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.

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. 

 

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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”.

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.

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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.

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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.

Sarah liked to see how much her burns had healed each time her dressings were changed.

I’d almost look forward to it, because then it was done for two days. You know, and also having the burns and not being able to see how they’re healing or anything like that, you know, it was nice to see how they were changing but equally, at the same time, to have to go through all that, it’s horrible. It’s a really weird one. But yeah, no, it was really weird, because it’s something that you kind of look forward to, so you could see it was healing you know, and mentally to think “Right, how’s it changed since 48 hours ago when we last saw it?” You know and then to know that, obviously, by the time you went back to hospital a week, or whatever, later, you can show them, you know “Look how much it’s healed in a week” which wasn’t very much but, yeah, it was weird. I mean, they were traumatic and, out of all the things, that’s probably the worst memory of it all, is going through the dressing changes. You know, obviously, it was really painful, and burns have a horrible smell and things like that. It was not pleasant. I won’t lie.

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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.

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.

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Mercy would sometimes pretend to be asleep to delay having her dressings changed.

Just thinking about it, it just makes you feel like they are going to do the thing again. That, I would say was very, very uncomfortable because I remember when I knew the nurses were coming to do my dressing, I would sometimes like pretend I’m asleep so that they don’t have to do it. And then, they would come and come back again and I’m still asleep and I think they realised kind of I’m avoiding it because I didn’t have any other way. Really, really painful and at the same time, they used to bring a, they used to call it a whirlpool bath, when it’s like they put some medication in the water and then you are put in there to wash off the wound. So, it was really, really painful, traumatic and it’s something you don’t want to remember.

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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.

Abi said that watching her son’s dressing changes was “the hardest part of the whole thing apart from the incident itself”.

Also, when they changed the dressings, they had to – which was probably the hardest part of the whole thing other than the incident itself – they had to scrape the scabbing to encourage it to bleed, which, obviously, on a baby that they’re having to pin down to do so, that’s absolutely screaming in pain, was horrific, and I remember one of the terms – I can’t remember what it was called – but they did actually explain in a bit of a basic term afterwards that one of the dressings after the first two or three days of it scabbing, they used silver inside the dressing and they said it basically tricks the body into thinking that it’s scabbed over so it heals a lot faster.

And then they had to sort of scrape them and they said “Oh, they’re bleeding, so it’s actually a good sign because there’s blood flow there” and that was all a good sign. But yeah, it was just awful. They did that on the first day and then re-dressed it and then leading up to that it was just changing them and changing them and putting different dressings that had different, like the silver etc., until it was down to just plasters.

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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.

Lily did her best to stay calm and reassuring as her son had his burns cleaned at hospital.

Yeah, they put him in the bath all the time and make him stand in front of me, and because he was only 15 months so he never let me go… So he keeps holding my hand, I would say, and they keep rubbing in front of me and I try to close my eyes but then, every single time I realised, no – I need to open my eyes and look… my baby’s eyes that, you know, ‘Don’t worry, it’s going to be fine.’

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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: 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.

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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.

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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.

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. 

 

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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.

Jessica’s daughter picked up an infection whilst she was being treated in hospital.

We were only home for less than 12 hours when I realised that something wasn’t right with her. She came home and she went to bed really easily and I thought that was a bit strange, being as she’d been away from home and then in the night she started being sick. One of the things they told me to look out for was about infections and so I drove her back to the hospital that night, in the night, and I got re-admitted in the middle of the night again. She had picked up an infection in hospital and she was very seriously ill then.

The infection caused a sepsis-type reaction in her. So, she then had to have intravenous antibiotics for two weeks every day through a canula. And so, after we came out of hospital, I then had to take her in every day for another week or 10 days, into a hospital that’s 35 minutes from us, to have her injections, her antibiotics every day.

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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.

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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Rhian started to feel unwell and the area surrounding her burn was red. She went to the hospital where she was told her burn was infected.

That evening I just went for a walk and started to feel funny again. I wasn’t feeling very well, went home and elevated my arm again. Following day, I called in as soon as the doctor’s surgery were open, because I realised that my redness had started to go up around my elbow.

Yeah, the redness was spreading. So, I went straight to the doctors in a lot of pain. I can remember, I was like “Oh, I’ll drive myself”, trying to turn the steering wheel. Just trying to move my arm really hurt. They took photographs of it. They sent it to a consultant, I think. I got told that I should go to A&E. So, I waited, gradually saw a nurse, who then organised me to have a consultation with someone the next day at 12. The next day when I got into the Burns Unit, I had to have it cleaned, which was the most painful thing I think I’ve done. I was on gas and air, really trying not to cry. Then, because of all that green stuff, it basically looked like it had gone off. Yeah, it wasn’t very nice. And yeah and the doctor came in and was like “Oh, I think we’re going to have to admit you to hospital because your infection is spreading up your arm.”

First time I’ve ever stayed overnight at a hospital and, yeah, I was put straightaway onto antibiotics through my vein and my arm basically got put into a sling. Whenever I sat down, when I was asleep, my arm was trying to drain all the fluid out of it and all the infection out.

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