Topic Three: Cleansing and Debridement

A new burn is essentially sterile, and it is important to keep it clean and moist to promote the development of healthy granulation tissue. To aid in minimising the bacterial burden and reduce the risk of infection, all wounds should undergo some form of cleansing to remove foreign bodies, soluble debris, necrotic tissue or slough, all of which can become a focus for infection.

Irrigation is the preferred method for cleansing wounds, and various solutions can be used, including normal saline or warm tap water. Mild soap may also be used.

Sterile solutions should be used for acute burn injury management and in situations where underlying structures are exposed, to cleanse tunnels or sinuses, where the patient is immune-compromised or is suffering from a current wound infection (or has a history of recurrent wound infections).

Topical wound irrigation solutions containing topical antiseptics (e.g. polyhexamethylene biguanide [PHMB]) can be considered to maintain a low bacterial load, reducing the risk of infection and improving healing time.

Wound cleansing is an integral part of burn management.

Debridement of the wound and wound edges to remove necrotic tissue can reduce the risk of infection and encourage epithelialisation. This may be a one-off debridement or ongoing for maintenance.

As with wound cleansing, the appropriate method of debridement should be determined based on the needs of the patient, their wound, the environment, available resources and the competency/skill of practice of the health-care professional performing the debridement. (International Best Practice Guidelines, 2014; Jeschke et al., 2018)

Appropriate analgesia should be given before dressing change to minimise pain for the patient. Surgical debridement would require that the patient is sedated and given a general anaesthetic.