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Burns In The Nursing Home Population Pose A Serious Threat Of Injury & Further Medical Complications

A hot cup of soup, a radiator, an uncalibrated water thermostat or a fire can all pose serious burn risks for nursing home patients. Your skin is necessary for your body’s regulation of fluid and temperature; it also acts as a barrier against bacteria and viruses. When you burn your skin, you put yourself at risk for infection, tetanus, scarring, permanent injury, and even death depending on the severity of the burn. 

Stages of Burns

Burns are categorized as first degree, second degree, or third degree based upon the depth of the burn and the percentage of total body area affected. 

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First-Degree Burn

A first-degree burn is the least serious type of burn where only the outer layer of skin (dermis) is burned. Symptoms include: redness, mild swelling, and skin that is tender to the touch.  

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Second-Degree Burn

A second-degree burn occurs when the first and second layer of the skin is burned. Symptoms include: blisters, reddened and splotchy skin, swelling, and pain.  

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Third-Degree Burn

A third-degree burn is the most serious type of burn and occurs when all layers of the skin are burned. This causes permanent tissue damage and may affect fat, muscle, and even bone. Third-degree burns damage the nerves and blood vessels, which can lead to a white and leathery appearance of the skin. Symptoms include: severe pain, areas of charred black skin, or skin may appear white or dry.  

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If you suffer a burn (second or third-degree) that covers more than 15-20% of your body, you are at risk for significant fluid loss, which could lead to shock if fluids are not replaced intravenously. If you suffer a burn affecting over 50% of your body, then you have a significant mortality risk, especially if compounded by underlying medical conditions and advanced age. 

Burn Treatment

In order to properly treat a burn, it is important to first determine the extent of tissue damage. Minor first-degree burns and second-degree burns that are no larger than 3 inches in diameter require different treatment than third-degree burns. It is important that burns are properly and thoroughly cleaned in order to prevent infection because your body’s barrier against germs. 

For minor burns, you should:

  • Cool the burn (hold burn under cool running water or immerse in cool water for 10-15 minutes)
  • Cover the burn with a sterile gauze bandage (wrap gauze loosely)
  • Take an over-the-counter pain reliever (aspirin, ibuprofen, naproxen, or acetaminophen)

It is important that you do not use ice directly on the burn (which could cause further damage to the wound), do not apply ointments to the burn (which could cause infection), and do not break blisters (which makes them more vulnerable to infection). As the burn heals, watch for signs of infection, symptoms include: increased pain, fever, redness, swelling, or oozing. 

For major burns, which are third-degree burns or large second-degree burns, you should contact emergency medical help and follow the following steps:

  • Do not remove burned clothing
  • Do not immerse burns in cold water (which could cause hypothermia and shock)
  • Check for signs of circulation (breathing, coughing, or movement)
  • Elevate the burned body part or parts
  • Cover the area of the burn

Also, for severe burns, it is important to get a tetanus shot or make sure you have had one in the last ten years because burns are susceptible to tetanus. 

For major burns, doctors can use skin grafts to improve the function and appearance for large burn areas. A skin graft is a surgical procedure where a piece of skin from the donor area of the patient’s body (usually the buttocks or upper thighs) is transplanted to the damaged area of the patient’s body. The graft can help reduce fluid loss, protect the burn from infection, reduce pain, allow tissues underneath to heal, and improve the appearance of burned skin. In order to prepare the burned area for the skin graft, doctors remove (excise or debride) the burned skin. There are also skin banks, which store donor skin from organ donors, which provide donor skin that can be used for temporary skin grafts. 

Preventing Burns in Nursing Homes

Older adults (≥ 60 years) are at increased risk for burn accidents, second only to young children. The National Fire Prevention Agency reported that adults age 75 and older are the age group most likely to die in house fires. Older adults also suffer larger size burns on average than any other age group. The most common type of burn injury for older adults is usually a scald (a type of burn injury caused by hot liquids or steam). Also, elderly burn victims have a higher mortality rate than younger burn victims. 

As you age, so does your skin, and the skin of older adults is dry, wrinkled, loose, and less elastic because the dermis layer of the skin becomes thinner over time. This makes the skin more susceptible to the absorption of heat, which means that even moderate heat sources (warm water, electric blankets, radiators) can cause serious physical damage. Also, older adults are more susceptible to fluid loss and shock after suffering from a burn, which requires proper fluid replenishment. 

Elderly nursing home residents are more susceptible to dangerous burns because of their advanced age, prevalence of mental illness, reduced mobility, and underlying medical conditions. Many elderly nursing home residents are weak and vulnerable because of disease and illness, which makes any additional illness or injury all the more dangerous. 

Therefore, it is important that nursing home staff members take steps to reduce burn risks. This includes monitoring the temperature of the water in resident bathrooms to prevent scalding, monitor the temperature of food served to residents, not allowing candles or other open flames, covering radiators, and complying with proper fire prevention and safety standards. 

If you or a loved one suffer a serious burn while living in a nursing home, you may be entitled to collect damages. Nursing homes must provide safe environments for their residents and monitor residents to ensure that there are not any burn risks and that all injuries are properly treated.   When nursing homes fail to meet this duty, they can be liable for negligence. 

Thank you to Heather Keil, J.D. for her assistance with this important topic.

Resources:

Burn Survivor Resource Center: Medical Care Guide
The Mediterranean Council for Burns and Fire Disasters: Annals of Burns and Fire Disasters: Considerations on Intensive Care in Elderly Burn Patients
Burn Recovery: Skin Grafts for Burn Treatment

Related Nursing Homes Abuse Blog Entries:

Smoking-Related Fires Are A Real Threat To Nursing Home Patients. Is It Time To Put Out The Fire?

Unsupervised Nursing Home Resident Dies From Burns

Even The Most Mundane Parts Of A Nursing Home Can Turn Deadly Without Proper Staff Supervision

Cigarette Lighter Mishap Results In Severe Burns To Nursing Home Patient

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