Burn wound after-care is an essential part of a complication-free recovery. However, even when doing everything right, something can still go wrong. At Burn and Reconstructive Centers of America, we work around the clock with our patients to ensure a smooth recovery back to a healthy life. Whether you’re at home healing from a burn or supporting a loved one, it’s important to know the signs of a healthy wound bed and the symptoms of burn infection.
What does an early infected burn wound look like?
All wounds or burns are susceptible to bacterial colonization. Some of those bacteria can be good and help heal the wound but often, it’s bad bacteria that cause complications with the healing process. The simplest way to know if a burn wound may be infected is a change of appearance.
How to tell if a burn is infected
Many surface infections begin with the presence of cellulitis. Cellulitis is a bacterial infection that presents as red, warm, swollen or tender skin around the wounded area. It can also appear as a red streak or a line emanating from the wound. So, at the beginning of an infection, the burn wound may look red around the circumference. This redness may grow over time, covering more surface area. In addition, the burn wound may feel warm or radiate heat, and the area around the wound may feel tender or painful to the touch. If this infection progresses, you may begin to smell a foul odor coming from your burn wound or develop a fever. These signs will also alert healthcare workers that you may have cellulitis.
Treatment options
If identified and diagnosed at this point, treatment might include cleaning the wound bed, applying topical antimicrobial medications and prescribing oral antibiotic medications.
What does a late-stage infected burn wound look like?
A burn infection may start off as a small local infection, such as Cellulitis, but can evolve over time to become a more serious infection or include a secondary infection. Secondary infections set in after the first infection, creating a burn wound infection that is double the trouble. While secondary infections don’t always occur, the primary burn infection will likely not go away on its own and progress into something more serious. Some of the more serious infections include:
Graft ghosting
Graft ghosting is a type of infection that affects skin grafts that have been placed on burn patients. The skin graft may appear to be healing and then seem to “dissolve” away with the onset of this infection. Often, ghost grafting requires special antibiotics that can, on some occasions, help the graft to recover. However, some infected grafts don’t heal. If an infected skin graft does not recover from the burn infection, the graft may be removed and a new one may be placed once the infection has been cleared.
How to tell if a burn is infected
A visual sign of this type of burn wound infection is the appearance of small abscesses (tender, red bumps filled with pus or fluid) on or near the graft site. If left untreated, this infection can spread and lead to the destruction of surrounding healthy tissue.
Treatment options
Before rendering treatment, this type of burn infection needs to be formally diagnosed by a healthcare professional. If diagnosed as graft ghosting, treatment might include frequent and regular dressing changes, cleaning and removing the abscesses, disinfecting the wound bed and applying topical antimicrobial medications. If the graft is beyond saving, then the current skin graft may be removed and placed later in the healing process.
Toxic shock syndrome (TSS)
Toxic shock syndrome (TSS) is a systemic illness that is the result of certain poisons emanating from bacterial infections. This infection can happen as a result of severe cellulitis, but more often as a result of a retained foreign body such as an impacted old bandage, gauze, tampons or sanitary napkins. This severe infection has a mortality rate as high as 50% that primarily appears in minor burns (less than 10% TBSA) in young children. When caring for a burn wound at home, it is important to follow your surgeon’s advice and change the bandages on your wound to avoid bacterial growth and infection. You might also be advised to lightly wash the wound with soap and water, please do so if it is a part of your homecare instructions. A strict at-home wound or burn care routine is important in maintaining the healing progress.
How to tell if a burn is infected
Symptoms of a TSS infection in burn wounds include fever, diarrhea, vomiting, malaise (faintness or fatigue) and a rash. This infection should be watched for in young children with minor burns and needs to be diagnosed as soon as possible.
Invasive burn wound infections
Invasive burn wound infections are infections that go deeper than just the top layer of skin and can cause tissue necrosis or death in the wound bed, skin grafts and surrounding tissue. Necrosis may present as red skin early on that slowly changes to a purple/blue hue before finally turning a purple or black color.
How to tell if a burn is infected
Invasive burn wound infections can be identified by the burn wound bed changing color, oozing and producing a foul odor. You may also experience a slow loss of sensation in the affected parts. While invasive wound infections do not always turn into sepsis or septic shock, medical attention should be sought early to prevent significant tissue loss or amputation.
Treatment options
Treatment options for invasive wound infections include cleaning the infected tissue, administering oral or intravenous (IV) antibiotics and applying antimicrobial ointment. If the infection continues to progress, aggressive surgical intervention may be necessary to remove all of the dead and infected skin, tissue and muscle (which may include amputation) to salvage as much healthy skin and tissue as possible and stop the infection from spreading.
Sepsis and septic shock
Sepsis is a generalized infection that has spread throughout the body and can be deadly for those trying to heal from burns, wounds or other comorbidities. It is complicated to diagnose sepsis and septic shock as they have become terms used to describe generalized infections of the body. However, burn patients who are delayed in receiving medical treatment or having their wounds or dead tissue cleaned and debrided are at the greatest risk of developing sepsis and septic shock. Sepsis can be extremely life-threatening, especially to those with compromised immune systems or comorbidities, because it negatively affects the body’s ability to heal.
How to tell if a burn is infected
To be diagnosed with sepsis, another infection usually needs to be present. However, according to the American Burn Association, the symptoms of sepsis include a progressively rapid heartbeat (over 110 beats per minute), a fever, rapid breathing (over 25 breaths per minute), high blood sugar (without a history of diabetes), inability to eat food orally and the presence of an infection. Of course, these criteria may differ when diagnosing children.
*Sepsis and septic shock are medical emergencies that require immediate transfer to a hospital.
Staphylococcal scalded skin syndrome
Staphylococcal scalded skin syndrome mimics the appearance and feel of a scald burn but is usually caused by a staph infection. This is a rare disease that mostly affects infants or those under the age of six who have not built up the antibodies to fight the disease.
How to tell if a burn is infected
Signs and symptoms include fever, fatigue, red and painful skin, skin that sloughs or falls off when touched or rubbed and sores. If you see something that looks like a scald when you know it’s not possible, contact your primary care provider.
Treatment options
Once diagnosed, treatment might include IV fluids, IV antibiotic medications and medicated or moisturizing topical skincare treatments. After receiving medical attention, most infants recover from this condition within two weeks with little to no scarring or disability; however, complications are possible.
Further Information
An infected burn wound or infected 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. In fact, the more severe the burn damage or the larger 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 and more.
Click here to find more information about thermal burns.
For more about how to treat an infected burn, please click here.
For more information about sepsis, please click here.
For more information about our specialties, experts and locations, please visit us at www.burncenters.com.