Does wound irrigation in the prehospital environment affect infection rates? – A Review of the Literature


Traumatic wound
simple wound
infection rate
emergency medical technicians

How to Cite

Smit L, Boyle MJ. Does wound irrigation in the prehospital environment affect infection rates? – A Review of the Literature. Australasian Journal of Paramedicine [Internet]. 2015Sep.3 [cited 2023May28];12(4). Available from:



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.


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.


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.


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.


Australian Bureau of Statistics. Injury in Australia: A Snapshot. Canberra2004-2005.

Gerhardt RT, Matthews JM, Sullivan SG. The effect of systemic antibiotic prophylaxis and wound irrigation on penetrating combat wounds in a return-to-duty population. Prehosp Emerg Care 2009;13:500–4.

Hollander JE, Singer AJ, Valentine S. Comparison of wound care practises in pediatric and adult lacerations repaired in the emergency department. Pediatr Emerg Care 1998;14(1):15–8.

O'Meara PM. Management of open fractures. Orthop Rev 1992;21:1177–85.

Patzakis MJ. Management of open fractures and complications. Instr Course Lect 1982;31:62–4.

Jacob E, Setterstrom JA. Infection in war wounds: experience in recent military conflicts and future considerations. Mil Med 1989;154:311-–5.

Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multicentre comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med 2007;14(5):404–9.

Bansal BC, Wiebe RA, Perkins SD, Abramo TJ. Tap water for irrigation on lacerations. Am J Emerg Med 2002;20(5).

Forgione MA, Moores LE, Wortman GW. Prevention of Combat-Related Infections Guidelines Panel. Prevention of infections associated with combat-related central nervous system injuries. J Trauma 2011;71(2):S258–63.

Hollander JE, Richman PB, Werbuld M, Miler T, Huggler J, Singer AJ. Irrigation in facial and scalp laceration: does it alter the outcome. Ann Emerg Med 1998;31(1):73–7.

The FLOW Investigators. Fluid Lavage of Open Wounds (FLOW): A Multicentre, Blinded, Factoria Pilot Trial Comparing Alternative Irrigating Solutions and Pressures in Patients with Open Fractures. J Trauma 2011;71(3).

Murray CK, Hsu JR, Solomkin JS, et al. Prevention and Management of Infections Associated with Combat-Related Extremity Injuries. J Trauma 2008;64(3):S239–51.

Markenson D, Ferguson JD, Chameides L, et al. Part 17: First Aid: 2010 American Heart Association and American Red Cross Guidelines for First Aid. Circulation 2010;122(18 suppl 3):S934–46.

Quinn RH, Macias DJ. The Management of Open Fractures. Wilderness Environ Med 2006;17(1):41–8.

Soreide E, Grande C, editors. Prehospital Trauma Care. Boca Raton, Florida, USA: Taylor & Francis Group; 2001.

Smith E, Archer F, Burgess S. The development of an updates prehospital search filter for the Cochrane Library: Prehospital Search Filter Version 2.0. Australasian Journal of Paramedicine 2010;8(4).

Cartotto RC, Peters WJ, Neligan PC, Douglas LG, Beeson J. Chemical burns. Can J Surg 1996;39(3):205–11.

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. J Bone Joint Surg 2005;87-A(7):1415–22.

Murray CK, Obremskey WT, Hsu JR, et al. Prevention of infections associated with combat-related extremity

injuries. J Trauma 2011;71(2):S235–57.

Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analysis. J Bone Joint Surg 1976;58:453–8.

Kim PH, Leopold SS. In brief: Gustilo-Anderson classification. Clin Orthop Relat Res 2012;470(11):3270–4.

Leonard LG, Scheulen JJ, Munster AM. Chemical burns: effects and prompt first aid. J Trauma 1982;22:420–3.

Wheeler CB, Rodheaver GT, Thacker JG. Side effects of high pressure irrigation. Surg Gynecol Obstet 1976;143:775–8.

Singer AJ, Hollander JE, Subramanian S, A.K. M, Vilez PA. Pressure dynamics of various irrigation techniques commonly used in the ED. Ann Emerg Med 1994;24:36–40.