Water Safety for the Elderly

8/6/2019 Water Safety for the Elderly

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For The Elderly And Infirm

I

t’s a classic Catch 22. Safer technology and Legionella liability havestirred a trend, moving accepted commercial and institutionalplumbing toward the need for running water in excess of 140

degrees F throughout potable system lines.At that temperature, within the heat source, all bacteria are killed.

Coming directly out of the heat source, free-roaming bacteria are killedon contact.

Yet, with those higher temperatures comes the need to protect people atthe fixtures. Mixing valves — and by far the safest of them is the thermo-static mixing valve — must be applied to protect users from r isk of burns.

Medical statistics reveal that scald burns caused by hot water flowinginto a tub or shower enclosure are among the leading causes of severeburn injuries in the United States. According to the American HospitalAssociation, more than 112,000 people are admitted into hospital emer-gency rooms each year for scald-related injuries.

Safe water delivery throughout any facility housing the elderly or

infirm is critical to reduce the threat of scalding, toxic bacteria growthand a facility’s liability exposure.

Unlike other commercial and institutional facilities wherebathers typically can respond to shower and point-of-use

temperature changes, senior health care facilities mustaccommodate a wider range of user needs and risks.

Among older people, the threat of scaldingattributed to pressure and temperature changesis dramatically increased. Consider that:

• Elderly people lose the ability to respondquickly; this worsens with age.

• With attendant bathing, temperaturechanges are not felt by the person control-

ling water temperature.• Bathing temperatures must be carefullycontrolled for patients with delicate healing

tissues, such as post-surgical or burn care.• Bathers who are unable to change water tem-

perature may be left unattended for extended peri-ods of time.

Related to the threat of scalding is a second chal-lenge. Recent studies have shown that temperatureswithin potable distribution systems — as high as 180degrees F — cannot immediately kill “biofilm-insu-lated” bacteria on contact. Biofilm forms when bacte-ria adhere to surfaces in aqueous environments and

BY BRUCE FATHERS

Combining bather safety and bacterial control.



begin to excrete a slimy, glue-likesubstance that anchors them to theinner walls of plumbing pipes. Abiofilm can be formed by a singlebacterial species, but more often abiofilm consists of many species of bacteria,as well as fungi, algae,proto-zoa, debris and corrosion products.

Even at temperatures of 180degrees F or more, it takes time topasteurize water within the pipes;thehigher the temperature, the less time

required to kill Legionella bacteria.A Solution: Is it a Catch 22?

Decreasing hot water temperaturein a delivery system reduces thedanger of scalding, but increases therisk of bacteria growth. Increase thehot water temperature and just theopposite risks occur.

Is there a solution?Some facilities distribute hot

water as low as 110 degrees F, toeliminate any risk of scalding.Unfortunately, Legionella will grow

in temperatures as high as 122degrees F, with the ideal growthrange from 95-115 degrees F. In thisinstance, solving one problem onlycreates another.

The recommended 140 degreesF temperature works, but only if constant-circulation techniques areused. The combination of 140degrees F water with constant circu-lation and thermostatic (Type T)valve technology is the only reliableway to kill bacteria and maintain

sanitary potable water pipes. Thismethod maintains the set tempera-ture within the piped system so thatcooling cycles between hot wateruse won’t give bacteria an opportu-nity to recover and grow.

According to the OccupationalSafety and Health Administration’stechnical manual on Legionnaire’sdisease, water should not only bestored at a minimum 140 degrees Fbut should be “delivered at a mini-mum of 122 degrees F to all outlets”

to “minimize the growth of

Legionella in a system.” At 140degrees F, Legionella are killed with-in 32 minutes. At 151 degrees F,Legionella die within two minutes.

Higher water temperatureswithin potable systems are indeed aconcern, especially when theAmerican Society of PlumbingEngineers reports that an estimated70 people in the United States dieeach year from bath and showerscalding. Yet, according to experts at

the Centers for Disease Control,many more people die from expo-sure to Legionella bacteria.

It’s common knowledge that, inresponse to energy-conservationurgings, many facility managershave reduced thermostat settingsfor water heaters. Legionella wel-come this news because the lowertemperatures allow them to multi-ply, causing a keen health risk forthose who shower — the bacteriaare most dangerous when atomized,

carried airborne with water andtransported into the lungs.

The use of chlorine, even at thehighest concentrations consideredacceptable for use in plumbing sys-tems, does not kill hardy bacteria likeLegionella. Which brings us back tothe issue of high temperature risks.

Hospital patients, those strug-gling with disabilities or duringphysical rehabilitation, and mostpeople within nursing facilities areknown to have delayed reaction to a

sudden r ise in water temperature.Pain is the body’s means of pro-tecting itself. At 130 degrees F, itrequires only 20 seconds of expo-sure to produce a first-degree burn.Yet, illness or medication, as well asthe delayed reactions of the elderly,can all affect the warning mecha-nism, and patients can unknowing-ly subject themselves to the risk of severe tissue damage and burns.

Even momentary exposure toscalding water can result in second-

or third-degree burns. At 135-140

degrees F, among the elderly, it takesonly five to six seconds to sustainthird-degree burns that can poten-tially destroy all skin layers. Thiscould cause permanent injury anddisfigurement, and depending onthe level of exposure, possiblydeath. It’s not at all uncommon forscald-related injuries to require skingrafts and an average hospitaliza-tion of 17 days.

The many dangers of scalding

water can expose a healthcare facil-ity to numerous liabilities, lawsuits,bad publicity and public ill will. If safety is a priority, providingbather protection is a must forhealthcare institutions. Adequateplumbing with temperature con-trol devices, proper plumbingmaintenance and education aresome of the steps that can help tominimize the r isks and liabilities.

Types Of Valves And ASSEStandards: The American Society

of Sanitary Engineers performancestandards that govern potable sys-tems safety valves are 1017 and1016. ASSE 1017 is applicable to thepoint-of-source and the distribu-tion system. ASSE 1016 governspoint-of-use or shower valves.

ASSE 1016 recognizes threebasic types of bath and showervalves. There are those that com-pensate for pressure changes only,known as Type P; those that com-pensate for temperature changes,

and to a lesser degree, pressure fluc-tuations (Type T); and those knownas “combination valves,” or TypeT/P, a hybrid of both pressure-bal-ancing and thermostatic perform-ance requirements.

The pressure-balancing valve(Type P) is designed to adjust watertemperature automatically bymaintaining a mix of hot and coldwater within 3 degrees F of the set-point when pressure changes occurin the system, say when a toilet is

flushed or an appliance is turned on.



While Type P valves provide an excel-lent way to compensate for pressurefluctuations within a plumbing sys-tem, they cannot make adjustmentsfor sudden, or gradual, changes insupply temperature. If hot water sup-ply line temperature unexpectedlyincreases to a dangerous level whileinlet water pressure remains constant,the pressure-balancing valve will con-tinue to pass water, but at a dramati-cally increased temperature.

Type P valves come with anadjustable limit stop that can beset to prevent handle rotation tothe maximum hot water posi-tion. The limit stop requires rou-tine seasonal adjustment toaccommodate for variations inseasonal temperature swings.This is especially important inregions where extreme weatherconditions dramatically affecttemperature from water sourcessuch as lakes and r ivers.

If the pressure-balancingvalve was installed during thewinter months, the limit stop isusually set to deliver higheroutlet temperature to compen-sate for colder conditions. Asthe weather gets warmer, tem-perature from water sourceswill rise, causing an increase inwater out let temperature. Sincetemperature variations areinevitable, periodic adjust-ments to the limit stop become

essential. How realistic is it toexpect that maintenance crews willadjust these seasonally — two, threeor four times a year?

Type T, or thermostatic mixingvalves, compensate for both fluctu-ations in temperature and pressure(though pressure to a lesser degreethan Type P valves, as required byASSE 1016). Type T valves aredesigned to mix hot and cold wateras well, delivering blended water ata constant, selected temperature.

Type T valves also feature an

adjustable limit stop to preventexcessive handle rotation .

The key advantage these deviceshave over Type P valves is that theyhave a temperature-sensing device.There’s no need to adjust the limitstop from season to season. The valvemakes the temperature correctionautomatically to maintain the highlimit setpoint.

Combination valves,or Type T/P, are

required to meet 1016’s most stringentperformance requirements for bothtemperature and pressure changes.Type T/P valves must respond not onlyto temperature fluctuations as definedfor a Type T valve, but must also meetthe pressure change criteria of a Type Pvalve, as set forth by the ASSE standard.Type T/P valves allow water to be gen-erated at higher temperatures, distrib-uted at higher temperatures,and deliv-ered at safe temperatures to the bather.

It’s important to point out that

Type T/P valves require no seasonal

adjustment of the limit stop, savingmaintenance personnel sometimeshundreds of hours of labor. It’s alsoimportant to note that Type T/Pvalves must compensate for the samepressure fluctuations as Type P valves,as set forth in ASSE 1016. While TypeP and Type T/P valves must compen-sate for 50 percent fluctuations, TypeT valves need only accommodate 20percent changes. Finally, Type T/P

valves provide redundant temper-

ature protection in the event of afailure upstream within the deliv-ery system.

A Catch 22? Not at all! Thepotential for scalding can be min-imized, while at the same timereducing the risk of bacteriagrowth. With a properly designeddelivery system and a tempera-ture/pressure-sensing showervalve (Type T/P) at the point of use, both risks are virtually elimi-nated. Water can be distributed at

higher temperatures, reducing theperil of Legionella, while protect-ing the bather with temperature/ pressure-sensing technology.

Remember, all shower valvesare not created equally. There arecritical distinctions in the per-formance requirement for thethree valve types set forth inASSE 1016. It’s important to look behind ASSE 1016 to understandthe fundamental differencesbetween Type P, Type T and Type

T/P valves and their implication tobather safety and facility liability.

About the author: Bruce Fathers ismarketing director for Powers ProcessControls, a Watts Water TechnologiesCo. He has spent 17 years in the water delivery and tempering industry. Hehas an MBA from DePaul University,Chicago, and a BS degree in market-ing from Northern Illinois University.

He can be reached by phone at:847.824.9723 ext. #6207 or by email

at: [email protected]

Reprinted with permission from PM Engineer , October 2003 ©2003, Business News Publishing Co.

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Water Safety for the Elderly