Should I keep my burn covered at night?

After suffering a burn injury, the body is more susceptible to infection and chronic or non-healing wounds. So, why should you cover a burn? Burns are considered open wounds. You should cover a burn to keep the wound bed sterile and free of harmful bacteria.

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Burn treatment doesn’t begin or end in the burn center. Burn care starts immediately after a burn injury is suffered and continues for days, months or years, depending on the severity and the total body surface area (TBSA) affected. Burn and Reconstructive Centers of America (BRCA) and our burn care teams across the country empower patients to be active participants in their individualized care plans for a better care experience, better recovery and an overall better outcome. From raising burn awareness in local communities to instructing patients on how to care for their burns, essential burn treatment begins and ends at home. So, what should those suffering from a burn injury do to encourage healing at home?

Should you cover a burn?

Burn injuries not only damage the epidermis (top layer of skin), dermis (second layer of skin) and underlying soft tissues but also the body’s largest immune system. The skin is the body’s first line of defense against outside pathogens, microbes, dirt and debris. After suffering a burn injury, the body is more susceptible to infection and chronic or non-healing wounds. So, why should you cover a burn? Burns are considered open wounds. You should cover a burn to keep the wound bed sterile and free of harmful bacteria. What if your burns involve blistering? Should you cover a blister or let it breathe? It is recommended to leave the blisters intact if possible. If the blisters remain intact, you may not need to cover them. However, if the blisters are already broken or open, the blisters should be covered in a sterile bandage. Popped blisters become open wounds and are susceptible to bacterial colonization, debris and infection.

What should you use to cover a burn?

For at-home dressing changes, some recommended supplies include:

Skin-safe medical tape

An odor-free, colorless soap

A basin of tepid or slightly warm water

A dry, sterile gauze

A non-adhesive wound dressing

Sterile gauze wraps or gauze roll

Wooden tongue depressors (for applying ointment)

Other supplies prescribed to you or recommended by your doctor

What steps should you take to cover your burn or perform a dressing change?

Step one: Gather your supplies. Make sure everything is easily accessible and within reach. Step two: The person performing the dressing change or covering the wound should wash their hands before continuing. Step three: If there is an old dressing, take notice of the color of the wound discharge. If the discharge appears dark brown, yellowish-brown or reddish-brown, this is common and not typically cause for concern. Discoloration of the discharge is common and doesn’t mean there’s an infection, however, you want to examine and pay close attention to the skin surrounding the burn wound. If that skin starts turning red you are at risk of infection, and you should seek medical care. Step four: Gently remove the old dressing. If the dressing seems a bit stuck on the wound, drip a few drops of water on the bandage, wait a minute and try again.

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Step five: Once the old dressing is off, take notice of the state of the wound bed and surrounding areas. If the wound smells foul or is excreting fluid that is green, tan, creamy or thick in appearance, this is cause for concern, and you should contact your burn care provider. Another sign of infection is growing redness or a change of color in the surrounding skin. This can indicate a wound or soft tissue infection and should be addressed immediately. Step six: The person performing the dressing change should wash their hands once more. Step seven: With tepid or slightly warm water, gentle soap and gauze squares, carefully wash the burn and the surrounding area by dabbing. If skin comes away during this process, do not worry. This is not unexpected. Pat the area dry with a clean gauze square. Step eight: Only apply ointments or creams that your doctor has recommended or prescribed. These might include antibiotic or antimicrobial ointments. Do not put the ointment directly onto the wound bed. Instead, spread the ointment on the non-adhesive wound dressing. It can be helpful or less uncomfortable to apply the ointment to the bandage prior to covering the wound. Step nine: Place the ointment-covered non-adhesive wound dressing on the burn wound. If no ointments are in your care plan, place a non-adhesive wound dressing on the wound bed without other ointments. Make sure the dressing covers the entirety of the affected area. Try to touch as little of the non-adhesive wound dressing as possible to keep the wound and bandages sterile. Step ten: Next, place dry, sterile gauze pads on the non-adhesive wound dressing. Non-adherent dressings are important as other forms of gauze can adhere to the wound and cause trauma when being removed. Step eleven: Wrap the affected area using the dry, sterile gauze roll. Do not wrap the gauze too tightly as this may cause constriction leading to swelling beyond the bandage. Wrap the site in multiple layers and then secure with medical tape. The bandages placed on the burn protect the burn or wound from infection and promote the healing process. They are layered, with the most important layers closest to the wound. It’s essential to keep the dressing clean, dry and intact. None of these layers should be removed before the scheduled dressing change but can be added to if necessary. If the dressing begins to come loose, you may wrap more gauze around the area to provide additional support and add more tape to help secure the dressing.

When should you change your dressing?

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The recommended time between dressing changes can vary depending on what your doctor recommends, the amount of drainage, how well the wound is healing and how far along you are in your care. Throughout your recovery, the dressing (not the wound) should be inspected every 24 hours to ensure the stability of the dressing and that the outside of the dressing remains dry. If the drainage is starting to come through the outer bandage, apply more layers of sterile gauze wrap. If you notice the wound or surrounding area becoming increasingly painful or if the dressing starts to smell, remove the old dressing immediately and apply a new clean one. If these symptoms continue, consult with your doctor about the possibility of infection and the following steps to take in the healing process.

When should you call a doctor?

All wounds or burns are susceptible to bacterial colonization. Harmful bacteria can colonize the wound and cause complications with the healing process. The simplest way to know if a burn wound may be infected is a change of appearance. Other skin and soft tissue infections can develop from neglected burn wounds and lead to more serious infections. Call your doctor if you experience:

Abnormal drainage

Change in skin or tissue color

Foul odor

A fever

Pain in the wound and surrounding areas

Pain in other areas

Call your doctor or BRCA’s burn information services at (855) 863-9595 for a consultation or to speak with a provider.

Further Information

An infected burn wound or burn blister can cause serious health problems and treatment complications if not identified and diagnosed early. It is uncommon for a first-degree burn to become infected. However, an infected second-degree burn is not uncommon. The more severe the burn damage or the more significant the burn wound, the more likely infection is to set in. If you feel your burn wound is infected, the best action is to contact your provider or call our 24/7 burn information service at (855) 863-9595. It is best to treat the infection as early as possible to prevent further complications. Leaving an infection untreated may lead to graft loss, tissue death, amputation, full-body infection, etc. For more information about burn and skin and soft tissue infections, please click here.