After a burn injury

Introduction

Following your burn injury there is a lot of information that will help you progress your healing.

You may find the adjustment from hospital easy, but you could still have some queries. This booklet aims to address some of the questions you might have about your injury, treatment, or future care.

If you have any questions or difficulties, you can contact the ward or a member of the burns team for advice (phone numbers below).

Dressings

Every individual has their own specific dressing requirements. Check with your nurse if you are unsure of yours.
You will likely go home from hospital with dressings on and your care will be taken over by your practice/district nurse for further dressing changes.
Your transfer into care of the practice/district nurse will be done by the ward nursing staff on the day of your discharge. You will be given a small supply of dressings and a letter to take with you.
Normally your dressings need to be changed every 2-3 days, but this will depend on your needs and you will be guided by your nurse.
If your burn requires a skin graft you will have a donor site. These areas usually take 10-14 days to heal, and if possible the dressing stays in place for this time.
Keep all dressings dry and clean to help prevent infection.

Hygiene

When you have been discharged home you may be unable to bath or shower until you are fully healed. When you are healed and no longer have any dressings you should clean your skin every day.
Your skin might be more sensitive to temperature or can be numb in places. Always test the water temperature with an area of undamaged skin before showering/bathing.
Use non-perfumed, hypoallergenic soap and cleansing products to prevent skin irritation.

Moisturising

Skin grafts, donor sites, and scars all require regular moisturising to prevent the area from drying, cracking, and becoming sore. This is because newly healed skin is unable to lubricate itself in the same way as undamaged skin.

At first moisturising creams or simple emollients should be applied gently. Gradually increase pressure until you can massage the skin.
Moisturise 2-3 times a day. Occasionally this may be needed more often if your skin is particularly dry.
It is very important to wash the skin free of cream each day as the build-up of too much can cause irritation.
Massage involves using firm pressure in circular movements over the scars. Early massage should be gentle, avoiding friction.
Moisturising creams normally used include E45 or similar oily, non-perfumed emollient creams. There is no good evidence that expensive creams help more than simple emollients.

Pain/itching and medication

Itching can be a major problem for some burn patients. Regularly using cool moisturising cream and massage can help. Wearing clothes made of natural fibres can also help. If you have any discomfort and your itching does not settle, then please discuss this with a member of the burns team. There are medications that can help.

When you leave hospital it is normal to still need medication to control pain, sensitivity, and itching.
All your medications will be explained to you.
If you have any questions, please discuss these with your nurse as soon as possible as alterations to medication can take time to organise.
You will be discharged home with a small supply of your current medication. Any further prescriptions must be organised with your GP.

The following medications may be given to help control pain at home:

Paracetamol - for pain.
Tramadol or codeine phosphate - for pain.
Ibuprofen or diclofenac - for pain and inflammation.
Gabapentin - for itching/nerve pain.

If you need further advice about medications after you have been discharged from hospital you should contact our GP or your team.

Thoughts and feelings

A burn injury doesn’t just affect someone’s skin, it can also influence how they think and feel. People cope in different ways and their reactions differ, but we know that leaving hospital or when treatment ends can be particularly difficult.

Common experiences include feeling low and vulnerable, while adjusting to changes in your situation or feeling stunned by the whole experience. Some people find the burn incident going over and over in their mind, may experience flashbacks, or distressing dreams. They may also avoid situations which are reminders of the incident or feeling more anxious. Emotions can go up and down in surprising ways without reason. These reactions don’t happen to everyone but are normal after a major event.

If you are finding any of these things difficult, please speak to your GP or contact us. Asking for help is not a sign of weakness - people manage these events in their own way, but sometimes need extra help like any other part of rehabilitation. Staff will listen and support, and we also have a psychologist on the team who you may have met as an inpatient.

Intimate relationships

People can find that intimate/sexual relationships sometimes change after a burn injury. This can be due to a range of things including fatigue (feeling too tired), distress (feeling low or anxious), worries about appearance, or practical difficulties with the location of the burn/donor sites. These issues usually resolve with time.

It can be difficult to talk about these issues but please speak your GP or a member of staff here as we can offer help. There is also useful information on the Changing Faces website: Changing Faces | Visible Difference & Disfigurement Charity.

Appearance concerns

Burns can lead to scarring including changes in colour, shape, and texture of your skin These changes may be very visible or not. Either way, it is common to have some concerns about your appearance, including feeling more self-conscious.

Some people feel less confident in social situations than before, especially being around people they don’t know, and can sometimes find it hard to deal with other peoples’ questions and comments.

If you are finding these sorts of things difficult please let us know as we can provide help. The scar management team are very experienced and you can speak to the burns psychologist. We also work closely with Outlook - a specialist psychology service to help people with concerns about appearance. If you would like an appointment please speak to the burns team or your GP. Changing Faces website also has some information you may find helpful: Changing Faces | Visible Difference & Disfigurement Charity.

Managing scarring

After a serious burn injury you are likely to have scarring. The severity of scarring depends on many different factors.

When burns heal there is a risk of developing hypertrophic scars which are red, raised, hard, sometimes sensitive, and often itchy. Once fully healed, treatment for scarring can being and commonly include:

Moisturising and massage.
Silicone creams.
Silicone dressings.
Pressure garments (made-to-measure Lycra® garments which are worn most of the time).
Face masks (solid, clear, plastic pressure mask).
Laser treatment.

Scarring can take up to 2 years to fully settle and some people will need treatment for this time.

Once you have healed and no longer need dressings you may be referred to the scar management team who will advise you about treatment. If you are worried about scarring and haven’t been referred, please speak to your doctor.

If we cannot see you face-to-face, we can offer video and phone appointments to help reduce travel to the service.

Physiotherapy/occupational therapy

During your stay on the ward you might see a physiotherapist and occupational therapist to help you regain and maintain your normal movement and function.

If you have been given an exercise plan and a splint, you will likely need to continue this when you are discharged home. This is very important to help prevent problems when returning to your normal activities. You should be given advice about this and may be referred for further treatment nearer to where you live. If you have any questions about your specific plan, please ask your therapist for further information.

Social support

When you first go home, you may have difficulty doing your everyday activities like cooking and cleaning. In many cases family and friends can support you until you regain independence but this isn’t possible for everyone. If you think you might have difficulties returning home without help, speak to your nurse as soon as possible. Services can take time to arrange and there are criteria for support.

If you need support with ongoing rehabilitation you may be referred to a local community team to provide help when you go home. Sometimes you will need to transfer to a hospital nearer to where you live so your local services can assess your support needs.

Sun protection

Following a burn injury it is recommended you fully protect yourself from the sun for 2 summers, or 2 years. Your new skin including skin grafts and donor sites will blister and burn more easily. To do this keep covered with clothing or using and regularly applying very high sun protection cream (for both UVA and UVB). If you work outdoors you are advised to wear sun protective garments and sun cream.

After this time you should continue using sun protection creams as normally recommended to prevent your skin burning.

Discharge transport

The hospital only provides transport home in exceptional cases. It is important you arrange to get home from hospital with family, friends, or public transport.

Follow-up appointments

When you leave hospital you will be given follow-up appointments to come back and see your doctor. This will be in the Acute Burns Clinic (ABC), next to the Adult Burns Unit (Gate 33a, level 2) or Burns Outpatients (Gate 24 Plastics Outpatient Clinic, level 1). Please ask a nurse if you need a map. You may be seen occasionally for several years after the injury.

Getting to and from follow-up appointments

Patients can claim back travel costs and car parking at the time of travel if you get any of these benefits:

Income Support.
Income Based Employment and Support Allowance.
Working Tax Credit or Family Tax Credit.
Job Seekers Allowance.
Pension Credit - guaranteed credit.
H2 form (NHS Tax Exemption Certificate).

Patients must show either a current order book or certificate of entitlement issued no more than 3 months before the appointment. The cashier’s office is in the atrium of the Brunel building and is open Monday to Friday, 10:00 - 12:00, and 13:00 to 15:00. Hospital transport is only provided in exceptional circumstances for medical reasons.

Returning to work, leisure activities, and driving

Work

You may be unable to return to work at first because of open wounds, pain, or tiredness. Please ask your doctor if you need a ‘fit note’ for your employer.

It is important to return to normal activities as soon as possible. This is beneficial to your physical and psychological recovery. At first you could do different tasks, reduce hours, or have a gradual return. Please speak to your doctor or a member of the burns team for advice about returning to work.

Leisure activities

An early return to your leisure activities will give you confidence. However you should not return to contact sports until your wounds have healed. If you wish to swim, your wounds need to be healed due to the risk of infection. Once swimming is recommended, you may find the chlorine irritates your skin. To help with this you can shower and re-apply moisturising cream afterwards.

Driving

There is no standard time before it is safe for you to drive again. You need to have strength, range of movement, and be free from pain to make sure you are safe to control your car. You need to be able to perform an emergency stop. We can offer guidance about this, but you must discuss your injury with your insurance company before driving.

Handy hints

Once home, remember to take pain relief before having a dressing change or doing physiotherapy.
Eat a healthy balanced diet to help promote healing.
You are advised to stop smoking as this can affect healing.
You are likely to be very tired and lack stamina when you first go home, so plan regular rest periods into your day.
To prevent long-term stiffness, keep the injured area moving.

Discharge checklist

Use the list below to make sure you have the necessary information and appointments before you go home:

Medication.
Dressings.
District nurse/practice nurse letter.
GP letter.

You may have these appointments:

Appointment with a practice or district nurse.
Acute Burns Clinic follow-up appointment.
Burns Outpatient Clinic appointment.
Physiotherapy.
Occupational therapy.

If you are unable to keep any appointments or need further information, contact the Adult Burns Helpline on 0117 414 3100 or 0117 414 3102.

To change or cancel your Plastics Outpatient appointment please phone 0300 555 0103.

If you have been an inpatient on the burns unit you will have the opportunity to complete an online questionnaire about your burns injury outcome within 3 months of discharge. This will be sent to your email address.

Discharge advice

Once you have been discharged from the Adult Burns Unit it can be helpful to take painkillers at least 20 minutes before dressing change appointments to help with any discomfort.

Please keep all dressings clean and dry.

If any of the following happen please contact the Adult Burns Unit for advice:

If you have a high temperature (with or without uncontrollable shaking), a skin rash, or vomiting or diarrhoea.
If your dressing becomes wet, dirty, smelly, dislodged (out of place), the wound is exposed or the wound leaks fluid through the dressing.
If your wound is not covered by a dressing and becomes red, inflamed, painful, wet, or bleeding.

Skin grafts and donor sites

Skin is especially important and is a protective barrier to the organs in the body: it prevents infection and water loss. When skin is damaged by a burn/scald the protection is lost. If the burn is deeper than the top layer of skin, a skin graft may be required. The burns team will explain and discuss your surgical and wound management options.

Further information on skin grafts and donor sites can be found in our skin graft and donor site leaflet. Ask a member or staff or visit Skin Grafts and Donor Sites Following a Burn Injury | North Bristol NHS Trust (nbt.nhs.uk)

Patient support

These are some useful patient support websites. If you think it would be helpful, and wish to meet a burns survivor please speak to a member of the burns team.

Useful websites

Adult Burns Unit

Burns | North Bristol NHS Trust (nbt.nhs.uk)

Adult Burn Support UK

Adult Burn Support UK – Information, support and advice about burns in the UK

A support resource for adult burn survivors in the UK.

Email: info@adultburnsupportuk.org

Funded by Dan’s Fund for Burns national charity.

Dan’s Fund for Burns

Dans Fund For Burns – Giving burn survivors the help they need

Dan’s Fund for Burns is a national charity offering practical help to burn survivors in the UK. The charity identifies those most in need of help and provides it in a swift and practical way.

Changing Faces

Changing Faces | Visible Difference & Disfigurement Charity

Changing Faces is a charity for people and families who are living with conditions, marks, or scars that affect their appearance.

Katie Piper Foundation

www.katiepiperfoundation.org.uk

The Katie Piper Foundation aims to:

Progress intensive rehabilitation and scar management for burns survivors.
Provide information on, and access to non-surgical treatments for burns and scars.
Campaign for consistent clinical care.
Develop a support network for people living with burns/scars.
Help people with burns/scars reconnect with their lives and their communities.

The Lee Spark NF Foundation

Help & Support for Dealing with Necrotising Fasciitis (nfsuk.org.uk)

01254 878 701

To help those whose lives have been affected by necrotising fasciitis and other severe streptococcal infections.

Outlook

Outlook | North Bristol NHS Trust (nbt.nhs.uk)

Psychological support for people with appearance concerns.

The Fire Fighters Charity Helpline

0800 389 8820

Monday-Friday, 09:00 - 17:00.

The Fire Fighters Charity has a wealth of experience in providing helpline services on a wide range of issues, directing to other relevant benefits that might be available to you, or organisations that may be able to provide assistance.

Skin camouflage

www.skin-camouflage.net

Bristol Laser Centre | North Bristol NHS Trust (nbt.nhs.uk)

Acid Survivors Trust International (ASTI)

A.S.T.i | Homepage (asti.org.uk)

A registered charity based in the UK operating as a centre of excellence supporting and working hand in hand with Acid Survivors Foundations (ASFs) in Bangladesh, Cambodia, Uganda, and Pakistan.