Preparing and cleaning the burn wound

Removal of non-viable tissue and contaminants is a crucial first step in burn wound management. If wounds are not cleaned or debrided adequately it can:

• Prevent or delay a wound’s normal healing process
• Mimic or hide infection
• Increase inflammation and pain
• Attract bacteria to the wound
• Prevent clinicians from accurately assessing the extent and depth of the wound
• Increase odour and exudate

Clean 

Cleaning the burn wound mnimises bacterial colonisation, remove loose skin, remove exudates and previous dressings and prepares the wound for the dressing. 

• Clean gently with gauze and Normal Saline or Aqueous Chlorhexidine ≤ 0.1%
• Gently remove loose skin and any visible contaminents  
• If gauze is unavailable, a clean lint-free cloth or flannel maybe useful

Shave 

Shave within the burn wound to a 2cm margin beyond the burn edge. Hair and hair follicles harbor bacteria that increase the bacterial load, delaying wound healing and increasing the risk of infection. 

Shaving should be completed during initial debridement and each dressing change if hair growth is noted in the wound. 

Blisters 

Burn blisters occur primarily in superficial partial thickness burns but also may overlay deeper burns. An increased capillary permeability caused by the inflammatory response to the burn injury, causes oedema formation separating the epidermis from the underlying dermis. 

Small blisters (<2cms diameter) can be left intact. The following types of blisters should be debrided: 

• Blisters over joints or dependent areas 
• Blisters > 2cms diameter 
• Ruptured blisters/loose skin 

Remove all non-viable tissue from the wound bed using either mechanical debridement with moist gauze or sharp dissection with scissors and forceps 

Snip the blister, drain the fluid and cut away the dead or devitalised tissue carefully up to (but not including) the margin of wound bed.