The Impact of a Legislative Intervention to Reduce Tap Water Scald Burns in an Urban Community:

Running water while bathing is a risk factor for pediatric scald burns

INTRODUCTION

Scalds are the most common mechanism of burn injury in pediatric populations and scald burns sustained during bathing present a unique opportunity for injury prevention. Evidence-based infant bathing educational resources recommend checking water temperature and having a caregiver present for the duration of the bath, but do not explicitly recommend avoiding running water or explain the associated risks. This study seeks to determine the incidence and role of running water in bathing scald burns at our institution.

METHODS

This is a retrospective review of pediatric patients (<3 years) admitted to the University of Chicago Burn Center with scald injury from bathing between 2010 and 2020. Cases were reviewed to assess the following risk factors: whether there was running water, whether water temperature was checked before placing the child in water, and whether a caregiver was present for the entire bath. Injuries in which the manner of injury was abuse or indeterminate were excluded.

RESULTS

The study cohort included 101 cases of scalds due to bathing, with a mean age of 13 months and mean burn size of 7% TBSA. Of these 101 cases, 96 (95%) involved running water. Thirty-seven cases (37%) had only one of the three risk factors and 95% of those 37 cases involved running water. Twenty-nine cases (29%) involved all three risk factors while only two cases (2%) involved none of the three risk factors. Sixty-one cases (60%), thirty-nine cases (39%), and one case (1%) occurred in a sink, bathtub, or infant tub, respectively.

CONCLUSION

We found that the vast majority of bathing scald burns involved running water, identifying a specific bathing recommendation that should be added to existing guidelines to reduce the incidence of bathing scald burns.

The cost burden of hospital-treated tap water scald burns in the United States

OBJECTIVE

We aimed to determine the cost burden and epidemiology of hospital-treated, tap water scald burns in the United States to inform consideration of policy proposals to require thermostatic mixing valves with all new water heaters.

METHODS

A retrospective, cross-sectional study was performed using the 2016-2018 National Inpatient Sample (NIS) and Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilisation Project (HCUP). We queried the samples to examine the prevalence, cost, and epidemiology of hospital-treated, tap water scald burns.

RESULTS

The NIS and NEDS identified 52 088 (weighted) emergency department (ED) visits, 7270 (weighted) hospitalisations and 110 hospital-based deaths attributable to tap water scald burns in 2016-2018. The average cost for each encounter was $572 per ED visit and $28 431 per hospitalisation. In aggregate, the direct healthcare cost of these initial encounters was $206.69 million for inpatient (IP) visits and $29.79 million for ED visits. Medicare paid $109.54 million of these costs and Medicaid paid $18.3 million. Multiple body surfaces were involved in 35.4% of IP visits and 16.1% of ED visits.

CONCLUSIONS

NIS and NEDS are valuable tools to examine the cost burden and epidemiology of hospital-treated, tap water scald burns. The high injuries, deaths, and overall cost of these scald burns suggest policy proposals are needed to require the use of thermostatic mixing valves.The additional detail provided by using the International Classification of Diseases (ICD)-10 External Cause of Morbidity Code allows for a better understanding of the size and scope of tap water scald injuries than was possible with ICD-9.

"The home, the bathroom, the taps, and hot water": The contextual characteristics of tap water scalds in Australia and New Zealand

INTRODUCTION

Scalds from hot tap water can have devastating consequences and lifelong impact on survivors. The aims of this study were to (i) describe the frequency, demographic profile, injury event characteristics, and in-hospital outcomes for people with tap water scalds admitted to Australian and New Zealand burn centres; and (ii) determine whether variation was present in the frequency and epidemiological characteristics of tap water scalds between jurisdictions.

METHODS

Data were extracted from the Burns Registry of Australia and New Zealand for people with tap water scalds admitted to Australian or New Zealand burn centres between January 1, 2010 and December 31, 2018. Demographic, injury severity and event characteristics, surgical intervention, and in-hospital outcomes were investigated.

RESULTS

We included 650 people with tap water scalds admitted to Australian and New Zealand burn centres during the study period. Australians with tap water scalds (median [IQR] 29 [1-69] years) were older than New Zealanders (2 [1-36] years). Most tap water scalds occurred in the home, and 92% of these occurred in the bathroom. More than 55% of injuries occurred due to the accidental alteration of water temperature at the tap fixture. Two thirds of patients underwent a surgical wound procedure. The overall mortality rate was 3.7%, and the median hospital length of stay was 8.8 days.

CONCLUSION

Tap water scalds remain a public health problem in Australia and New Zealand. Our research highlights where gaps in current heated water regulations in residential homes perpetuate risks of tap water scalds, particularly in high-risk groups at the extremes of age. Extending current heated water regulations to include all Australia and New Zealand homes is urgently needed in conjunction with design safety improvements, and ongoing education of key stakeholders.

A state-wide analysis of pediatric scald burns by tap water, 2016-2018

INTRODUCTION

Unsafe tap water temperatures (>120 °F) are a risk factor for pediatric burns, which may disproportionally impact low-income, urban communities. We sought to estimate the incidence and demographic characteristics of tap water burns and their association with housing characteristics.

METHODS

We performed a secondary data analysis to summarize emergency department discharge records from 2016 to 2018 involving children <18 years with an ICD-10-CM code for tap water burn (X11), and town-level housing data from the American Community Survey. Unpaired student's t-test and spearman's correlation analysis were performed for comparative analyses.

RESULTS

A total of 146 tap water burn visits were identified, representing an incidence of 2 per 10,000 ED visits. The majority of cases were male, non-Hispanic White, of public insurance type, and from an urban CT town. The median age was 3 years, with 58% of cases <5 years. Towns with at least one tap water burn had a significantly higher average percentage of multi-family unit and renter housing as compared to towns with no tap water burns (p < 0.0001).

CONCLUSIONS

Our results identified a significant number of tap water burns in children. Primary prevention efforts targeting education or regulation of water temperatures may work to reduce burns in underserved areas.

Still too hot: examination of water temperature and water heater characteristics 24 years after manufacturers adopt voluntary temperature setting

Although water heater manufacturers adopted a voluntary standard in the 1980s to preset thermostats on new water heaters to 120°F, tap water scald burns cause an estimated 1500 hospital admissions and 100 deaths per year in the United States. This study reports on water temperatures in 976 urban homes and identifies water heater and household characteristics associated with having safe temperatures. The temperature of the hot water, type and size of water heater, date of manufacture, and the setting of the temperature gauge were recorded. Demographic data, including number of people living in the home and home ownership, were also recorded. Hot water temperature was unsafe in 41% of homes. Homeowners were more likely to have safer hot water temperature (<120°F) than renters (63 vs 54%; P < .01). For 11% of gas water heaters, the water temperature was >130°F, although the gauge was set at less than 75% of its maximum setting. In a multivariate logistic regression, electric water heaters were more likely to have safe hot water temperatures than gas water heaters (odds ratio R=4.99; P < .01). Water heaters with more gallons per person in the household were more likely to be at or below the recommended 120°F. Our results suggest that hot water temperatures remain dangerously high for a substantial proportion of urban homes despite the adoption of voluntary standards to preset temperature settings by manufacturers. This research highlights the need for improved prevention strategies, such as installing thermostatic mixing valves, to ensure a safer temperature.

Hot tap water legislation in the United States

Excessively hot tap water results in an estimated 1500 hospital admissions and up to 50 deaths in the United States every year. This study reviewed the current state of tap water temperature regulation in the United States, including the model plumbing code standards on which state legislation in this area is based; assessed the level of public awareness regarding the risk, prevalence, and severity of such injuries; and identified specific prevention measures. Relevant information was obtained from state legislative codes, model code development organizations, the US Consumer Product Safety Commission, and a survey of knowledge, attitudes, and behaviors related to tap water temperature safety. Model building and plumbing codes related to tap water temperature regulation and their subsequent adoption by state legislatures vary widely across the United States. The states also vary with respect to the authority provided to lower levels of government (counties or municipalities) to modify and enforce code provisions. Public awareness of hot tap water hazards and implementation of preventive measures are limited. A broader and more uniform application of codes for regulating tap water temperature in both institutional and residential settings can be achieved through input from affected users, government agencies, legislators, advocacy organizations, and the general public. Safer hot water temperatures and a reduction in scald injuries can be achieved through regulating hot water temperature level at the thermostat, installing temperature-regulating valves at the tap, and raising public awareness of hot tap water hazards.