The NHS Estates Health Guidance Notes, "Safe hot water and surface temperatures” - ISBN 0113221584 (formally known as DN4) was issued following a number of serious accidents, some of which proved fatal, arising from the high surface temperatures of radiators.
The publication shows that with a water temperature of 70°C, people will receive partial thickness skin burns in approximately 7/10ths of a second and full thickness burns in 10 seconds. The issue is therefore a serious one and cannot be ignored.
Many hot water radiators in use today have been sized to operate with a flow water temperature of 80°C to the radiator and a 70°C return, providing indoor air temperatures ranging from 19°C to 28°C. The higher the indoor temperature requirement the larger the radiator needs to be. Even with thermostatic radiator valves fitted, dangerously high surface temperatures are still possible.
The maximum surface temperature recommended in the Guidance Notes should not exceed 43°C.
With the introduction of condensing boiler systems in recent years, radiators can be sized to operate at less than 50°C. However, unless additional controls are employed to limit the flow water temperature coming from the boiler and radiators are selected with much larger heat transfer surfaces, standard control systems for this type of boiler will allow the flow water to rise well above 50°C when for example, the outside temperature is plus 5°C – see graph below.
The principle of condensing boilers should not be misunderstood. They have the capability to produce high flow water temperatures but depend upon low water temperatures to achieve fuel savings. Typical temperature control for a condensing boiler operating with large radiators sized for 50°C flow, 30°C return and an indoor temperature of 20°C :
What types of establishment should consider the Health Guidance Notes?
All health care and personal social services premises and those buildings registered under the Registered Homes Act 1984. It may also be appropriate in non-registered premises, for example sheltered accommodation, where the occupants are equally at risk.
Some patients, residents and visitors are more vulnerable to scalding and skin burns than others; for example the elderly, mentally impaired and the young. However, all staff, patients, residents and visitors must be presumed to be potentially at risk. The recommendations regarding water and surface temperatures apply to all ward accommodation, residents’ rooms and those areas to which patients, residents and visitors have free access (including public areas). Where the patient or resident is under adequate continuous supervision, compliance may not be warranted.
The risk must be evaluated and the majority decision found to be that the savings do not justify exclusion. Until the recommended precautions are put into effect, staff should be made aware of the potential danger and take the necessary steps to protect themselves, patients, residents and visitors. Areas which do not meet these recommendations should be identified and plans to comply as soon as reasonably practicable should be devised and be available for the Healthy & Safety Executive to examine.
Where does the responsibility lie for ensuring that staff, patients, residents and visitors are not at risk?
Chief executives, general managers and managers, under the Health and Safety at Work Act 1974, have a "duty of care" and should be able to demonstrate that they are providing care in a safe environment. Thus, this guidance is equally applicable to new and existing premises.
Correspondence received from the Department of Health states that whilst the NHS Estates Health Guidance Notes are not law, it is reasonable to suppose that should litigation arise from the injury or death due to scalding or burns from radiators, a plaintiff would cite the "Safe hot water and surface temperatures” publication.
To which appliances do the recommendations apply?
The maximum surface temperature of space heating devices must not exceed 43°C when the system is running at maximum output. Space heating devices include thermal storage heaters, oil-filled radiators, as well as conventional radiators, towel rails and other heating devices.
Surface mounted pipe work, whether horizontal or vertical, which is exposed at low level, within 2m (approx. 6 feet) of the floor, should be securely insulated or boxed in.
Where Low Surface Temperature covers are selected as the best and cheapest method of conforming to the NHS Estates Health Guidance Notes then it is stressed…
The size of the mesh, inlet/outlet vents should be carefully selected. Small hands can penetrate many of the mesh guards currently in use so they offer little protection to some of those most at risk. Guards should be cleaned regularly to prevent the build up of debris. Thus if the external or internal surfaces are rough or a course wood construction debris can accumulate and thereby cause a build up of bacteria.
Registration Officers will be looking much more carefully than they have done hitherto at the precautions being taken by owners and managers to ensure that the recommendations are being complied with. The NHS Estates Health Guidance Notes number ISBN 0113221584 can be ordered via www.tso.co.uk/bookshop/bookstore.asp The following documents are also relevant and are obtainable from the Office of Public Sector Information via www.opsi.gov.uk.
The Disability Discrimination Act 1995
The Building Regulations Part M
The Health and Safety at Work Act
A copy of British Standard 8399:2001 may be purchased from…
The British Standards Institution via www.bsi.org.uk
