394 - Reducing Waste and Cost by Utilizing Tap Water for Laceration Irrigation: A Quality Improvement Approach

Publication Number: 4386.394

Alison L. Fowler, Children's Mercy Hospitals and Clinics, Shawnee, KS, United States; Leslie A. Hueschen, University of Missouri-Kansas City School of Medicine, Kansas City, MO, United States; Rohan Akhouri, Childrens Mercy Hospital, Kansas City, MO, United States; Isabella Dunt, Children's Mercy Hospitals and Clinics, Parkville, MO, United States; Josaih Galdean, University of Kansas School of Medicine, Kansas City, KS, United States; Chris Kaberline, Children's Mercy Hospitals and Clinics, Prairie Village, KS, United States; Sarah K. Nienhaus, Children's Mercy Hospitals and Clinics, KANSAS CITY, MO, United States; Viktoriya Stoycheva, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States

Background: Lacerations requiring closure make up 8 million emergency department (ED) visits annually. Irrigating prior to closure with potable tap water does not increase rates of infection compared to sterile fluids. Using tap water decreases cost and waste. Currently, only 3.5% of lacerations closed by ED providers in our institution are irrigated with tap water.

Objective: This project aims to increase the percentage of lacerations closed by ED providers irrigated with tap water from 3.5% to 60% by January 2026 in a Midwestern freestanding pediatric emergency department across two locations (ED 1, ED 2).

Design/Methods: A multidisciplinary team (ED physicians, nurses, quality improvement consultant, parent advisors) formed in November 2024. Driver diagram, fishbone, and PICK charts were used to identify interventions which were implemented in Plan-Do-Study-Act (PDSA) methodology (Table 1). The outcome measure was percentage of lacerations closed by ED providers irrigated with tap water. Process measures included the number of sterile fluid bottles ordered for ED 2, use of laceration order sets, and percentage of lacerations irrigated by nurses. The balance measure was the rate of return visits for wound infection within 3 days. Fifty randomized charts were reviewed monthly. IRB deemed this study as quality improvement, not human subjects research.

Results: There were 150 eligible encounters per month; 985 encounters (50/month) were randomized for review. Tap water irrigation increased from 3.5% to 64.6% (Fig 1). The average number of sterile bottles ordered monthly for ED 2 decreased from 102 to 16 (Fig 2), representing a monthly savings of at least $430. This also represents a reduction in plastic waste by at least 9 kg per month, reducing carbon emissions equivalent to 26 miles driven in a gas-powered car. There were no differences in irrigation by nurses or order set usage. There were no return visits for infection.

Conclusion(s): Altering the environment by removing sterile irrigation supplies from quick access locations was the most impactful intervention, allowing the team to meet our goal of increased tap water irrigation and decreased cost and waste. Future interventions include developing patient/family education and a new clinical pathway for lacerations. Limitations include inability to change existing order sets and limited monitoring of return visits. With the success of this project, the team plans to expand tap water irrigation to urgent care and subspecialist laceration repairs.

Table 1: PDSA Cycles


Fig 1: Tap Water for Laceration Irrigation


Fig 2: Sterile Saline and Sterile Water Bottles Ordered