Home safety education about safe tap water temperature can be provided at prenatal or well-baby visits at a health clinic, as part of well-baby home visits, or as part of community canvassing programs. Interventions can include safety counseling, educational books or leaflets, and home safety checks. Such efforts are often paired with provision of home water safety equipment such as water heater temperature gauges; thermometers to test household water temperature or bath water, especially for babies; or plumber-installed thermostatic mixing valves1, 2. Burns from tap water affect young children and older adults most3. Bathing or tap water is one of the major causes of scald burns in children under 3 years of age4.
Expected Beneficial Outcomes (Rated)
Improved home water temperature safety
Other Potential Beneficial Outcomes
Reduced energy expenditures
Reduced energy use
Evidence of Effectiveness
There is strong evidence that home safety education regarding safe water temperature increases home safety practices such as testing home water temperature; education is most effective when paired with the provision of home water safety equipment1, 2, 5. Effects appear greater when interventions are delivered in homes than in clinics1. Additional evidence is needed to determine the effect of educational interventions on the incidence of tap water scald burns1, 2.
Providing thermostatic mixing valves along with educational leaflets can increase the likelihood of having safe hot water temperature among families with a young child6. An evaluation of a Baltimore-based fire department home visiting program indicates that residents who receive educational materials with a thermometer are more likely to test water temperature and lower water heater gauges than residents who do not receive such interventions5.
General home safety educational efforts have been shown to be effective for children of various ages, genders, races, and ethnicities. Such efforts have demonstrated effects for children in single parent and two parent households, children living in rental units, and children in family-owned homes1.
Homeowners appear more likely to have a safe hot water temperature than renters. Households with electric water heaters are more likely to have a safe hot water temperature than those with gas water heaters3.
In the US, water heating is usually the third largest source of residential energy consumption7. Households that set water heater thermostats to lower temperatures such as 120 degrees Fahrenheit or halfway between the low and medium settings can reduce energy expenditures and energy use8, 9. Typically, for every 10 degrees Fahrenheit reduction on water heater thermostats households save 3-5% of water heating costs8. A UK-based cost analysis of a large-scale scald education and thermostatic mixing valve installation program suggests that installation of thermostatic mixing valves in government-owned apartments produces net benefits for society10.
Impact on Disparities
The Centers for Disease Control and Prevention11, American Burn Association12, the US Consumer Product Safety Commission13, and child safety organizations such as Safe Kids Worldwide14 urge individuals to set a water heater’s thermostat to 120 degrees Fahrenheit or lower and then test tap water to ensure running tap water is no more than 120 degrees Fahrenheit. Safe bath water temperature is 100 degrees Fahrenheit12, 15.
ABA-Scald injury - American Burn Association (ABA). Scald injury prevention: Educator's guide. 2017.
SKW-Burns and scalds - Safe Kids Worldwide (SKW). Safety tips: Burns and scalds.
BIRC-Scald burns - Burn Injury Resource Center (BIRC). Tap water and scald burns (part II). November 25, 2014.
CIRP-Safety resources - Johns Hopkins Center for Injury Research and Policy (CIRP). Resource library: Materials for parents and caregivers.
USFA-Burn prevention materials - United States Fire Administration (USFA). Burn and scald prevention outreach materials.
ACEEE-Energy saving tips - American Council for an Energy-Efficient Economy (ACEEE), Smarter House. Home systems and energy: Water heating: Energy saving tips.
* Journal subscription may be required for access.
1 Cochrane-Kendrick 2012* - Kendrick D, Young B, Mason-Jones AJ, et al. Home safety education and provision of safety equipment for injury prevention. Cochrane Database Systematic Reviews. 2012;(9):CD005014.
2 Zou 2015 - Zou K, Wynn PM, Miller P, et al. Preventing childhood scalds within the home: Overview of systematic reviews and a systematic review of primary studies. Burns. 2015;41(5):907-924.
3 Shields 2013 - Shields WC, Mcdonald E, Frattaroli S, et al. Still too hot: Examination of water temperature and water heater characteristics 24 years after manufacturers adopt voluntary temperature setting. Journal of Burn Care & Research. 2013;34(2):281–7.
4 Shields 2015* - Shields WC, McDonald EM, Pfisterer K, et al. Scald burns in children under 3 years: An analysis of NEISS narratives to inform a scald burn prevention program. Injury Prevention. 2015;21(5):296-300.
5 Shields 2016 - Shields WC, Omaki E, Zhu J, et al. Some like it hot: Results of a community intervention trial aimed at improving safety behaviors to prevent hot water scald burns. Journal of Epidemiological Research. 2016;2(2):74-80.
6 Kendrick 2011 - Kendrick D, Stewart J, Smith S, et al. Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing. Archives of Disease in Childhood. 2011;96(3):232-239.
7 ACEEE-Smarter House - American Council for an Energy-Efficient Economy (ACEEE). Smarter House: Reduce your impact and home energy breakdown.
8 ACEEE-Energy saving tips - American Council for an Energy-Efficient Economy (ACEEE), Smarter House. Home systems and energy: Water heating: Energy saving tips.
9 ACEEE-Environment - American Council for an Energy-Efficient Economy (ACEEE), Smarter House. Energy and the environment.
10 Phillips 2011* - Phillips CJ, Humphreys I, Kendrick D, et al. Preventing bath water scalds: A cost-effectiveness analysis of introducing bath thermostatic mixer valves in social housing. Injury Prevention. 2011;17(4):238-43.
11 CDC-Burn prevention - Centers for Disease Control and Prevention (CDC). Child safety and injury prevention: Burn prevention.
12 ABA-Scald injury - American Burn Association (ABA). Scald injury prevention: Educator's guide. 2017.
13 US CPSC-Scalds - US Consumer Product Safety Commission (US CPSC). CPSC safety alert: Avoiding tap water scalds. Washington, DC: US Consumer Product Safety Commission; 2012. Pub. No. 5098.
14 SKW-Burns and scalds - Safe Kids Worldwide (SKW). Safety tips: Burns and scalds.
15 BIRC-Scald burns - Burn Injury Resource Center (BIRC). Tap water and scald burns (part II). November 25, 2014.
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