Overview of the ProblemRecent literature suggests that scaldburns caused by hot water pouring into the bathtub or shower, is the leadingcause of severe burn injuries in the United States 1. According to the American HospitalAssociation, more than 100,000 people are admitted into the hospital emergencyrooms each year for scald-related injuries. These incidents are on the risegiven higher birth and aging trends. Hot water poses are risk for scalding toalmost anyone, however hospitalized patients, disabled persons, those inphysical rehabilitation or those residing in nursing facilities are known to beat significant risk due to their delayed reactions to a sudden increase inwater temperature. No one can prevent all scalding incidents; however,hospitals like the Veterans Health Administration (VHA) are working hard to tryto reduce the number of preventable scalding events. Delivery of water safely creates acatch 22 situation.
Legionella, a typeof bacteria that causes Legionnaire’s disease, is found primarily in tepidwater environments. This disease can be contracted by inhaling airborne waterdroplets containing the bacterium. Legionella thrive within a constricted water temperature range between67-121 ?F. Therein lies the solutionand problem: Decreasing the water temperature so that it does not scald makesit the perfect temperature for legionella to thrive.
In recent guidelines for bacteria control andLegionella risk reduction, the CDC advise hot water recirculation at a minimumof 124?F and installing temperature valve controls at the point ofuse to reduce scalding risk 1. The objective of this project is topresent the key findings from a patient safety prospective surrounding hot waterdelivery in the geriatric patient care setting. This will be done in the formof a patient safety alert which will be used as a recommendation to theleadership at VA Hospitals around legionella scald prevention and riskmitigation. LiteratureReview After conducting literatureresearch the following takeaways can be applied to the VHA legionella scaldprevention patient safety alert. According to the CDC, which are burns caused by hot liquids or steam,account for approximately 50% of all patients hospitalized for burns in theUnited States between 2001 and 2006 1. Compared with younger adults, older adults with scald-related burns aremore commonly admitted to hospitals, experience extended intensive-care unitand hospitalization, have increased hospital mortality, and are transferredmore frequently to long-term nursing and rehabilitation facilities.
The burnsresulted mainly in injuries to the arms, hands, legs, and feet, were causedmostly by hot food and hot water or steam, and occurred most often in thekitchen, dining area, or bathroom 2. RecentNational Burn Registry show that 14% of patients hospitalized with all types ofburns were aged ? 60 years, and approximately 35% of these patients sustainednonfatal scald burns from hot liquids, steam, or boiling tap water. Byeducating staff and patients, surrounding these mentioned high-risk eventsfuture scalding can be prevented 3. ProjectScope Patient care rounds andinformational interviews with staff (directly and indirectly affected by scaldevents) will be conducted to identify the root cause(s) and gauge the currentstate of the problem. A risk assessmentwill be carried out to identify potential scalding risks from hot watertemperatures and to assess the vulnerability of all those who have access tobathing and washing facilities. Literature research will be conducted to assess the best scalding preventioninterventions and the latest engineered controls that ensure either: Water is delivered to the bath/shower outlet at no more than 44oC; or Water is prevented from being discharged at >44oC from taps, which may be accessible to vulnerable people using care services, especially in areas where there is the potential for whole body immersion