Burn wounds are easily infected.

Goal: Prevent burn wound infection through wound care. If evacuation to higher level of care is anticipated within 24 hours, simply cover burns with clean, dry gauze and leave intact blisters in place. Always avoid wet dressings, because of the risk of hypothermia. If evacuation is not anticipated for more than 24 hours, and time, medication, and human resources permit, provide wound care as soon as possible after the injury (within the first 24 hours). If resources are not available initially, provide wound care as soon as possible.

- Best: Clean wounds and debride loose dead skin by scrubbing gently with gauze and chlorhexidine gluconate solution (e.g., Hibiclens, Mölnylcke Health Care, http://www.hibiclens.com/) in clean water; apply topical antimicrobial cream (silver sulfadiazine [Silvadene, Pfizer Inc., http://www.pfizer.com/] or mafenide acetate [Sulfamylon, Mylan, http://www.mylan.com/]), followed by gauze dressing. Repeat daily.
  - Alternative: instead of cream, use silver nylon dressing (Silverlon, Argentum Medical, http://www.silverlon.com/), covered by gauze dressing.
  - Silverlon can be left in place for 3–5 days as long as the wound is clean when the Silverlon is applied.
  - The outer gauze dressings (e.g., Kerlix [Covidien]) should be moistened (not soaked) at least daily. Use sterile (or at least clean, uncontaminated) water or normal saline.
  - The outer gauze dressings should be changed, leaving the Silverlon in place, sooner than 3 days if they become saturated with exudate or otherwise dirty.
  - If the patient develops any evidence of infection, the Silverlon must be removed and the wound inspected sooner than 3–5 days.
  - The Silverlon can be removed and cleaned in sterile, or at least clean uncontaminated, water and reused for up to 5 days.
- Better: Clean wounds and debride loose dead skin by washing with any antibacterial soap in clean water, dress wounds with any available dressings; optimize wound and patient hygiene to the extent possible given environment.
- Minimum: Cover with clean sheet or dry gauze. Leave blisters intact. Avoid wet dressings.