Prevention of scalding and drowning policy

1 Policy summary

This policy relates to people who are at risk of drowning or scalding in inpatient settings.it is recognised at times when people are acutely unwell, they may pose a risk. This policy aims to support and guide staff in recognising and minimising the risk.

2 Introduction

The Management of Health and Safety at Work Regulations (1999) require employers to carry out risk assessments of all hazards that pose a risk to staff and service users including the assessment of the risks from hot water temperatures being too high and presenting a scalding risk to vulnerable people who use health and social care services.

Those at risk from scalding include service users who: lack capacity; have learning disabilities; sensory impairments and, those who cannot react appropriately or quickly enough to prevent injury due to mental and, or physical health problems or mobility problems.

Where it is considered that service users are vulnerable to scalding, the health and safety executive (HSE) recommends that:

• water temperature to the bath or shower outlet is no more than 43C (plus or minus 1C) for baths, wash basins and showers
• water is prevented from being discharged above this temperature from taps that are accessible to vulnerable people, especially where there is a risk of total body immersion

Water temperature is controlled by thermostatic mixer valves (TMV’s). However, in health centres and clinics where TMV’s are not fitted, all outlets have fixed notices indicating “very hot water”.

The trust has a separate water systems policy, the purpose of which is to make sure as far as possible that the trust is exposed to minimum risk in relation to water systems.

The policy for the prevention of scalding and drowning supplements the water safety policy.

3 Purpose

The purpose of this policy is to raise staff awareness of the risks of scalding and drowning to vulnerable people in in-patient and, or residential areas and the arrangements and procedures in place to minimise those risks.

4 Scope

The policy covers the risk to vulnerable people of scalding from hot water outlets and the risk of drowning and is applicable to staff working within in-patient and residential areas. This is a trust wide policy and is relevant to all members of trust staff, trust employees based within trust premises or service provision, students, contractors and visitors.

5 Procedure

5.1 Key principles

• Prioritise safety: the immediate safety of patients and staff
• Empowerment and choice:
• Confidentiality: maintain confidentiality within legal and ethical boundaries.
• Information and support: ensure all staff are aware of this policy and the implementation of it
• Multi-agency working: collaborate effectively with other agencies to ensure a coordinated response.
• Training and competency: ensure colleagues receive regular training where required.
• Support for colleagues.

5.2 Hot water temperatures

All hot water outlet temperatures must be monitored weekly and recorded on the trusts formal recording sheet for hot water temperature (see appendix A). The process of how to test the water temperature will be covered during the local induction process for staff.

5.3 Estates department

If the water temperature does exceed 43C (plus or minus 1C) the estates department contact must be notified immediately, and a visible sign displayed informing others that it must not be used until further notice (in areas where the service users may be unable to read a notice, the area must be made in accessible, or the hot water tap disarmed).

5.4 Initial and subsequent assessments

All staff must familiarise themselves with the service user’s individual needs and abilities as identified in their initial or subsequent assessments. The findings of which must be recorded in all the service users care plans which cover any activity that presents a scalding or drowning risk. This information should be identified to the team via the handover and all departments should have appropriate recording arrangements in place to evidence that this information has been communicated.

5.5 Risk

Service users who have been assessed as being at risk and are using bathrooms must be supervised according to their assessed need as identified in the care plan. Staff must be conscious that any health risks, for example epilepsy, outweigh other considerations, for example, individual’s privacy.

5.6 Checking the temperature

Where a service user has been identified as being at risk, staff must check the temperature of the bath water using a bath thermometer prior to the patient entering the bathroom.

5.7 Security of bathroom area’s

Baths should not be filled and left unattended except in exceptional circumstances, and in such cases the room should be secured to prevent unauthorised access.

5.8 Appropriate risk assessments

Risk assessments which are determined by the manager as appropriate must be undertaken when other premises are accessed, for example, leisure centres or service user holidays.

5.9 Hot surfaces

Health care providers care for people who are vulnerable to the risk of scalding or burns. Contact with surfaces above 43C can lead to serious injury. Prolonged contact often occurs because people have fallen and are unable to move or are trapped by furniture. Incidents often occur in areas where there are low levels of supervision, for example in bedrooms, bathrooms and some communal areas.

You should assess potential scalding and burning risks in the context of the vulnerability of those being cared for. A risk assessment of the premises should be carried out to identify what controls are necessary and how the systems will be managed and maintained.

6 Training implications

The requirements for temperature monitoring will be included during local induction, and new colleagues informed how to access the policy. Awareness of the policy will also be made at the following:

• one-to-one’s
• team meetings

6.1 Community life support or moving and handling, staff working in in-patient or residential areas

• How often should this be undertaken: annually community life support (CLS).
• Length of training: 3 hours.
• Delivery method: face-to-face.
• Training delivered by whom: community life support trainer.
• Where are the records of attendance held: electronic staff record system (ESR).

6.2 Community life support or moving and handling, staff working in in-patient or residential areas

• How often should this be undertaken: moving and handling.
• Length of training: 2 hours.
• Delivery method: face-to-face.
• Training delivered by whom: moving and handling.
• Where are the records of attendance held: electronic staff record system (ESR).

7 Equality impact assessment screening

To access the equality impact assessment for this policy, please email rdash.equalityanddiversity@nhs.net to request the document.

7.1 Privacy, dignity and respect

The NHS Constitution states that all patients should feel that their privacy and dignity are respected while they are in hospital. High Quality Care for All (2008), Lord Darzi’s review of the NHS, identifies the need to organise care around the individual, “not just clinically but in terms of dignity and respect”.

As a consequence, the trust is required to articulate its intent to deliver care with privacy and dignity that treats all service users with respect. Therefore, all procedural documents will be considered, if relevant, to reflect the requirement to treat everyone with privacy, dignity and respect, (when appropriate this should also include how same sex accommodation is provided).

7.1.1 How this will be met

A plan will be in situ to ensure that vulnerable patients have any risks minimised and care is delivered to them with privacy, dignity, and respect. The wishes of patients for same sex staff will be accommodated.

Toilet signage in public areas to read as non-gender specific. Most in-patient areas are single room with en-suite facilities.

7.2 Mental Capacity Act (2005)

Central to any aspect of care delivered to adults and young people aged 16 years or over will be the consideration of the individuals’ capacity to participate in the decision-making process. Consequently, no intervention should be carried out without either the individual’s informed consent, or the powers included in a legal framework, or by order of the court.

Therefore, the trust is required to make sure that all staff working with individuals who use our service are familiar with the provisions within the Mental Capacity Act (2005). For this reason all procedural documents will be considered, if relevant to reflect the provisions of the Mental Capacity Act (2005) to ensure that the rights of individual are protected and they are supported to make their own decisions where possible and that any decisions made on their behalf when they lack capacity are made in their best interests and least restrictive of their rights and freedoms.

7.2.1 How this will be met

All individuals involved in the implementation of this policy should do so in accordance with the guiding principles of the Mental Capacity Act (2005).

8 Links to any other associated documents

• Health and safety policy
• Incident management policy
• Water safety policy

9 References

• Health and Safety Executive (2012) Scalding Managing the risk from hot water and surfaces in health and social care
• National Institute for Health and Care Excellence (NICE) (2012) Patient experience in adult NHS services: improving the experience of care for people using adult NHS services (CG138)
• National Institute for Health and Care Excellence (NICE) (2018) People’s experience in adult social care services: improving the experience of care and support for people using adult social care services (NG86)
• NHS England (2015) Independent review into issues that may have contributed to the preventable death of Connor Sparrowhawk (2015)

10 Appendices

10.1 Appendix A responsibilities, accountabilities and duties

10.1.1 Chief executive

The chief executive retains overall responsibility for the development and implementation of trust policies.

10.1.2 Matrons or residential area managers

• Risk assessing and reviewing service user’s needs regarding scalding or drowning risk, on admission services (or equivalent clinical risk assessment procedures) and have in place suitable care plan arrangements.
• Making sure their staff are aware of and comply with the policy, through local induction, instruction, supervision and audits.
• Monitoring adherence to the policy and taking immediate action where non-adherence is identified.
• Bringing to the attention of estates staff any issues to do with the regulation of water temperature.
• Immediately restricting the use of any hot water outlet where problems with temperature regulation arise, until such time as estates staff have dealt with the problem.
• Reporting all incidents via the Safeguard electronic (IR1) incident reporting system.

10.1.3 Staff in in-patient or residential areas

• Risk assessing and reviewing service user’s needs regarding a scalding or drowning risk.
• The patients care plan will reflect if there have been any episodes or incidents that indicate a seizure may have occurred including the same observation needs as if epilepsy were present until a definite diagnosis is established.
• Care plans must reflect the National Institute for Health and Care Excellence (NICE) guidance standards. NICE clinical guidelines are recommendations on how healthcare and other professionals should care for people with specific conditions. The recommendations are based on the best available evidence. Clinical guidelines are also important for health service managers and those who commission NHS services (30 November 2012).
• Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible (NG86) (2018).
• Temperature modulating valves are used in patient areas for anti-scolding for compliance with this policy.
• Bringing any issues in relation to the regulation of water temperature to the attention of the manager. Ensuring that with immediate effect the use of any hot water outlet where problems with temperature regulation arise is restricted until such time as estates have dealt with the problem.
• Reporting all incidents via the Safeguard electronic (IR1) incident reporting system.

10.1.4 Estates department

• Responding urgently to requests from managers or staff to review any issues to do with the regulation of water temperatures and completing any remedial action required.
• Making sure that any new buildings or those which undergo change of use where service users who may be vulnerable to scalding will be cared for comply with the Health and Safety Executive (HSE) recommendations.

10.2 Appendix B monitoring arrangements

10.2.1 Hot water temperature

• How: weekly monitoring (see appendix A).
• Who by: designated member of staff.
• Reported to: matron or area manager.
• Frequency: weekly.

10.2.2 Incident reports where water temperature is highlighted as a contributing factor

• How: ongoing review of incidents and quarterly report.
• Who by: health and safety lead and patient safety lead.
• Reported to: senior manager where concerns arise from incident report and health, safety and security forum.
• Frequency: as incidents are identified and quarterly.

10.3 Appendix C recording sheet for hot water temperatures

Refer to appendix C: recording sheet for hot water temperatures (staff access only).

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Document control

• Version: 14.
• Unique reference number: 404.
• Approved by: clinical effectiveness meeting.
• Date approved: 5 August 2025.
• Name of originator or author: community nurse.
• Name of responsible individual: chief nursing officer.
• Date issued: 8 October 2025.
• Review date: 31 October 2028.
• Target audience: colleagues working in in-patient areas or with estates functions and responsibilities.
• Description of change: 3-year review amendments and updates.

Page last reviewed: October 08, 2025
Next review due: October 08, 2026

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