The importance of safe showers and water temperature

Michael Chotiner
Michael Chotiner

In their 2012 report , the Assisted Living Federation of America noted that 57% of states reported maintenance and building code deficiencies in long-term care facilities. Among the top 10 issues is non-compliance with codes that require automatic temperature control of water used in resident bathrooms.

The extent of the problem was confirmed in the Assisted Living Regulatory Review, compiled and published by the National Center for Assisted Living, which found widespread citations for failures to comply with applicable life safety codes designed to prevent accidental scalding.

It is an issue that senior care facilities can address in two ways:  

1. By installing automatic temperature control valves at points of use, such as showers and lavatory sinks

2. By installing shower heads that reduce the chance of scalding for residents—namely, hand-held shower heads with or without temperature controls.

In most jurisdictions, the following rule, based on the 2014 International Building Code, applies:

Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120⁰F (49⁰C).

Herein lies the problem: The American Association of Sanitary Engineers recommends that hot water in a holding tank be maintained at approximately 140⁰F (60⁰C) to prevent the growth of dangerous bacteria (Legionella, for one) normally present in cooler water.  But water at 140⁰F will cause third-degree burns in adults within seconds.

Scalding is not the only risk: in the shower, a bather suddenly exposed to extremely hot water tends to reflexively jerk away to avoid contact. With the elderly, this frequently leads to a fall.

In facilities that follow the 140⁰F recommendation—and even those that limit water temperature to 120⁰F—secondary controls beyond the tank thermostat are needed to ensure that water no hotter than 120⁰F is dispensed at the point of use for showering and hand washing.

Typically, any of the following devices may be installed:

  • Temperature-actuated mixing valve
  • Automatic compensating mixing valve
  • Temperature-limiting device
If these safety controls are not already in place in resident bathrooms, your facility will need a plan to have them retrofitted in locales where the Life Safety Code or a similar code applies.

Temperature control shower heads are also now available. Although they don't generally meet codes that require automatic temperature controls, they can help residents avoid exposing themselves to uncomfortable water temperatures—either too hot or too cold—and thus reduce or avoid falling and scalding injuries in your facility. Most temperature-control faucets provide an LED readout of the temperature of water being dispensed.

Temperature-control shower heads are available in stationary and hand-held models. As most healthcare professionals know, hand-held shower heads are preferable for elderly residents. They make it easier for those with limited mobility to rinse off in any position, especially when seated. A hand-held spray can also help to prevent falls since the stream can easily be directed away if the water is too hot—no need for the bather to lurch out of the way. Shower heads—with or without temperature controls—are relatively inexpensive, and can simply be screwed onto an existing shower arm.

Do you know the temperature that your facility's water is stored at? Do you have steps in place to avoid scalding-related injuries among your patients?

Michael Chotiner has many years of experience as a general contractor, and shares his expertise writing for The Home Depot. To research Home Depot shower heads available online,  visit the Home Depot website.

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