One resolution adopted by the ACEP Council this year was particularly well-timed. As members in the southeastern states were faced with Hurricanes Helene and Milton during and after ACEP24, the 2024 Council approved a resolution for the College to advocate for the use of hospital tap water for wound irrigation.
Resolution 59 calls for health care professionals to:
- emphasize the importance of research and education within the emergency medicine community on the safety, efficacy, and potential cost savings of using hospital tap water for wound irrigation.
- urge U.S. policymakers and health care administrators to support initiatives, such as the use of hospital tap water for wound irrigation, that contribute to broader global efforts to enhance environmental sustainability and combat climate change in health care by decreasing the carbon footprint of emergency departments.
In the wake of Hurricane Helene, the Baxter International factory in North Carolina was flooded and shut down, preventing development and distribution of intravenous fluids around the country. The facility is one of the largest suppliers of IV fluids, the Food and Drug Administration has said. Baxter has said they do not have timeline for when the factory will be back up and running.
The American Society of Health-System Pharmacists (ASHP) issued a drug shortage alert for 0.9% Sodium Chloride Irrigation on Oct. 4. ACEP, and many hospitals nationwide, were encouraging physicians to help conserve the supply and establish protocols for reserving IV fluids for the most necessary use cases. Using tap water for wound irrigation was a common recommendation.
Resolution 59 pointed out the efficacy of tap water compared to sterile saline in the United States would result in potential cost savings as 12.2 to 14.1 million people present to the ED for wound management. Assuming each one uses one bottle for irrigation, that would be 12.2 to 14.1 million bottles of plastic saved each year.
According to the background information provided with the Resolution, endorsing the use of tap water in the United States, instead of sterile saline solutions, can contribute to significant cost savings, reduce the carbon footprint of emergency departments, and advance efforts to mitigate climate change, all while maintaining high standards of patient care.
Several studies have endeavored to compare the use of tap water versus normal saline for wound cleansing. A 2021 Cochrane Review by Fernandez et al. included 13 randomized controlled trials that compared wound cleansing with tap water, distilled water, cooled boiled water, or saline with each other or with no cleansing on wound infection, wound healing, reduction in wound size, rate of wound healing, costs, pain, and patient satisfaction.
For all wounds, eight trials found the effect of cleansing with tap water compared with normal saline was uncertain: very low-certainty evidence. Regarding cost, two trials examined in the systematic review reported cost analyses, but the cost-effectiveness of tap water compared with the use of normal saline was uncertain: very low-certainty evidence. A relevant paper published after the Cochrane Review is a literature review by Monika Holman published in the Journal of Wound Care.
Of the seven studies included in the literature review, six studies demonstrated that use of tap water had no significant influence on wound infection rates when compared to normal saline; one study demonstrated that tap water did not increase wound contamination; and four studies established that tap water was cost-effective compared to normal saline.
More than 70 resolutions were considered during the ACEP24 Council Meeting in Las Vegas, Sept 27-28, with many of them drawing considerable debate before 55 were ultimately adopted.
The ACEP Council, the College’s representative governing body, meets annually to discuss and consider resolutions on issues impacting emergency physicians.
The Council consists of members representing ACEP’s 53 chapters, 39 sections of membership, the Association of Academic Chairs of Emergency Medicine, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, and the Society for Academic Emergency Medicine.
Any member can submit a resolution, if it is supported by at least one other ACEP member. If adopted by the Council and approved by a majority of the Board of Directors, the resolutions become official ACEP policy.
