Burns sustained by hot bath and shower water

doi:10.1016/S0305-4179(99)00127-8

Burns

Volume 26, Issue 3, 1 May 2000, Pages 251-259

https://doi.org/10.1016/S0305-4179(99)00127-8 Get rights and content

Abstract

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (<16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10 % total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Introduction

Although scald burns are the most common type of thermal injury in childhood [1], [2] and the second commonest in the elderly [3], [4] those caused by hot tap water have received little attention in the literature. Burns sustained during bath or shower account for approximately 5–10% of all burn admissions and represent a significant clinical problem with morbidity and mortality usually higher than for those burns caused by other hot modalities [5], [6]. Risk of burn accident is, unfortunately, the highest in the most vulnerable groups of society: infants, the elderly, handicapped and incapacitated.

One of the most important attributes of these accidents is that they are particularly amenable to prevention. Although, simple measures could virtually eliminate this cause of burn morbidity, the incidence of tap water scald burns does not seem to have declined [7], [8].

Despite the fact that hot water has been recognised as hazardous for a long time it was not until the 1970's that the epidemiology of tap water scalds was studied and the importance of prevention emphasised [5]. At that time the water heater industry practice used to pre-set water heaters at temperatures as high as 60–65°C, resulting in significant numbers of bath accidents [2], [5]. Continuous pressure and endeavours to legalise lower home water temperatures by changes in building regulations etc. in most countries resulted in the publication of safety recommendations by health authorities, but rarely implementation of these in practice [8], [9], [10].

This study was undertaken to determine the magnitude of tap water scalds as a clinical and public-health problem. We have identified groups at risk, the scenario of the injury and the extent and outcome of burns treatment in patients who required hospitalisation.

Basic measures that can reduce the incidence of hot tap water burns are also discussed.

Section snippets

Patients and methods

This study included all patients admitted to a regional burns unit, Stoke Mandeville Hospital (SMH) because of burns inflicted by hot bath or shower between January 1990 and December 1997 (8 years). Data were collected retrospectively from hospital admission records and patients notes.

The total number of paediatric and adult burn admissions for the period was 1498, and 57 (3.8%) of those were sustained by hot water during a bath. Eighteen (32%) were adults and 39 (68%) children (age under 16).

Patient's age and gender

Among the 39 children 26 were male, 13 female (male:female ratio 2:1). The mean age was 3.95±3.2 (range between 11 months and 13 years). Children under age of 4 represented the largest single group — 82% of paediatric and 56% of all patients sustaining bath burns.

Ten female (55%) and eight male patients (44%) represented the adult group with the mean age 66±S.D. 19 (range 27–88 years). Ten (55%) were over 70 and 15 (83%) over 60 years of age (Fig. 2).

Burn size

The mean burn size in children was

Discussion

In the context of more frequent hot liquids scalds and flame burns, tap water scalds may seem to be an infrequent and insignificant problem. However, they account for approximately 10% of paediatric admissions and 1–4% of adult burn admissions with nearly twice as many patients treated on an outpatients basis [2], [6], [11], [12], [13]. Tap water scalds are life threatening injuries; mortality rates reported in adults are 15–46% [2], [3], [8] and children between 8 and 12.5% [2], [7]. It is a

References (19)

S.E Morrow et al.
Etiology and outcome of pediatric burns
J. Pediatr. Surg.
(1996)
C Tejerina et al.
Burns in patients over 60 years old: epidemiology and mortality
Burns
(1992)
B.M Herd et al.
Burns to the elderly: a reappraisal
Br. J. Plast. Surg.
(1987)
A.R Walker
Fatal tapwater scald burns in the USA, 1979–1986
Burns
(1990)
R.D Harper et al.
Reducing the burn risk to elderly persons living in residential care
Burns
(1995)
W Phillips et al.
The epidemiology of childhood scalds in Brisbane
Burns
(1986)
C Mercier et al.
Epidemiological survey of childhood burn injuries in France
Burns
(1996)
M Cutillas et al.
Epidemiology of elderly patients' burns in the southwest of France
Burns
(1998)
H Trier et al.
The nursing home patient: a burn prone person. An epidemiological study
Burns
(1987)

There are more references available in the full text version of this article.

Cited by (37)

Effects of subjective perceptions of indoor visual environment on visual-related physical health of older people in residential care homes
2023, Building and Environment
Aging profoundly affects people's visual functions, and older persons generally show a declination of visual abilities. The indoor visual environment (IVE) in residential care homes (RCHs) is vital to ensure the visual-related physical health of older people (i.e., general vision, functional vision, visual acuity, physical discomfort, and injuries). The IVE, including opening design, interior design, and lighting conditions components, should be designed to satisfy older people's special visual needs. Hence, this study aims to investigate the effects of older people's subjective perceptions of the IVE on their visual-related physical health. In total, 197 questionnaires were collected from older persons living in RCHs. The integrated IVE–Visual-related Physical Health model was established based on multiple statistical methods for older residents in RCHs. The model revealed that the view out, window, corridors, furniture locations, curtains or louvers, handrails, and light level significantly affected the visual-related physical health of older people. Practical recommendations were proposed, including beds and seats near the windows with beautiful scenery, corridors with night lights and unblocked vision, automatic curtains with light sensors, handrails with a high color contrast with the background walls, minimum 200lx ambient lighting, etc. This study's findings provide valuable insight into enhancing the IVE in RCHs for older people's visual-related physical health.
Thermoregulation and thermal sensation during whole-body water immersion at different water temperatures in healthy individuals: A scoping review
2023, Journal of Thermal Biology
Citation Excerpt :
To date, attention has been directed to assess thermal comfort, especially in cold water, because of its links with detrimental incidents such as loss of consciousness, frostbite, and drowning (An et al., 2019; Tipton et al., 2017; Bradford et al., 2019). The thermal sensation variability can be explained, by the belief that water temperature assessment is a deep internal cognitive and experienced personal matter of interpretation (Calthrop, 1928; Chatonnet, and Cabanac, 1965a; Guéritée et al., 2015; Tipton and Bradford, 2014). New knowledge about TRPs function within the concept of TNZ and TCZ has provided an integrated physiological and psychological understanding of how thermoreceptors modify our thermal sensation and that are influenced by both the mind and body (Oi et al., 2017; Lv and Liu, 2007; Li, 2017; Wang and Siemens, 2015; Weyer-Menkhoff et al., 2019).
Severe thermal discomfort may increase risk of drowning due to hypothermia or hyperthermia from prolonged exposure to noxious water temperatures. The importance of using a behavioral thermoregulation model with thermal sensation may predict the thermal load that the human body receives when exposed to various immersive water conditions. However, there is no thermal sensation "gold standard" model specific for water immersion. This scoping review aims to present a comprehensive overview regarding human physiological and behavioral thermoregulation during whole-body water immersion and explore the feasibility for an accepted defined sensation scale for cold and hot water immersion.
A standard literary search was performed on PubMed, Google Scholar, and SCOPUS. The words “Water Immersion,” “Thermoregulation,” “Cardiovascular responses” were used either as independent searched terms and MeSH terms (Medical Subject Headings) or in combination with other text words. The inclusion criteria for clinical trials terms to thermoregulatory measurements (core or skin temperature), whole-body immersion, 18–60 years old and healthy individuals. The prementioned data were analyzed narratively to achieve the overall study objective.
Twenty-three published articles fulfilled the review inclusion/exclusion criteria (with nine measured behavioral responses). Our outcomes illustrated a homogenous thermal sensation in a variety of water temperatures ranges, that was strongly associated with thermal balance, and observed different thermoregulatory responses. This scoping review highlights the impact of water immersion duration on human thermoneutral zone, thermal comfort zone, and thermal sensation.
Our findings enlighten the significance of thermal sensation as a health indicator for establishing a behavioral thermal model applicable for water immersion. This scoping review provides insight for the needed development of subjective thermal model of thermal sensation in relation to human thermal physiology specific to immersive water temperature ranges within and outside the thermal neutral and comfort zone.
Comparison of the characteristics of hot tap water scalds and other scalds in Germany
2020, Burns
Mortality associated with hot tap water scalds remains significant, owing to a lack of up-to-date regulations on tap water temperature. We aimed to evaluate the effect of hot tap water scalds on patients admitted to our adult burn intensive care unit (BICU), and compare them to those with other scald types.
We enrolled patients treated for scalds at the BICU of Cologne-Merheim Medical Center from 1989 to 2014, and retrospectively analyzed their age, sex-specific differences, characteristics, length of hospital stay, number of operations, and mortality. Patients were categorized into two groups: patients with hot tap water scalds and those with all other types of scalds.
A total of 333 patients were enrolled. In 23.4% (n = 78) of the cases, the scalds were associated with hot tap water. Such injuries were more commonly observed in older men than women. Hot tap water scalds involved a significantly higher total burned surface area (TBSA) than other scalds, with TBSA values of 24.0% and 15.9% for men, and 21.8% and 10.9% for women, respectively. Hot tap water scald patients had a greater number of surgeries and longer BICU stays (27.8 days vs 9.1 days), and significantly higher mortality values (30.8% (n = 24) vs 4.7% (n = 12)) than those with the other scald types.
Hot water scalds are associated with large TBSAs, long stays in the BICU, and worse outcomes compared to the other scald types.
Structural model for the relationships between indoor built environment and behaviors of residents with dementia in care and attention homes
2020, Building and Environment
Behavioral symptoms such as distress, sleep disturbance and aberrant mobility are common in all types of dementia. Indoor built environment (IBE) of care and attention (C&A) homes should be optimized for the abilities, health and morale of their elderly residents with dementia, to reduce the likelihood of it inducing in residents problematic behaviors with burdensome symptoms. Therefore, it is necessary to investigate the interactions between the IBE and the behavior of the elderly with dementia. This study aims to establish an integrated IBE-Behavior model to uncover these complicated relationships. The daily activities and engagement of 40 residents with dementia were observed and recorded using dementia care mapping. A questionnaire survey of a total of 96 respondents with mild and moderate dementia was conducted in C&A homes. Multiple research methods were applied to develop the integrated IBE-Behavior model, including factor analysis, reliability test, Pearson correlation, multiple regression analysis and structural equation modeling. The model confirmed the following: 1) surprisingly, both factors of the space management component (i.e., distances and privacy) are found to have no impact on the behavioral symptoms of residents with dementia in C&A homes; 2) three IBE factors belonging to building services components – lighting (E4), lifts (E6) and water supply (E7) – influence demented residents’ negative emotion, positive emotion, sleeping disturbance and limited mobility; 3) loneliness is affected by the supporting facilities factor of furniture (E8). Practical recommendations are made, including: automatic adjustment of lighting, anti-scald devices, seats around small tables or in a sociopetal position, etc.
A qualitative and quantitative investigation of effects of indoor built environment for people with dementia in care and attention homes
2019, Building and Environment
Citation Excerpt :
A satisfactory water supply was found in the current study to positively lead to an increase in the physical and psychological health of the demented elderly. Due to the decline in their cognitive functioning, the demented elderly have difficulty using complex showers and adjusting the appropriate water temperature, and that difficulty can easily cause them to experience uncomfortable bathing and even suffer from burns caused by hot bath or shower water [25] which in turn can prompt physical complaints and make them feel frustrated and irritable. In contrast, bathing with an adequate water temperature can bring them comfort [65] and can refresh them and enable them to recover, thus helping them be cheerful, lively, contented, and full of energy.
The demented elderly have physical, emotional and behavioral patterns that differ from those of the normal elderly, and those patterns differentiate their needs in terms of the indoor built environment (IBE). Therefore, it is essential to investigate the effects of the IBE on the quality of life (QoL) of the demented elderly. To ensure the study's reliability and validity, multiple research methods were applied, including qualitative methods (i.e., an interview) and quantitative ones (i.e., a questionnaire survey). In total, 96 demented elderly residents and 18 caregivers from eight care and attention (C&A) homes were involved in the current study. Based on the data collection, an IBE-QoL model was developed using a reliability test, correlation analysis and regression analysis. The model confirmed the following: 1) building services factors – lighting, temperature, lifts and water supply – predict demented elderly residents' physical health, psychological health, independence, activities of daily living and social relationships; and 2) supporting facilities factors – signage, finishes and furniture – also exert a positive impact on the residents' physical health, activities of daily living, social relationships and cognitive functioning. Practical recommendations are made, including that C&A homes provide access to a sky garden on each floor, label water taps with hot/cold signs, provide signage with iconic information at different strategic locations, employ color contrasting finishes in different rooms, use historical furniture, and so on. This study's results provide valuable insight into improving C&A homes' IBE in order to enhance the QoL of the demented elderly.
Effect of working parameters of the plate heat exchanger on the thermal performance of the anti-bact heat exchanger system to disinfect Legionella hot water systems
2018, Applied Thermal Engineering
The objective of the current study is to analyze the effect of different working parameters on the thermal performance of the Anti-Bact Heat Exchanger system (ABHE). The ABHE system is inspired by nature and implemented to achieve continuous disinfection of Legionella in different human-made water systems at any desired disinfection temperature. In the ABHE system, most of the energy is recovered using an efficient plate heat exchanger (PHE). A model by Engineering Equation Solver (EES) is set-up to figure out the effect of different working parameters on the thermal performance of the ABHE system. The study shows that higher supplied water temperature can enhance the regeneration ratio (RR), but it requires a large PHE area and pumping power (PP) which consequently increase the cost of the ABHE system. However, elevate temperature in use results in a reduced PHE area and PP, which accordingly reduce the cost of the ABHE system. On the other hand, the EES-based model is used to study the effect of the length and the width of the plates used in the PHE on the RR and the required area of the PHE. Finally, taking into account the geometrical parameters, flow arrangement and the initial operating conditions of the PHE, the EES-based model is used to optimize the PHE in which its area is minimized, and the RR of the ABHE system is maximized.

View all citing articles on Scopus

View full text

Burns sustained by hot bath and shower water

Abstract

Introduction

Section snippets

Patients and methods

Patient's age and gender

Burn size

Discussion

J. Pediatr. Surg.

Burns

Br. J. Plast. Surg.

Burns

Burns

Burns

Burns

Burns

Burns