From the Guidelines
For a hot water burn, immediately run cool water over the affected area to stop the burning process and reduce pain, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. The first step in treating a hot water burn is to cool the affected area with running water, which has been shown to decrease the need for subsequent care in patients with thermal burns 1.
- Remove any jewelry or tight items near the burn before swelling occurs.
- After cooling, gently pat the area dry with a clean cloth.
- It may be reasonable to apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds, as suggested by the guidelines 1.
- Covering the burn with a nonadherent bandage or clean cloth protects the wound and reduces pain while avoiding heat entrapment until the burn can be assessed by a health care professional 1.
- Take over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) as directed for pain relief, as recommended by the guidelines 1. It is essential to seek medical attention if the burn is larger than 3 inches, affects the face, hands, feet, genitals, or major joints, appears deep, or shows signs of infection like increasing pain, redness, swelling, or pus.
From the Research
First Aid for Hot Water Burns
- The first aid for hot water burns involves cooling the burn with running water, as recommended by 2.
- The ideal duration of cooling remains controversial, but studies suggest that cooling for 20 minutes or more may not provide additional benefits compared to cooling for less than 20 minutes 2.
- It is essential to note that the evidence for the optimal duration of cooling is of very low certainty due to limitations in study design, risk of bias, and indirectness 2.
Prevention of Burn Wound Infection
- Antibiotic prophylaxis is one of several interventions that may prevent burn wound infection, but the effects of prophylactic antibiotics in people with burns are limited by the volume and quality of existing research 3.
- Topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared to dressings or skin substitutes, although the evidence is at unclear or high risk of bias 3.
- International guidelines tend to recommend silver-containing dressings over antiseptics or antibiotics, regardless of the depth of the burn, but there is no ideal topical antimicrobial agent that can be recommended for all clinical scenarios 4.
Systemic Antibiotic Prophylaxis
- Systemic antibiotic prophylaxis has a beneficial effect in burns patients, but the methodological quality of the data is weak, and it is currently not recommended for patients with severe burns other than perioperatively 5.
- Prophylaxis with systemic antibiotics may reduce all-cause mortality, pneumonia, and wound infections, but it can also increase resistance to the antibiotic used for prophylaxis 5.