Scald Injury Prevention

Scalds are most commonly a result of exposure to high-temperature water such as tap water in baths and showers, cooking water boiled for the preparation of foods, and spilled hot drinks. Most scalds are considered first or second degree burns. Occasionally third degree burns can result, especially if there is prolonged contact. Scalds caused by steam are typically far more severe because of a greater amount of latent heat that is absorbed.

The two high risk groups are children under the age of five and adults who are elderly and/or have disabilities.

Children: Young children are especially vulnerable to burn-related injury and death. They do not perceive danger, have less control of their environment and have a limited ability to react promptly and properly to a burn situation. A child in hot water will scream, but may not withdraw from the water. Additionally, children's skin is thinner than that of adults and therefore burns at lower temperatures and more deeply. For example, a child exposed to hot tap water at 140° for three seconds, or 156° for one second, will sustain a third degree burn, an injury requiring hospitalization and skin grafts.

According to data from the National Safe Kids Campaign, 4,000-5,000 children are scalded each year, most often in bathtubs. The average bathtub scald burn covers 12% of the body surface with a full thickness third degree burn. Statistics from the National Safe Kids Campaign indicate that the scald burn sources were 95% in residential settings, of which 54% were in apartment buildings and 46% in single family homes.

Adults: Adults with disabilities are also susceptible to scald injuries. Those at risk from scalding/burning include the elderly, those with mental illness, learning disability, reduced mobility and anyone with reduced sensitivity to temperature, or who cannot react appropriately, or quickly enough, to prevent injury. They may be in hospitals, care homes, social services premises, and special schools (i.e.. health and social care establishments). The risk of scalding/burning should also be assessed in community facilities such as community centers, staffed and sheltered housing for the elderly, the mentally ill, and those with cognitive disorders or disabilities.

Fatal accidents and major injuries to vulnerable service users continue to occur. Scalding is one of the main causes of fatal incidents to non-employees in the healthcare sector. Since 1996, approximately 13 fatalities and 42 major injuries were attributable to hot water scalds in health-care premises alone.

Large Loss Example:

•	Circumstance leading to large loss: Injured party was a male adult, developmentally disabled and living in an adult group home for about seven years. He was severely injured sustaining second and third degree burns while taking a shower and facing the shower handles with the spray hose draped behind him. The group home supervisor shut the curtain to go retrieve something in the closet. While STILL in the bathroom, the supervisor noticed the steam. The injured party was not capable of yelling and did not have the cognitive ability to react quickly.
•	Loss Cause Analysis: Shower was not provided with an anti-scald device. The attendant did not provide adequate supervision per company standard operating procedure and was unknowledgeable to the individual's disability to communicate fully.
•	Exposures leading to the loss: 1. There was no anti-scald device in the shower 2. The individual was improperly supervised 3. The attendant was not trained to understand claimant's disabilities
•	Controls which should be in place: 1. Never leave a child or person with a disability alone, especially in the bathroom or in the kitchen. If you must leave the room, take the person with you 2. Set your water heater thermostat to 120°F or less. The lower temperature, the lower the risk of sustaining scald-burn related injuries 3. Install anti-scald devices in bathtub faucets and shower heads 4. Always test the water temperature before putting a child or an adult with disabilities in the bathtub or shower 5. Provide training for staff. Never depend solely on any one water temperature control procedure or product. Products malfunction and can never replace physically checking the water