Tap Water Scalds
Background
Hot water, including tap water in bathtubs and showers, is the leading cause of both scalds and hospital admissions for burns (1). Each year approximately 3,800 injuries and 34 deaths occur in the home due to scalding from excessively hot tap water. The majority of these injuries involve the elderly and children under the age of five years (2). It takes less than 3 seconds to produce a partial-thickness burn when the water temperature is 145°F, but with a water temperature of 120°F, it would take much longer -- approximately five minutes (3). Since infants, young children and the elderly may not be able to respond quickly to a situation involving contact with hot water, a constant, safe water temperature is essential for preventing scalds from tap water.
Policies
States and communities should enact and enforce building codes that require the installation of water heaters that keep tap water temperature at or below 120 degrees F.
Tap water scalds can be prevented by lowering the water temperature at the source. To reduce the risk of scalds, water heater manufacturers have agreed to voluntary standards. The Gas Appliance Manufacturers Association, the trade organization for companies making gas-fired water heaters, directs all units to be preset at the factory to their lowest setting and have a dial marking or "detent" to indicate 120°F. The electric hot-water heater voluntary standard directs that the factory preset temperature not exceed 125°F (4). However, there have been no studies that examine compliance with this voluntary agreement and despite these standards, children are still being injured from tap water scalds. In addition, these standards do not prevent property owners, residents, water heater installers, plumbers and others from increasing the temperature setting once the heater is manufactured and distributed.
Legislation that requires new water heaters to be preset at no higher than 120° F (49°C) when they are installed would prevent tap water scalds. Such legislation should also mandate that water heater temperatures be checked as part of regular, periodic building code inspections of multi-family dwellings. Florida and Washington passed laws in the early 1980s that required water heaters to be preset at lower temperatures. Both the American Academy of Pediatrics and the American Public Health Association have issued policy statements that recommend that water heaters be set at no higher than 130°F (5, 6).
Effectiveness Data
Legislation requiring a safe pre-set temperature for all water heaters has proven to be a more effective method of reducing scald burns than education to encourage parents to turn down water heaters. One study found that the implementation of a state law requiring water heater manufacturers to preset their products at a safe temperature (120°F) increased the number of homes with hot water temperatures less than 130°F when compared to educational programs alone. Water heaters on almost all of the homes with water heaters installed after the law went into effect remained set at the lower temperature. This finding indicates that the lower water temperatures did not present other types of problems for consumers, such as not enough hot water or the inability to adequately clean clothes or dishes (7). These safe temperatures should be maintained through building code inspections to ensure that the hot water temperature setting for multi-family housing units are not increased.
Contacts
David Lawrence, Center Director
Center for Injury Prevention Policy and Practice
San Diego State University
6505 Alvarado Road, Suite 208
San Diego, CA 92120
Phone: (619) 594-3691
Fax: (619) 594-1994
E-mail: dlawrenc@mail.sdsu.edu
Web site: http://www.cippp.org
References
- Baker SB, et al. The Injury Fact Book: Second Edition. Oxford University Press, New York, NY, 1992.
- Tap Water Scalds. Consumer Product Safety Commission. 5098. Web site: http://www.cpsc.gov/cpscpub/pubs/5098.html, May 31, 2000.
- Moritz AR and Henriques FC. Studies of Thermal Injury: the Relative Importance of Time and Surface Temperature in the Causation of Cutaneous Burns. American Journal of Pathology, 1947. 23:695.
- Schieber RA, Gilchrist J and Sleet DA. Legislative and Regulatory Strategies to Reduce Childhood Unintentional Injuries. Unintentional Injuries in Childhood. The Future of Children, 2000. 10(1): 111-136.
- American Academy of Pediatrics. Office-Based Counseling for Injury Prevention (RE9427). Pediatrics, October 1994. 94(4): 566-567. Web site: http://www.aap.org/policy/00410.html, June 8, 2000.
- American Public Health Association. Tap Water Scald Injuries. American Journal of Public Health, 1979. 7.
Erdmann TC, et al. Tap Water Burn Prevention: The Effect of Legislation. Pediatrics, 1991. 88(3): 572-577.
Acknowledgements
Leroy Frazier. Jr., M.S.P.H., C.H.E.S., Director, South Carolina Dept. of Health and Environmental Control, Injury & Disability Branch, Columbia, SC.
Chris Hanna, M.P.H., National Children's Center for Rural and Agricultural Health Safety, Marshfield, WI.
Diane Winn, M.P.H., R.N., University of California-Irvine, Pediatric Injury Prevention Research Group, Irvine, CA.
David F. Zane, M.S., Director, Texas State Department of Health, Injury Epidemiology and Surveillance Program, Austin, TX.
We extend special thanks to the California Center for Childhood Injury Prevention (CCCIP) for their extensive contribution and commitment to the production of this publication.
