We would all like to think that if we or someone we know had to go in to care, the care providers would be well aware of the risks to vulnerable people involving hot surfaces and water temperatures. However, this is not always the case as was highlighted by the tragic death of paraplegic teenager, Yelena Hasselberg-Langley. The Health and Safety Executive reported that Yelena suffered horrific burns and was fatally scalded after being placed in a bath of water which was described as “excessively hot” up to 66ºC (150ºF). Yelena was blind, paraplegic, epileptic and severely disabled. She was unable to communicate her distress and would have suffered “excruciating agony”. After sustaining 13 separate injuries, Yelena died four days later from multiple organ failure. The court heard that investigations found that although the bath was fitted with a special valve to prevent scalding, this valve had never been set. In addition to this, staff had no training in the risks of scalding and there was no bath thermometer. The care home provider admitted health and safety breaches and was fined £100,000 with costs of £45,000.
There have been a number of other highly successful prosecutions following accidents to vulnerable people, including one instance where a company was fined £30,000 for failure to fit thermostatic mixing valves to a bath. Between April 2001 to March 2006 statistics identified 2 fatal incidents and 8 major injuries attributable to hot water scalds. Victims who suffer personal injuries may also be entitled to damages for the harm that they have suffered.
In an attempt to address the number of serious burning incidents, to people who use care services, from hot surfaces and water temperatures, the Health and Safety Executive has issued guidance. The health and safety of those who use care services is governed by legislation and it is the responsibility of the Health and Safety Executive and the Local Authority Inspectors, to enforce the requirements.
The Health and Safety Executive recognises that in a scenario where a vulnerable person has access to water over 44ºC and is capable of whole body immersion, there is a risk of serious personal injury. It is common for social care premises to maintain water temperatures above 50ºC and some would question why this is the case. One of the main reasons is to control legionella bacteria, which can lead to Legionnaires' disease, a type of pneumonia. This can be particularly harmful to the elderly and those with cancer, diabetes, chronic respiratory or kidney disease.
It should be obvious that high water temperatures create a scalding risk to vulnerable people who use care services. Those at risk from scalding/burning include children, the elderly, those with reduced mental capacity, reduced mobility and anyone with sensory impairment , or who cannot react appropriately, or quickly enough, to prevent injury. This could therefore include people in hospitals, care homes, social services premises and special schools. The risk of scalding/burning also extends to community facilities such as hostels, staffed and sheltered housing for the elderly, the mentally ill, and those with learning difficulties.
The question is therefore, what can be done to keep vulnerable people safe? The Health and Safety Executive has identified that a risk assessment should be carried out to identify potential scalding risks from hot water temperatures and to assess the vulnerability of all those who have access to bathing and washing facilities. Where a risk is identified, precaution should be taken to ensure that water is delivered to the bath/shower outlet at no more than 44ºC or water is prevented from being discharged at more that 44ºC from taps, which may be accessible to vulnerable people especially in areas where there is the potential for whole body immersion. The safest acceptable way for service providers to ensure that the above precautions are met is to fit thermostatic mixing valves. Other recommended precautions include labelling hot water outlets with ‘very hot water’ signs to prevent inadvertent scalding.
Employers also have a duty to ensure that adequate training and supervision is provided to ensure that staff involved in bathing people understand the risks and precautions. This will include, steps such as filling the bath before the person gets into it and monitoring the outlet temperature of the bath/shower water using a bath thermometer. If it is necessary to add hot water whilst the person is in the bath, this should be done slowly and the water should be tested as it is added. Staff should be instructed that water in excess of 44ºC coming from a tap should be reported to a responsible person, and access to the bath/shower concerned restricted until repairs to the thermostatic mixing valve have been carried out
This link will take you to the HSE article of Yelena Hasselberg-Langley http://www.hse.gov.uk/PRESS/2010/hse-1192010.htm