Barriers to safe hot tap water: results from a national study of New Zealand plumbers

"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.

Incidence of hot tap water scalds after the introduction of regulations in Ontario

Hot water scalds can be quite debilitating for a prolonged period of time. It has been previously determined that the severity of hot water scalds increases in a logarithmic trend with water temperature, which has led to legislations requiring changes to the physical environment to reduce the temperature of hot water. In September 2004, Ontario changed its Building Code, requiring all new or renovated residential buildings to lower the maximum setting of their hot water heaters to 49°C (120°F). The aim of the present study was to evaluate the effectiveness of the legislation at reducing both the overall incidence and hospitalizations caused by hot tap water scalds. Hot tap water scald cases were identified from the National Ambulatory Care Reporting System and Discharge Abstract Database databases provided by Canadian Institute for Health Information for April 2002 to March 2010. Annual incidences, hospitalizations, and outcomes were recorded. There were a total of 6952 hot tap water scald cases in Ontario, including 408 hospitalizations in the 8-year period. The average annual incidence rate for hot tap water scalds for the study period was 6.93 cases per 100,000 population and the average hospitalization rate was 0.4 cases per 100,000 population. The high-risk population group of children and elderly comprised the majority of hospitalization cases (60%); however, adults are responsible for the majority of the ambulatory cases (67%). There was a significant decrease in the age-standardized monthly ambulatory scald cases per 100,000 population after the intervention of 0.01055 (95% confidence interval [CI] [0.004, 0.017]; P = .0018) with a rate of change of 0.9455 (95% CI [0.90, 0.98]; P < .0001) and a long-term decrease of 0.19 per 100,000. There was no significant difference in length of stay of hospitalized cases after the intervention (rate ratio = 0.91; 95% CI (0.70, 1.18); P = .4624). Overall, the regulation of limiting the maximum hot water temperature in residential homes has had a positive impact on reducing the overall number of hot tap water scalds; however, they still cause a considerable amount of morbidity because the number of hospitalized cases did not change significantly. In addition to implementing regulations, active prevention and educational campaigns are still necessary to eliminate this preventable injury.

Preventing unintentional childhood injury at home: injury circumstances and interventions

New Zealand's (NZ) preschoolers carry the greatest injury burden among children aged 0-14 years. These injuries commonly occur at home. To identify how NZ addresses child injury the 1990s national injury datasets and associated free text were examined retrospectively, NZ injury circumstances and interventions were compared to internationally recognised hazards and best practice, and whether NZ interventions addressed common circumstances of injury was assessed. Certain injuries, often associated with activities of daily living, were not addressed by interventions, although most interventions advocated internationally are implemented in NZ. Possible reasons for main injuries not being addressed were the specificity and variable effectiveness of interventions, normality of many injury circumstances, difficulties in evaluating complex environments, and the need for active intervention. There is considerable scope for NZ to improve its child safety. It is unlikely that simple solutions will be found for complex circumstances in which injury events occur. Strategies to address multifaceted problems requiring changes to personal, social and societal factors are required, with evaluation methods able to match their complexity.

Legionella contamination in hot water of Italian hotels

A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of > or =10(3) CFU liter(-1), and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

Epidemiology of Scalds in Vulnerable Groups in New South Wales, Australia, 1998/1999 to 2002/2003

In this study, the recently introduced International Classification of Disease, 10th revision, code for hot tap water scalds was used to examine the epidemiology of these cases and other scalds injuries in children younger than 5 years of age and adults aged 65 years and older. Although the trunk was the most common area in which scalds occurred, young children were more likely to sustain head and neck scalds (15%, 95% confidence interval 10.8-18.3) because of hot tap water than older people (2%, 95% confidence interval 0.2-4.4). Hospital separation rates for hot water scalds decreased significantly during the study period in both boys (chi(2) = 15.6, df = 1, P < .001) and girls (chi(2) = 5.6, df = 1, P < .001) who were younger than 5 years of age, which might be attributable to the introduction of new standards regulating the provision of hot tap water to various buildings. The severity of scalds cases did not seem to be correlated with the length of hospital stay, which remained unchanged in both age groups.

Risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households

BACKGROUND

More needs to be known about the prevalence of risk and protective factors for fires, burns, and carbon monoxide poisoning in U.S. households.

METHODS

A random-digit-dial survey was conducted about home safety with 1003 respondents representing households in the continental United States. Descriptive statistics assess the prevalence of risk and protective factors for fires, burns, and carbon monoxide overall, and by demographic characteristics, household structure, region, and residential tenure. The data were weighted to adjust for nonresponse and to reflect the U.S. population.

RESULTS

Although most respondents reported having a smoke alarm (97%), and 80% reported having one on each level of their home, <20% reported checking the alarm at least every 3 months. Seventy-one percent reported having a fire extinguisher, 29% had a carbon monoxide detector, and 51% of those living with at least one other person had a fire escape plan. Few could report the temperature of their hot water at the tap (9%), or the setting on the hot water heater (25%). Only 6% had an antiscald device.

CONCLUSIONS

Results suggest that there is much room for improvement regarding adoption of measures to prevent fires, burns, and carbon monoxide poisoning. Further investigations of the efficacy of carbon monoxide detectors, fire extinguishers, and escape plans, as well as effectiveness studies of fire and burn-prevention efforts are needed.

Prevention of unintentional injury to people with intellectual disability: a review of the evidence

BACKGROUND

Recent research evidence shows that people with intellectual disability (ID) have double the unintentional injury risk of the general population and the risk is further increased in the presence of psychopathology and epilepsy. The pattern of injury and the circumstances surrounding an injury event in those with ID have some similarity with that of young children in the general population. Interventions to prevent injuries are an important health priority in this vulnerable population. This paper reviews evidence from injury prevention studies for people with ID and also considers the relevance of general population injury interventions for this population.

METHOD

Information regarding injury prevention in both ID and general populations was identified using online systems and consultation with research and public health organizations.

RESULTS

Few published studies were identified addressing the issue of injury prevention for those with ID. Possible injury prevention strategies appropriate for the major causes of injury in the ID population were identified from the general population literature. While many environmental injury prevention strategies for young children in the general population are applicable to the population with ID, some may require design modification to ensure effectiveness. Other promising approaches include improved information for parents/carers, primary care physician counselling, and home visits by well-informed and motivated professionals. There may be injury prevention benefit from improved management of psychopathology and epilepsy.

CONCLUSIONS

The issue of injury prevention for those with ID has not been addressed to the extent that the magnitude of the problem requires. Injury prevention programmes trialling a variety of evidence-based approaches and strategies are needed to protect the quality of life for the ID population and their families.