ACQSC's hot water scalding clinical alert

The Aged Care Quality and Safety Commission (ACQSC) recently issued a clinical alert on hot water scalding.

The alert follows an incident in NSW where a person receiving personal care from a disability services provider suffered severe burns (scalds) while being bathed and subsequently died from their injuries.

Providers are reminded that they must ensure there is clear oversight of staff, and that they receive appropriate education and training to safely provide personal care, such as bathing and/or showering.

Those providing direct care need to:

• always check the water temperature
• know the immediate response required to treat a scald/burn
• apply immediate and appropriate first aid treatment
• understand when to seek medical attention and/or seek emergency treatment.
   

Burns are caused by exposure to thermal (heat), electrical, chemical or radiation sources. Scalds are a form of thermal burn caused by heated fluids such as hot water or steam. Water does not have to be boiling to cause serious scald burns.

Scald burns from showering and bathing are one of the most common burn injuries affecting adults over the age of 80 years. Older people are more vulnerable to burn injury as their skin is thinner and more prone to tearing. They may also have reduced perception of heat, and they may not be able to quickly move themselves away from a heat source.

Providers must ensure that the risks of providing care to each individual consumer are managed in the specific context and environment of care delivery. This includes knowledge of the hot water systems being used, and how temperature can be monitored and assessed before a person is placed under a shower or into a bath.

To help reduce the risk of scalding:

• Always check the water temperature before the care recipient enters the water.
• If the person is identified as at risk, constant supervision is required.
• Never fill a bath or sink with hot water only.
• Turn the cold water on first and adjust the temperature of the water by adding hot water.
• Make sure the water temperature is comfortably warm, but not hot, by using your forearm or elbow to check the water. Hands are not sensitive enough to check temperature reliably.
• In the home setting, be aware that the water temperature may fluctuate when other people in the home use the water or flush the toilet.
• There are risks relating to swing taps (inadvertent bumping) and high hot water thermostat settings in private homes. These potential risks need to be highlighted and staff educated.
   

If someone sustains a scald burn:

• Consider your own safety and move the person away from the heat source.
• Immediately apply cool running water to the scald and continue for 20 minutes. Do not use ice, butter, creams or alternatives.
• Call triple zero (000) if the scald is severe (ie, if the affected area rapidly reddens, swells and blisters, and is very painful) or if it involves the person’s airway/breathing or is spread over a large area.
• After cooling the scald, cover the area with a light, loose, non-stick dressing — preferably clean, dry, non-fluffy material (eg, plastic cling placed lengthways, or a clean plastic bag for a hand) and keep care recipient warm (large area burns can cause a decrease in body temperature).
• Seek medical attention for any scald bigger than 3 cm; or with blisters; or if the scald involves the face, hands, genitals or buttocks.
   

Image credit: iStock.com/nikkytok