How to Dress a Burn
All wounds can present healing complications, and burns are no different. In fact, the nature and presentation of burns often lead to a heightened risk of complications than wounds such as incisions that can be closed up easily.
According to the WHO, there are over 180,000 deaths associated with burn injuries yearly. The difficulty surrounding the maintenance and healing of burn wounds means that non-fatal burn injuries are the leading cause of fatality worldwide. This is why it’s vital to ensure burn wounds are treated correctly and properly from the earliest opportunity until fully recovered.
What is a burn wound?
A burn is an injury caused by extreme heat, radiation, chemical contact, or friction. The trauma caused by a burn results in cell damage that can affect several layers of the skin.
Minor burns may only damage the very top layer of skin cells and might not even need to be treated or covered up. Severe burns could penetrate deep into the dermis and layers below and could require skin grafting or even amputation.
Degrees of Burn Wound
Burns are categorised by ‘degree’ to help medical professionals identify the severity level and the type of treatment needed.
1st Degree Burn
2nd Degree Burn
3rd Degree Burn
| Degree | Details | Symptoms | Treatment |
|---|---|---|---|
| 1st-Degree Burns | The burn affects the epidermis (the outer layer of the skin). | Redness, tenderness, pain, minor peeling, dryness. |
|
| 2nd-Degree Burns | The burn affects the epidermis and the dermis below. | All of the above, plus thickening of the skin and blisters with possible scarring. |
|
| 3rd-Degree Burns | The burn affects the top two layers of the skin and the fat below. | All of the above, with blackening or browning of the skin and a leathery appearance. Nerve damage and numbness are possible, and scarring is inevitable. |
|
1st-degree burns often don’t need to be dressed at all, but the patient might want to have the sensitive area covered and protected while it heals.
Dressing a second-degree burn is usually necessary because there will be blisters or areas where exposed tissue is present where the skin has come away. This open wound is at risk of infection and should be covered to keep it free of bacteria. Maintaining a moist environment will also help the body to heal more quickly.
| Degree | 1st-Degree Burns |
|---|---|
Details | The burn affects the epidermis (the outer layer of the skin). |
| Symptoms | Redness, tenderness, pain, minor peeling, dryness. |
| Treatment |
|
| Degree | 2nd-Degree Burns |
| Details | The burn affects the epidermis and the dermis below. |
| Symptoms | All of the above, plus thickening of the skin and blisters with possible scarring. |
| Treatment |
|
Degree | 3rd-Degree Burns |
Details | The burn affects the top two layers of the skin and the fat below. |
Symptoms | Immobilising injured limbs, bandaging head injuries, creating make-shift tourniquets, applying pressure and stopping the bleeding of wounds. |
| Treatment |
|
1st-degree burns often don’t need to be dressed at all, but the patient might want to have the sensitive area covered and protected while it heals.
Dressing a second-degree burn is usually necessary because there will be blisters or areas where exposed tissue is present where the skin has come away. This open wound is at risk of infection and should be covered to keep it free of bacteria. Maintaining a moist environment will also help the body to heal more quickly.
A hydrocolloid dressing for 2nd-degree burns is a good choice because it will draw exudate out of the wound and form a gel ‘scab’ over the top, keeping it moist and protected.
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How to Dress a Burn Wound
The best way to dress a burn wound is with a non-adherent dressing that will protect any open wounds and keep the area protected from the risk of infection. There is a little debate about dressing burn blisters, so it’s good to make an assessment case-by-case. Generally, smaller blisters should be left intact, but larger ones may be deroofed using an aseptic technique and the dead skin removed.
How to Dress Burns
Before dressing a burn, ensure the area has been cooled to stop the burning process. Immersion in tepid water, or having water run over the burn for up to 20 minutes, in the 20 minutes after the accident, will help stop the injury's progression, soothe pain, and reduce oedema (swelling).
Immediately after a burn occurs, dress the burn by covering it with cling film, or use a Burnshield dressing if there is one in your first aid kit. This will protect the burn area without adhering to the skin. Uroll the clingfilm and discard the first few inches to ensure you use a clean section. Do not wrap clingfilm around a limb, as swelling after the injury could result in cutting off circulation.
The burn will need to be thoroughly cleaned and debrided if possible. Any clothing, jewellery, or other materials that have become stuck to the burn area should be left until it can be examined by a professional. You can clean a burn using saline wound wipes or squirt sterile saline solution over it if wipes are too painful.
Once clean, the burn can be covered with a low-adherent, occlusive or semi-occlusive dressing. Jelonet or Burnshield are excellent recommendations.
| Jelonet | Burnshield |
|---|---|
| A non-medicated, low-adherent tulle gras dressing impregnated with paraffin. | Hydrogel or Hydrogel impregnated dressing. |
|
|
Find out more about Jelonet and Burnshield.
How to Dress Minor Burns
Should you dress a burn when it’s only very minimal? It’s not always necessary. Some 1st-degree burns heal well on their own. If you want to protect a 1st-degree burn, and there are no blisters, you could wrap the area in a loose white open weave bandage.
Find a detailed burn dressing procedure PDF on the link below for NHS Scotland. This PDF details how to approach burns of different degrees and thicknesses.
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What is a burn dressing?
A burn dressing is a special type of dressing designed to help provide soothing and protection to burns and assist the body with its natural healing process.
The purpose of a burn dressing should be:
- To maintain a moist environment in which the wound can heal more effectively
- To protect open wounds from infection-causing bacteria
- To protect the area from bumps and scratches
- To cool and soothe the damaged tissue
Burn dressings tend to be low adherent meaning they won’t stick to the wound bed, and often they are occlusive meaning they don’t let any moisture out at all. Common types of burn dressing include impregnated film and foam dressings and active dressings such as alginates, hydrocolloids and hydrogels.
Jelonet is a popular type of sterile paraffin tulle gras dressing made from an open weave gauze and designed for use on burn and other open wounds like skin graft sites, ulcers, and abrasions.
Read our guide to types of burn dressings to find out what different dressings there are. You can also find out about different types of wound dressings in general, not just those for burns.
Dressing Burns at Home: Considerations You Need to Make
You may have been discharged from the hospital or sent home by your GP and need to know how to dress a burn wound at home. Whether you’re looking after yourself or someone else, the GP or a nurse should show you exactly how to care for the wound at home, so be prepared to ask any questions you need to.
When dressing wounds at home—especially open wounds like 2nd-degree burns—it’s really important to ensure you have a sterile field
Keeping a well-stocked first aid kit at home is the best way to be prepared for a burn. If you run a business where people are at risk of burns, you will need to provide access to burn first aid supplies as part of your duty of care.
Find out what items go into a burn first aid kit and how to use a burns kit.
How Often to Change a Burn Dressing
How often should you change a burn dressing? Here’s a good guide for how often to change dressing on 2nd-degree burns. 1st-degree burns and 3rd-degree burns may need to be changed less or more frequently.
A burn dressing should be inspected at 24 hours. You will be looking for signs that the dressing needs to be changed, such as saturation with exudate. At 48 hours, the dressing should be removed regardless, and the wound inspected. At this stage, the extent of the burn is much more likely to be visible, and the dressing almost certainly will need to be changed.
After this first change, it’s a good idea to change the dressing every three to five days. However, you should keep an eye on the state of the dressing to pick up on whether it needs to be changed more frequently. Change the dressing if:
- The dressing becomes soaked in exudate
- The dressing becomes soiled or gets wet
- There is a bad smell coming from the dressing
- The wound is painful
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