Burn Injuries
Dressing changes, cleaning burn wounds, debridement, and treating infections
This section covers:
- Dressing changes
- Cleaning the burn and debridement (removing damaged skin)
- Experiences of infected burns
Wound care is very important after a burn. All of the people we spoke to had experienced their burns being cleaned and having dressings changed. Some people also spoke about debridement – a process in which unhealthy or dead skin is removed from the burn to reduce the risk of infection and to encourage the wound to heal. A few people had developed infections in their burns which often required extra treatment like antibiotics.
A burns surgeon explains why people with a burn sometimes need to wear dressings and why it’s important for them to be changed regularly.
A burns surgeon explains why people with a burn sometimes need to wear dressings and why it’s important for them to be changed regularly.
People need to have dressings for their burns because if you imagine the skin has been damaged, and the skin is our protective layer, and without that protective layer we’re much more likely to get an infection of the area and we may also lose lots of fluid. But, protecting it also allows the skin to heal so that we don’t have the outside world interfering with the skin healing as well as preventing infection. Often dressings do need to be changed, but they don’t all need to be changed, certain dressings are almost designed to stay stuck to the burn wound and only separate when the burn wound is healed. That said, quite a lot of dressings do need to be changed and the reason they need to be changed is they often absorb a lot of the fluid that’s coming from the burn and that can become infected if we don’t get rid of it. Keeping the wound as clean as possible helps us prevent infection and allow healing to progress. So, bottom line, burn wounds don’t absolutely have to be dressed, they can be left open and the scab forming, but actually burn wounds tend to heal better and safer and quicker if they are dressed and changing the dressing frequently means that we can keep the burn wound clean to make sure that it doesn’t get infected and we get the burn wound healed as quickly as possible to reduce the chances of scarring.
Dressing changes
A sterile dressing is usually applied to a burn to stop germs from infecting the wound and to protect the surface of the burn. There are different types of dressings used in burn care. Sometimes dressings that contain silver, seaweed, or honey are used by doctors and nurses to help the burn heal. For those who had skin grafts, dressings were also needed for the wound area where the replacement skin had been taken from.
After some initial dressing changes by a nurse, Frazer learnt how to do it at home. His mum helped at first, but he also saw it was part of a “transition period” of “being responsible”.
After some initial dressing changes by a nurse, Frazer learnt how to do it at home. His mum helped at first, but he also saw it was part of a “transition period” of “being responsible”.
It was either once a day or once every other day, I had to change it. And my mum helped quite a bit because trying to peel the thing off myself. Sometimes, it’s got too much. It’s quite painful, so we’ve got a bit too much to sort of do it myself. So, Mum would have to come, help pull it off but she didn’t like doing that. She didn’t like seeing me in pain and all that stuff. So, it was all sort of a learning curve, doing my own dressings and some stuff.
So, it’s been... Mine hurt quite a bit, like it was really painful and it’s, you know, it’s really stuck, all the like, puss and stuff would really get stuck to the dressing. It may... I tell you, I think because I was in that weird transition period already of like, being responsible, it was sort of a responsibility I just had to take. You know, I was no longer a 14-year-old kid who Mum did everything for you, so although she helped the first ones, eventually got to a point where it wouldn’t get stuck, so I could change it all myself and clean it, you know. just becoming self-reliant. So, it was a weird stepping stone. It was one of the first sort of big responsibilities I had for myself.
Marilyn went “back and forth” to hospital for dressing changes twice a week for three months, but found it was better than when she and her husband had tried to do these at home.
Marilyn went “back and forth” to hospital for dressing changes twice a week for three months, but found it was better than when she and her husband had tried to do these at home.
We tried that, and it... it was difficult because, you know, as much as, you know, my husband was putting the gloves on and all the rest of it and he did a wonderful job, you know, a wonderful job and... but it didn’t really work out. we tried it for a couple of weeks, and then we went back. And... and they said, I think you take over because they said that really, the two of us were getting tired, you know, with it. You know, I remember we were getting, you know, all worked up about it. You know, when you knew that dressing change was coming up and they said let us take the stress and the strain of that. If you don’t mind coming in twice a week, we are happy to do this for you and we were happy to let them. So yeah, we, in fairness, we did have a go at that, but it was too stressful, you know.
Most people we spoke to had their dressing changes done by nurses, either at hospital or at home. With time and support, some went on to learn how to do their own dressing changes by themselves with support of their family.
How long a person needs a dressing, and how many dressing changes they have, will vary depending on the size and severity of the burn. Some people we spoke to needed dressing changes twice a day, whereas other people had their dressings changed once a week.
As the burn heals, the frequency of dressing changes usually reduces. Sarah needed her dressings changed every 48 hours at the beginning of her recovery; she would “almost look forward to it” because “then it was done for two days” and she could see how much her burns had healed each time.
Many people referred to dressing changes as the worst part of recovering from a burn injury. Tom said that sometimes his dressing would stick to his burn and this “really hurt” when nurses were trying to change his dressings. When Helen X told us about her experience, she said that dressing changes for the area where her skin graft was taken from was “the most painful thing”.
Charlotte found dressing changes to be very traumatic.
Charlotte found dressing changes to be very traumatic.
So, with the dressing changes, they would happen. As I said, they'd be every other day, but they'd come in and they bring the dressing trolley in the morning. At which point, you're already panicking. Like as soon as that trolley, like if I can still, like even now with all my, like there are things I can bring back to mind that can, but the trolley would come in and sit there for a while, and you knew then you're on borrowed time. And then it would be the removal of the bandages which was, I mean, just, I can't... there's no words. So, it's just horrendous which might take, I don't know. It felt like hours, but mostly that was an hour.
Pain relief will sometimes be given during a dressing change. Rhian told us she was given gas and air to help her manage the pain of having her burns cleaned and redressed after developing an infection.
Parents of children with burns found it incredibly difficult to watch as their child’s dressings were changed. Some of the parents referred to witnessing dressing changes as “painful” and “upsetting”. Lily told us that her son’s dressing changes were “the most painful moment for both of us”. You can read more here about experiences of looking after a child with a burn.
Cleaning the burn and debridement
After someone is burnt, it is important to keep the wound clean to prevent infections and to encourage the skin to heal. Cleaning a burn may involve using a sterile gauze or cloth and an antibacterial solution. Sometimes, doctors and nurses may also debride the burn (remove unhealthy or dead skin). Helen X recalled nurses used tweezers to remove dead skin from her burn.
Some of the people we spoke to told us that blisters formed on their burn. Sometimes blisters ooze liquid when they are cleaned. A blister formed on Frazer’s wrist after he was burnt which a nurse “wiped” off. Frazer said this process was “disgusting” but that his burn “didn’t look as ugly” underneath.
Amy said that witnessing her son’s burns being debrided was “traumatic”.
Amy said that witnessing her son’s burns being debrided was “traumatic”.
Amy: Yes. I would say, probably the most traumatic thing and Chris missed that bit, they call it debriding and it basically takes all the blisters off, and I never knew that you could lose so much liquid from your body, because actually William, one of the first things they did was hook William up to a drip, to start replacing fluids. But they basically take all of the blisters and the gunk away and then they dress over the top.
Chris: So, when I saw him on the Saturday morning, he was lying in his bed and all of his dressings were wet and that was just all of his fluids coming out of him, because he basically didn’t have the protective layer of skin on the top and whatever they were putting into him was coming out. And the thing that stuck in my mind about that was the smell. And it’s not a pleasant smell. It’s really quite a nasty, sweaty kind of, don’t know how to describe it, but it’s a, it’s kind of, almost oily stuff comes out of you when you kind of damage yourself that badly.
Although Marilyn found having her burns cleaned to be a “pain”, she told us that the doctors and nurses were “so gentle” and “caring” with her.
Although Marilyn found having her burns cleaned to be a “pain”, she told us that the doctors and nurses were “so gentle” and “caring” with her.
They would send me for a shower, and, you know, tell me to, you know, really try and get all the sludge off it really. And then they would put some kind of cream on it and redress it.
I was just so grateful that they were paying attention to it and they were so gentle. And it was actually a relief to be honest to get the dressing off and have the shower and clean it all down, and they were so gentle when they were cleaning it up, and I found it a relief to be honest just to get it redressed. Even when I was having it redressed in the 12 weeks after, I found that fine absolutely no problem. I mean, it was a pain going into the hospital obviously but, you know, they were so lovely and so caring that no, there was no problem with that.
Experiences of infected burns
A burns surgeon explains why people with a burn sometimes need to wear dressings and why it’s important for them to be changed regularly.
A burns surgeon explains why people with a burn sometimes need to wear dressings and why it’s important for them to be changed regularly.
People need to have dressings for their burns because if you imagine the skin has been damaged, and the skin is our protective layer, and without that protective layer we’re much more likely to get an infection of the area and we may also lose lots of fluid. But, protecting it also allows the skin to heal so that we don’t have the outside world interfering with the skin healing as well as preventing infection. Often dressings do need to be changed, but they don’t all need to be changed, certain dressings are almost designed to stay stuck to the burn wound and only separate when the burn wound is healed. That said, quite a lot of dressings do need to be changed and the reason they need to be changed is they often absorb a lot of the fluid that’s coming from the burn and that can become infected if we don’t get rid of it. Keeping the wound as clean as possible helps us prevent infection and allow healing to progress. So, bottom line, burn wounds don’t absolutely have to be dressed, they can be left open and the scab forming, but actually burn wounds tend to heal better and safer and quicker if they are dressed and changing the dressing frequently means that we can keep the burn wound clean to make sure that it doesn’t get infected and we get the burn wound healed as quickly as possible to reduce the chances of scarring.
In some cases, a burn can become infected. An infection can happen if bacteria gets into the wound. A person who has been burnt is also at an increased risk of developing infections because their immune system is weaker than usual whilst focused on helping the burn to heal.
For the people we talked to, some of the signs of infection included a high temperature, being sick, and a spreading red rash. Antibiotics are usually required to treat infections like these. Rhian's and Jessica’s daughters were connected to an intravenous (IV) line, where a soft tube is inserted into the vein and antibiotics were administered directly into their veins. Others had antibiotic injections or took antibiotic tablets.
Chris Y’s son, William, had silver dressings to help his infected burn to heal.
Chris Y’s son, William, had silver dressings to help his infected burn to heal.
And the other thing that I learnt about burns was actually they smell. And they smell-, and if you get an infection in them, they smell really bad. And William unfortunately did get infected and it was only when we mentioned it to the staff and they said “Ah, ok, right we need to look at this” and then they changed what they were dressing him with and they tried, he had been dressed with, some new bandages that contain a lot of silver and these had managed, they were effectively fighting the infection from the outside whilst William’s body was fighting it from the inside. And it was that that kept him fairly-, it enabled him to start healing but he was still having to fight this infection off as well, which was quite disgusting when they peeled the bandages off, and all this goo and stuff is coming out of them and it’s like “Oooh that’s really quite nasty.”
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