Hydrotherapy for Burns

Hydrotherapy, the external use of water, has been used to treat burns for many thousands of years. Whether it’s holding a finger under the cold water faucet after touching a hot pan or immersion in a hydrotank for a victim of severe third-degree burns, hydrotherapy remains a frontline defense against burn damage.

How Does Hydrotherapy Treat Burns?

Burns from excessive heat, fire, sun, hot liquids, electricity, or chemicals affect millions of people every year. Most burns are minor injuries that occur at home or work. Hot water and the kitchen stove are common culprits. Hydrotherapy is the best first aid for such burns. Running cool water over the burned skin for 5 to 10 minutes soothes the pain immediately and helps avoid skin damage.

For more serious burns, hydrotherapy promotes healing by softening and removing the dead tissue and enabling new healthy tissue to form.

In addition to removing dead tissue, hydrotherapy can:

  • Clean the surface of the wound and remove debris
  • Prevent loss of fluid through the skin, which often occurs with burns and can lead to dehydration, especially in babies and young children
  • Provide a moist environment for wound healing
  • Remove pus
  • Protect the healthy tissue around the burn from trauma
  • Minimize scar tissue formation
  • Adjust the microbial flora of the wound
  • Minimize the risk of infection
  • Help the physician assess healing
  • Facilitate physical therapy
  • Provide comfort and psychological improvement
  • Promote the formation of healthy tissue and healing

How Is Hydrotherapy Used in Burn Units?

Most hospital burn units have hydrotherapy rooms. Hydrotherapy for burns can start within a few days of the trauma, once patients have recovered from the initial shock and their condition has stabilized. Burn patients often receive daily hydrotherapy throughout their hospitalization. As the burns begin to heal, hydrotherapy may be reduced to three times per week on an outpatient basis. Hydrotherapy is usually administered by nurses and specialized technicians. Sometimes physicians or physical therapists are also involved in the hydrotherapy sessions.

Immersion Hydrotherapy

Many hospital burn units use immersion hydrotherapy on all patients, regardless of the extent of the affected body surface. Immersion hydrotherapy is performed in tubs called hydrotanks, Hubbard tanks, or burn tanks. These may be equipped with lifts to ease the patient in and out. Hydrotherapy tubs must be carefully disinfected after each use, since infection of the damaged tissue is one of the most serious side effects of burns. Disposable liners are used in some burn tubs, and the water is sterilized. Hydrotherapy for burns should never be performed in a public tub because of the risk of infection.

Shower Hydrotherapy

Many burn units are replacing immersion hydrotherapy with shower hydrotherapy, because of the risk of infection from hydrotubs and because showering immediately rinses away dead skin and bacteria. Showering removes dead tissue as effectively as immersion hydrotherapy. A shower trolley or stretcher is draped with a sterilized disposable plastic sheet to reduce the risk of contamination that can cause infection. The patient lies on the sheet and receives hydrotherapy through a showerhead. Patients with less severe burns can be showered while sitting in a chair. Shower hydrotherapy utilizes tap water, but a chlorine solution is run through the showerhead to disinfect it. Handheld showerheads are recommended when performing hydrotherapy at home, since strong hospital-grade disinfectants require special handling.

Whether in a tub or shower, hydrotherapy is performed with warm running water. Antiseptics may be added to the water to treat the burns during hydrotherapy. Sometimes an antiseptic scrub is used during hydrotherapy.

Additional Information About Hydrotherapy Sessions

The duration of hydrotherapy treatments varies greatly. Hydrotherapy for burns is often performed for just a few minutes at a time because it can be intensely painful. Pain medication is often administered before hydrotherapy, and general anesthesia may be required before performing hydrotherapy on the most severe burn victims. Some burn centers have begun using water-friendly virtual reality during burn treatment in hydrotherapy tubs. This diverts the patient’s attention away from the pain signals. Patients have reported significant reductions in severe or excruciating pain when they are immersed in virtual reality during hydrotherapy.

Burn patients often undergo physical therapy during hydrotherapy. The physical therapist encourages the patient to perform movements and participate in the bathing when possible. It has been found that patients are more comfortable, experience less pain, and make better progress when the two treatments are combined.

How Is Hydrotherapy Used for Chemical Burns?

When hydrotherapy is administered for chemical burns, either acid or alkali, within one minute, there is far less damage to the skin than if treatment is delayed for even three minutes. A delay in hydrotherapy can lead to irreversible damage. Prolonged gentle rinsing of the burn with a large volume of water under low pressure dilutes the chemical, washes it out of the skin, and normalizes the pH of the skin. The pH of skin burned with hydrochloric acid returns to normal within about two hours of initiating hydrotherapy. However, with strong alkali burns, such as those caused by sodium hydroxide or other caustic agents, it often takes at least 12 hours of continuous hydrotherapy for the skin pH to normalize.

If the chemical exposure is limited to the hand, the hand is placed under running tap water. For chemical burns on other parts of the body, immersion in a hydrotherapy tank is required.

Following exposure to a toxic liquid chemical, contaminated clothing is not removed until after hydrotherapy has begun. However, following contact with a solid chemical such as lye, contaminated clothing is removed before beginning hydrotherapy. All solid particles must be washed from the skin with large amounts of water under the lowest possible pressure.

Locating a Burn Center

Burn centers are located throughout the country to handle cases of severe burns. The American Burn Association and the American College of Surgeons verify burn centers under a joint program. The American Burn Association maintains a listing by state of verified burn centers.
