounds with tap water for disinfection, including open and surgical wounds. Additionally, a systematic review indicates that cleansing wounds with surfactant-containing soap shows little difference compared to conventional dressing in the treatment of burns [
2].
For years, patients have been encouraged to use soap and tap water for wound management at home as a validated alternative to conventional disinfection methods, although this practice was based on empirical evidence. We present a preliminary report on the use of tap water and commercial soap for wound management. This study aims to clarify the safety and efficacy of using tap water and commercial cleansing soap in managing wounds in outpatient clinical settings.
IDEA
Patients and methods
Patients presenting with open or surgical wounds were enrolled in the study at the Department of Plastic and Reconstructive Surgery. The wounds varied in etiology, including incisional, operative, infectious, and trauma-related wounds.
The protocol for washing involved the use of commercial soap containing conventional surfactants, specifically decyl glucoside and sodium C14-16 olefin sulfate (Senicos Rejuphen cleanser, Seojin Biopharm). This was part of a standard soap-and-water washing procedure. The patient performed self-wound cleansing daily using tap water and the specified commercial soap. Each washing session lasted at least 5 minutes and included gentle rubbing. After the wound was dried, it was covered with a foam dressing.
Patients with severe systemic diseases who were unable to manage their wounds independently, those with uncontrolled diabetes, and those who were immunosuppressed were excluded from the study. Additionally, patients with an insufficient follow-up period (less than 2 weeks) were also excluded. The study received approval from the Institutional Review Board at Hanyang University Hospital.
Results
A total of 15 patients were enrolled in the study. The etiology of the wounds varied: nine patients presented with surgical wounds, four with trauma-induced wounds, and two with infection-related wounds. Most wounds were located on the face, with additional wounds recorded on the scalp (1), trunk (1), and extremities (2), as detailed in
Table 1. All wounds healed completely within 2 weeks. Throughout the study period, there were no instances of wound infection, dehiscence, or delayed healing.
DISCUSSION
Managing wound care at home can be challenging, especially for patients without medical training or access to professional support. Wound dressing plays a vital role in the healing process, and improper care can lead to complications such as infections, delayed healing, and scarring. Many patients and caregivers lack familiarity with proper wound care techniques, including how to cleanse wounds, apply dressings, and recognize signs of infection. This knowledge gap can lead to inadequate cleansing, the use of inappropriate materials, or failure to create an optimal environment for wound healing.
Furthermore, the accessibility of dressing materials and associated financial concerns present additional barriers. High-quality wound care supplies, including sterile dressings, antiseptics, and adhesive tapes, may not be readily available or affordable for some patients. Home wound care can be expensive, particularly when specialized dressings and wound-cleansing solutions are utilized.
To overcome the challenges of wound management by non-healthcare professionals, numerous studies have been conducted over an extended period [
1,
3-
5]. However, these procedures are often carried out based on the empirical preferences of surgeons. Additionally, many physicians are reluctant to use tap water as a cleansing agent, and some even advise their patients against allowing their wounds to come into contact with water. This study aims to provide scientific evidence supporting the safety of using tap water and commercial soap in wound management.
This study evaluated the efficacy and safety of a standard soapand-water washing procedure for managing open and surgical wounds. The results were positive, with all wounds healing completely within 2 weeks and no instances of infection, dehiscence, or delayed healing reported.
Fig. 1 illustrates the outcomes of a subbrow incision used for the reduction of frontal sinus and upper orbital rim fractures, monitored intraoperatively and at a 2-month follow-up. The incision measured 4 cm. The patient was instructed to cleanse the incisional wound with tap water and commercial soap starting 2 days post-operation. The patient did not perform any disinfection procedures and continued washing until the stitches were removed 7 days after the surgery. There were no occurrences of dehiscence or infection, and the final scar quality was satisfactory.
Fig. 2 depicts another instance where washing with commercial soap was employed for a cosmetic procedure. The patient underwent conventional lower blepharoplasty and was advised to wash the wound with tap water and commercial soap. The total wound length was 8 cm, and stitches were removed 5 days post-operation without any complications (
Fig. 2A). The final scar quality remained satisfactory up to 2 months post-operation (
Fig. 2B).
Several studies have reported the cost-effectiveness of using tap water for wound cleansing [
6-
8]. One study suggests that using tap water instead of sterilized saline could save patients $100 million annually [
8]. In our study, we estimated a reduction in the total cost of disinfection. Patients did not require forceps, trays, or disinfection solutions, which are not covered by national insurance. There were no complaints regarding procedural difficulties or pain during the washing.
The etiology of the wounds varied, with the majority resulting from surgical procedures, followed by trauma and infection. Despite these differences in origin, the consistent and rapid healing observed suggests that the cleansing protocol provided adequate wound hygiene, potentially reducing the risk of complications. A key strength of this study is the simplicity and accessibility of the methodology, which utilizes readily available materials. The cleansing material used in this study contains conventional surfactants such as decyl glucoside and sodium C14-16 olefin sulfate, which are commonly used in skin care products due to their effective cleansing properties [
9]. By removing debris and reducing microbial load without causing irritation, the cleansing agent likely played a critical role in preventing secondary infections and promoting optimal wound healing.
The exclusion of patients with severe systemic illnesses, uncontrolled diabetes, or immunosuppression ensured a homogeneous study population capable of self-care and compliance with wound management protocols. While this approach enhanced the internal validity of the study, it may limit the applicability of the findings to more vulnerable populations at higher risk of wound complications.
The lack of adverse events such as infection or delayed healing in this study stands in contrast to previous reports that have noted higher rates of wound complications, especially in situations involving contaminated or traumatic wounds [
1,
2]. This difference could be due to the thorough cleansing protocol and the effectiveness of the surfactant-based cleanser employed in this research.
Despite these promising results, several limitations must be acknowledged. The relatively small sample size (n=15) may restrict the generalizability of the findings. Additionally, the short follow-up period precludes evaluation of long-term outcomes or late complications, such as scarring. Future studies with larger cohorts and extended follow-up durations are recommended to confirm these findings and explore their applicability in high-risk patient groups.
In conclusion, the challenges of managing wounds outside of a hospital setting underscore the necessity for increased support and resources for the general public. Although this is only a preliminary report, the study indicates that a standardized cleansing regimen using a surfactant-based commercial cleanser with soap and water can be an effective and safe method for managing both open and surgical wounds. This method offers a straightforward, accessible, and cost-effective approach to wound care in clinical settings.