How should I manage a patient with a partial thickness burn to ensure optimal healing and prevent infection?

To manage a patient with a partial-thickness (superficial dermal) burn and ensure optimal healing while preventing infection, follow these steps:

• Immediate first aid: Confirm that appropriate immediate first aid has been given, such as cooling the burn with a cool bath, shower, or cold compresses to reduce pain and limit injury progression.
• Wound assessment and cleaning: Fully assess the wound depth and extent. Clean the wound carefully before dressing.
• Blister management: Leave blisters intact where possible to reduce infection risk. Consider aseptic de-roofing of large blisters (>1 cm²), those likely to rupture, or those over joints.
• Dressing selection: Use a non-adherent dressing (e.g., paraffin gauze, silicone-coated nylon, polyurethane film, or hydrocolloid) covered by a secondary absorbent dressing secured with a lightweight conforming bandage or tubular gauze. The dressing should maintain a moist wound environment to promote re-epithelialization and prevent dehydration and infection.
• Dressing changes and monitoring: Change dressings initially after 48 hours to check for infection signs (increased pain, odour, excessive exudate, fever, erythema), then every 3–5 days depending on exudate and healing rate. Support patient or carer to change dressings if appropriate, ensuring analgesia is taken before dressing changes.
• Analgesia: Provide simple analgesia such as paracetamol or ibuprofen as needed for pain relief.
• Hydration and symptom relief: Advise maintaining adequate hydration and using emollients to relieve itching and dryness.
• Infection prevention: Do not routinely use systemic or topical prophylactic antibiotics, antimicrobial-impregnated dressings, or antimicrobial creams like silver sulfadiazine due to limited and conflicting evidence.
• Sun protection: Advise protecting the healing skin from sun exposure using sunscreen, protective clothing, and avoiding peak sunlight hours (10 am to 4 pm).
• Referral and follow-up: Arrange urgent review if blisters develop or signs of infection occur. Refer to a specialist burns unit or seek specialist advice if the wound is not healing as expected or remains unhealed after two weeks.

This approach promotes optimal healing by maintaining a moist, protected environment, minimizing trauma and infection risk, and providing symptom relief.

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