According to the findings of a Cochrane Review, using drinkable tap water to clean wounds does not increase infection rates. There is, however, no evidence that it reduces infection rates or increases healing rate over leaving the wound alone.

The objective of this review was to compare the effects of water versus other solutions used for wound cleaning. Cochrane researchers conducted electronic searches of Cochrane Wounds Groups Specialized Register, MEDLINE, EMBASE and the Cochrane Controlled Trials Register and identified and considered data from eleven trials that compared rates of infection and healing in wounds when treated with various cleansing regimes. Of the included trials: seven compared rates of infection and healing in wounds cleansed with water versus normal saline; three trials compared cleansing versus no cleansing; and one trial compared procaine spirit (mixture of procaine HCI 2% with spirit 70%) versus water.

The researchers noted that for chronic wounds the relative risk (RR) of developing an infection when cleansed with tap water compared with normal saline was 0.16 (95% confidence interval [CI], 0.01 - 2.96). Compared with saline, tap water was more effective in reducing the infection rate in adults with acute wounds (RR, 0.63; 96% CI, 0.40 - 0.99) and in children it was not associated with a statistically significant difference (RR, 1.07; 95% CI, 0.43 - 2.64). No statistically significant differences in infection rates were seen when wounds were cleansed with tap water or not cleansed at all (RR, 1.06; 95% CI, 0.07 - 16.50).

Normal saline is typically preferred for wound-cleansing solution because it is isotonic and does not interfere with healing, damage tissue, provoke an allergic reaction, or affect normal skin bacterial flora. However, the advantages of tap water for wound cleansing are efficiency, cost effectiveness, and accessibility.

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Drinkable Tap Water May Be Suitable for Wound Cleansing

Iraqi health experts are warning that the country could be hit by new cases of cholera once temperatures start to rise. The Iraqi government said its last cholera case was recorded in late November and has credited a public-awareness campaign and the colder winter temperatures for halting the spread of the disease. However, doctors warn that because of poor sanitation conditions, cholera could recur as summer approaches.

Cholera is a potentially lethal disease, characterized by excessive diarrhea, which is primarily spread through contaminated water or food. Vibrio cholerae is quickly killed or inactivated by chlorination of drinking water. However, the disease often festers in overcrowded areas with poor infrastructure. According to the World Health Organization (WHO), an outbreak last year in Iraq resulted in 30,000 people falling ill and exhibiting acute watery diarrhea.

While the Iraqi government has pledged to increase monitoring of restaurants and cafes in order to try to prevent widespread outbreaks in the future such precautions may have a limited effect. In December, UNICEF identified pollution of waterways by raw sewage as "perhaps the greatest environmental and public health hazard facing Iraqis."

Chlorination is the least expensive and most effective barrier against the transmission of cholera through drinking water supplies. However, the health ministry has stated that Iraq will continue to suffer cholera outbreaks for two more years - the time it will take for sanitized water and new sewage systems to be completed. Until then, UNICEF warns that Iraqis could face serious health problems. The agency estimates that just one in three Iraqi children can rely on a safe water source, particularly in Baghdad and southern Iraq, and that only 20 percent of families outside of Baghdad have access to sewage services.

In situations where water distribution systems are not being chlorinated, then chlorination can be carried out at the household level.

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Iraq Braced for More Cholera Outbreaks

In the journal of Chemistry and Biology, researchers at Brandeis University and the University of Georgia report they have identified lead compounds that inhibit Cryptosporidium's effect, paving the way for an effective antibiotic treatment. Cryptosporidium is a major cause of diarrhea and malnutrition in small children in developing countries. The parasite is resistant to water chlorination and has caused major outbreaks in the U.S.

Until recently, it had been very difficult to find drugs against pathogens like Cryptosporidium because the proteins of these parasites are actually very similar to those of their human hosts and because little was known about its metabolism. However, genome sequencing has enabled scientists to get a genetic blueprint of Cryptosporidium. Using this blueprint, researchers discovered that Cryptosporidium has a very simple process to produce the building blocks of DNA and RNA, and that the parasite stole a critical gene in this pathway from intestinal bacteria.

Scientists identified ten new compounds that inhibit the parasite, but not the human counterpart. Four of these compounds are better at stopping Cryptosporidium infection than the antibiotic paromomycin, the current gold standard for evaluating anticryptosporidial activity.

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Research May Yield Effective Antibiotics for Cryptosporidium

The Environmental Protection Agency (EPA) is preparing to launch the second half of a unique project to assess human exposure to pathogens linked to health risks. The research may help the Agency quantify the effectiveness of agency drinking water regulations in protecting public health.

The so-called "pilot accountability study" focuses on the city of Lawrence, MA, which updated its 69-year-old drinking water treatment facility in March 2007 to comply with EPA's Long-Term 2 enhanced Surface Water Treatment rule (LT2). For the study, researchers took saliva samples from approximately 400 families in the area before the water treatment plant was updated and will return to Lawrence to collect follow-up samples beginning in June 2008. The salvia samples will be tested for "immunoconversions," which are increases in antibodies that result from human exposure to specific pathogens including Cryptosporidium, noroviruses and rotaviruses. The EPA will compare the incidence of immunoconversions before and after the new drinking water treatment technology's construction and use that data, as well as associated exposure and illness questionnaires completed by study participants, to determine the extent to which the LT2 rule - and the resulting change in water treatment technology - improved public health.

EPA has laid out an aggressive plan to complete research and issue new recreational water quality criteria for bacteria by 2012, and the use of the new study technique could potentially help the agency quantify any public health benefits associated with the new standard when it is put in place. Similarly, EPA is weighing whether drinking water distribution system standards should be put in place to address potential health risks - including risks posed by the accumulation of biofilms in distribution system pipes.

In The News-is a bi-weekly, online service from the Water Quality & Health Council.  The publication is updated every other Friday and can be viewed by logging onto www.waterandhealth.org.  To receive the publication via e-mail, please click here and enter your e-mail address to join our mailing list.