Encouraging the use of thermostatic mixer valves to reduce scalds in children (product and education)

Conclusion: Indications for effectiveness

In a review by Kendrick et al. (2007) evidence was found that families in a home safety education group are more likely to have a safe hot water temperature than control group families. The same review concludes there is no evidence of reduced thermal injuries by such programs, most likely because the numbers of injuries are so small that no effect can be found unless research groups would be very large. Another explanation might be that the definition of safe hot water temperature was too high since new standards by the Child Accident Prevention Trust (CAPT 2004) define a safe temperature at 46˚C.

Kendrick et al. (2010) found in a recent Randomised Controlled Trial that TMVs are effective at reducing bath hot tap water temperatures in the short and longer term and are acceptable to families with young children, living in areas of social housing.

Conclusions on the product
There are indications of effectiveness of thermostatic mixer valves on bath hot tap water temperatures in one study. There is no convincing evidence of the effect of thermostatic mixer valves in reducing scalds in children.

Conclusions on educational efforts to encourage the use of TMV's
There are indications of moderate effectiveness of home safety education programs on reducing hot water temperature.

Recommendations (for research & practice)

Suggestions for future research
The Kendrick et al (2010) trial demonstrated that TMVs are effective in reducing bath hot tap water temperatures in families with young children living in areas of social housing. Future work replicating these findings in similar settings would be useful. In addition research could also investigate whether TMVs may benefit a wider population such as older people and those with disabilities. The limitations of a single trial must be borne in mind when considering wider scale implementation of its findings.

Although it might be useful to use a multi-strategy, multi-focused approach for injury prevention counter-measures (because multiple measures combined might be more effective in reducing burns), the effectiveness of each counter-measure by itself should be known as well. Therefore we recommend research on these multi-strategy community programs to look at the effect of both the whole program and separate counter-measures.

Suggestions for practice/policy
Housing providers should consider fitting TMVs in their properties and legislators should consider requiring the fitting of TMVs as part of housing refurbishments.

In order to minimize unintended consequences of TMVs, messages need to be reinforced about the need to check water temperatures despite having a TMV fitted and about the dangers of leaving children alone in the bath.

Useful background information on how TMVs work is available at: Building Research Establishment (2003). Preventing hot water scalding in bathrooms using TMVs. London, BRE.

Review
Date: 27/10/2011
Version: 1.0
Status: Publish

Procedure
Articles (reviews) and reports were included that were published between 1980 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2010.

Background documents

Home safety education and provision of safety equipment for injury prevention (version 1.0)
D. Kendrick, C. Coupland, C. Mulvaney ... [et al.] (2007)

Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing (version 1.1)
D. Kendrick, J. Stewart, S. Smith ...[et al.] (2010)