Please note if you are a provider registered with the Care Quality Commission (CQC), and with premises located in England, they are the relevant regulatory body for patient safety matters. You can find guidance on the Care Quality Commission website.
Risks from hot water and hot surfaces
The health and social care sector often provides care and services for individuals who may be vulnerable to risks from hot water or surfaces. Those at risk include:
- children
- older people
- people with reduced mental capacity, reduced mobility, or a sensory impairment
- people who cannot react appropriately, or quickly enough, to prevent injury
Risk of scalding
Health and social care settings have increased water temperatures for a number of reasons including:
- the need to satisfy hot water demand
- efficient running of the boiler
- controlling the risk from legionella bacteria
High water temperatures (particularly temperatures over 44°C) can create a scalding risk to vulnerable people who use care services.
Those who are vulnerable to the risk may be in hospitals and other care settings, care homes, social services premises and special schools. The risk of scalding or burning should also be assessed in community facilities such as hostels, or staffed and sheltered housing, where vulnerable people may be at risk.
Many accidents involving scalding have been fatal and have mainly occurred during bathing or showering. Where vulnerable people are at risk from scalding during whole body immersion, water temperatures must not exceed 44°C.
Any precautions taken should not introduce other risks, for example from legionella bacteria.
Risk of burn injuries
Serious injuries and fatalities have also been caused by contact with hot pipes or radiators. Where there is a risk of a vulnerable person sustaining a burn from a hot surface, the surface should not exceed 43°C when the system is running at the maximum design output. Precautions may include insulation or providing suitable covers.
When your care home has bedrooms with en-suite facilities
You should develop safe bathing procedures if people you care for are assessed as being vulnerable to scalding.
Where storage and distribution temperatures are being used to control legionella (above 60ºC and 50ºC respectively), or high temperatures might otherwise be achieved, baths and showers should be fitted with thermostatic mixer valves (TMVs) to ensure water temperatures do not exceed 44ºC. Outlet temperatures and TMVs should be monitored and maintained to ensure the controls are effective.
Where electric showers are fitted, the potential output temperatures should be checked under fluctuating local conditions (different pressure/flow) to ensure temperatures above 44ºC (maximum 41ºC required in NHS) are not achievable. Where electric shower temperatures have the potential to exceed 44ºC, you will need to install healthcare standard electric showers unless your assessment indicates adequate control of the risk by other means.
While the risk from basins is much lower, as there is no full body immersion, if someone is assessed as being vulnerable to the risk of scalding at basins, adequate controls on output temperature (such as TMVs) should be in place.