Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing - small sink in bathroom

by:KEDIBO     2019-08-20
Randomised controlled trial of thermostatic mixer valves in reducing bath hot tap water temperature in families with young children in social housing  -  small sink in bathroom
Objective to evaluate the effectiveness of the constant temperature mixing valve (TMVs)
In terms of reducing the temperature of Bath hot water, the acceptability of TMVs to the family and the impact on safe practice of bath time were evaluated.
Designed for Practical Parallel Arm randomized controlled trials.
A social housing organization was established in Glasgow, Scotland, England.
Participants were in 124 families with at least one child under the age of 5.
Intervene with the TMV installed by a qualified plumber and make educational flyers before and during installation of the TMV.
Main observation indicators hot faucet bath water temperature in the month-month and 12-month post-
Intervention or random, acceptability, problems with TMVs and bath time safety practices.
Results The intervention arm family was significantly lower than the Bath hot water temperature month-month and 12-month follow-
Than the family in the control arm (
3 months: median intervention arm 45.
0 ℃, the median value of the control arm is 56.
0 °C, difference between medians,-11. 0, 95% CI −14. 3 to −7. 7);
12 months: median intervention arm 46.
0 ℃, the median value of the control arm is 55.
Difference between 0 °C, medians-9. 0, 95% CI −11. 8 to −6. 2)
They are very satisfied with the temperature of the hot water in the bath or very satisfied with the possibility is very large (RR 1. 43, 95% CI 1. 05 to 1. 93)
The possibility of reporting too hot (RR 0. 33, 95% CI 0. 16 to 0. 68)
And report that the possibility of checking the temperature of each bath is greatly reduced (RR 0. 84, 95% CI 0. 73 to 0. 97). Seven (15%)
Families in the intervention group reported problems with the TMV.
Conclusion TMVs and the accompanying educational leaflet effectively reduce the hot water temperature in the bathtub in the short and long term, which is acceptable to the family.
Housing providers should consider installing TMVs in their properties, and lawmakers should consider authorizing them to use TMVs in renovations and new buildings.
Objective to evaluate the effectiveness of the constant temperature mixing valve (TMVs)
In terms of reducing the temperature of Bath hot water, the acceptability of TMVs to the family and the impact on safe practice of bath time were evaluated.
Designed for Practical Parallel Arm randomized controlled trials.
A social housing organization was established in Glasgow, Scotland, England.
Participants were in 124 families with at least one child under the age of 5.
Intervene with the TMV installed by a qualified plumber and make educational flyers before and during installation of the TMV.
Main observation indicators hot faucet bath water temperature in the month-month and 12-month post-
Intervention or random, acceptability, problems with TMVs and bath time safety practices.
Results The intervention arm family was significantly lower than the Bath hot water temperature month-month and 12-month follow-
Than the family in the control arm (
3 months: median intervention arm 45.
0 ℃, the median value of the control arm is 56.
0 °C, difference between medians,-11. 0, 95% CI −14. 3 to −7. 7);
12 months: median intervention arm 46.
0 ℃, the median value of the control arm is 55.
Difference between 0 °C, medians-9. 0, 95% CI −11. 8 to −6. 2)
They are very satisfied with the temperature of the hot water in the bath or very satisfied with the possibility is very large (RR 1. 43, 95% CI 1. 05 to 1. 93)
The possibility of reporting too hot (RR 0. 33, 95% CI 0. 16 to 0. 68)
And report that the possibility of checking the temperature of each bath is greatly reduced (RR 0. 84, 95% CI 0. 73 to 0. 97). Seven (15%)
Families in the intervention group reported problems with the TMV.
Conclusion TMVs and the accompanying educational leaflet effectively reduce the hot water temperature in the bathtub in the short and long term, which is acceptable to the family.
Housing providers should consider installing TMVs in their properties, and lawmakers should consider authorizing them to use TMVs in renovations and new buildings.
In the UK, about 2000 children are treated annually in emergency and 500 in hospital after scalding the bath water.
1 admission occurs primarily in children under 5 years of age, usually including long-term hospital stays, transfer to specialist hospitals or burn wards.
1 The cost of treating severe burns is estimated at £ 250, and there is very little space here. 1 Longer-
Long-term effects include disability, disfigurement, or psychological injury.
What has been known about this topic▶Hot water burns are an important public health problem.
Their incidence has not declined in recent years.
▶Constant temperature mixing valve (TMVs)
It is possible to reduce the risk of burns, but there is no randomized controlled trial to assess their efficacy and acceptability to the family.
What has been added to this study▶TMVs and education flyers effectively reduce the hot water temperature in the bathtub in the short and long term and are acceptable to the family.
▶Families with TMVs are unlikely to check the bath water temperature.
During the installation of the TMV, the importance of checking the temperature should be emphasized, and further research should explore ways to increase this safety measure.
Children and young children in disadvantaged areas have a greater risk of burns.
3 when a child falls or climbs into the water without supervision, there is usually a bath water burn;
The child turns on the tap or the parent puts the child in too hot water.
1 4 home water temperature thermostat is usually set at 60 °c or above.
5 Water at this temperature can cause full thickness burns in adults faster in 5 seconds, 1 second, in children.
6 It is recommended that the temperature of tap water for bathing hot water should not exceed 46 ℃.
7 Early studies that provide educational interventions to promote tap water temperature testing and/or thermostat reduction show at most minimal impact on tap water temperature, and often a reduction in them is not sufficient to reduce the risk of burns, A recent yuan-
Analysis of family safety interventions found a significant reduction in water temperature, most of which included education and the provision of equipment to prevent a range of child family injuries;
But in most studies, the temperature
The intervention is still higher than the current level of recommendation.
Legislation to reduce the setting of thermostats has been more successful, and uncontrolled studies have shown a reduction in hospital inpatient rates, total burn area, scars and skin grafting.
13 constant temperature mixing valve (TMVs)
Designed to reduce the risk of hot water burns.
They do not affect the temperature at which hot water is stored, nor do they interfere with the heating system, and allow the supply of hot water to different locations in the home.
They are installed on the hot and cold water supply pipes in the bathtub and set the hot water tap water at a fixed temperature regardless of the pressure or temperature change in the water supply system.
Since the bathtub water supply pipes are usually located behind the bathtub panel, it is difficult for families to reach them.
Although, in theory, families can adjust their TMV, its positioning makes it difficult.
The British government recently announced a revision to the building code, requiring TMVs to be installed in new buildings, expansions and converted into residential buildings.
14 however, TMVs did not test effectiveness and acceptability in the UK's domestic environment, and it is important that the effectiveness was not highPeople at risk.
So we did a randomized controlled trial in the poor community of Glasgow.
16 practical ways to design (
That is, to measure the benefits of intervention in normal practice)
A randomized controlled trial.
Extensive inclusion and minimum exclusion criteria are used to maximize the general competence of participants.
Families of children under 5 years of age living in Glasgow Housing Association (GHA)housing (
Largest provider of social housing in Europe)
Eligible for inclusion.
The exclusion criteria are from the property, pipe works that are not suitable for installation of the TMV, and participation in other water scalding prevention programs.
Recruitment is a written invitation from GHA to tenants of the East District children's safety program database, a family database participating in previous child safety programs, it is also the database of tenants aged 18-40 identified in the GHA tenant database; or by face-to-
Engage with local housing organizations.
Families were randomly assigned to either the intervention group or the control group.
Interventions include:▶A study-specific educational leaflet mailed before installation of the TMV, provides information about the way the bath water burns occur, the time when the burns occur at different temperatures, the usual bath temperature What is the TMV, the true story of 2-year-
The child was scalded with hot water.
▶TMV installed by qualified plumbers of urban buildings at a maximum temperature of 45 °c (Glasgow)
Limited liability partnership (LLP).
Accessories usually include removing the bathtub panel, connecting the TMV to the hot and cold water supply pipe, replacing the bathtub panel;
And▶The plumber hangs a waterproof guide on the faucet.
This provides information about the bathtub with the installation of the TMV, reiterates some information on the flyer, and recommends continuing to check the temperature of the bath water and not leaving the child alone in the bath.
Families randomly assigned to the control group received intervention after Collection follow-upup data.
Objective: to evaluate the effectiveness of TMVs in reducing the temperature of Bath hot water;
TMVs acceptability of the family and its impact on safety practices in bath time.
Definition of primary and secondary outcome measurement the primary outcome measurement is 3-month and 12-month post-TMV fitting (
Intervention Group)or post-randomisation (control arm)
It is considered to be the most interesting result for decision makers.
Secondary outcomes in the intervention group include TMV issues (
For example, failure, replacement)
, Adjustment of the TMV settings and satisfaction with the TMVs and installation process.
Secondary outcomes of both weapons include Bath hot water temperature ≤ 46 °c, satisfaction with Bath hot water and bath time safety practices selected to reflect family with housing providers, young children
They were measured 12-month post-
Accessories for TMV and 12-month post-
Straight line data from a random baseline database collected through a postal or telephone questionnaire includes socio-demographic and economic features, bath time safety practices, and satisfaction with hot water supply.
Reward the family (
Bath mat or first aid kit available free of charge)
Improve the response rate of baseline questionnaires.
GHA reports that it is difficult for them to enter the home of the tenants and often requires multiple attempts.
In view of this, after completing the water temperature measurement, the family received a £ 10 gift certificate for use by the local store, and we plan to require participants to measure the water temperature only once during the study, select the top 50% to recruit to each arm for baseline measurements.
Qualified plumbers from urban buildings (Glasgow)
LLP measures the temperature using a K-type thermocouple thermometer and a circular immersion probe.
The hot water temperature of the bathroom sink was also measured to detect other ways to reduce the water temperature
Reduce thermostat settings, for example. Follow-
Families who did not choose to perform baseline temperature measurements were randomly assigned to 3-according to the treatment group-month or 12-
Measure the monthly water temperature using a random number list.
Plumbers go home many times but can't find anyone at home (
Cannot access properties for short)
, Family with baseline measurements were randomly selected for follow-up
Up temperature measurement until measurement results are obtained on at least 15 families
There is a point in time on each arm.
After completing the water temperature measurement, families can get a £ 10 gift voucher for use by local shops.
Secondary outcome measurement data is collected via a postal or telephone questionnaire and a £ 5 gift voucher is provided to the family upon completion of the follow-up
Questionnaire to improve response rate.
Issues with TMVs can also be identified from maintenance requests or complaints to GHA.
The sample sizeTen family of each arm was asked to detect a reduction in the average bath hot water temperature from 60. 4°C (SD 9. 1°C)
19 the recommended temperature in the control arm to the intervention arm is 46 °c 20 (90% power, two-
Sided 5% meaning level).
However, baseline measurements indicate that SD in the control arm is larger than this (mean 60. 8°C, SD 10. 25°C)
The temperature after the valve fitting is not distributed normally with a very small SD (mean 45. 5°C, SD 0. 51°C).
Therefore, the sample size was recalculated based on reducing the average temperature from 60 °c. 8°C to 46°C (SD 10. 25°C), (90% power, two-
Sided 5% meaning level)
, Assuming the asymptotic relative efficiency of Mann-
The Whitney U test is never less than 0 relative to the t test. 864.
According to these assumptions, 14 families are required for each arm.
Random sampling continued until measurements were obtained from 15 households per arm at 3 and 12 months.
For the secondary outcome measure, at the significance level of 80%, 50 households per arm provided 5% of the electricity (two-sided)
The difference in the proportion of households satisfied with the water temperature was detected, from 90% of the control arm to 67% of the intervention arm.
50 households in the intervention group provided 80% of the electricity (one-
Meaning of edge 5%)
Test the assumption that the TMVs ratio removed, disabled, or adjusted does not exceed 6.
If the real percentage of deletion, disable, or adjustment is 5%, it is 1%.
Subsequent losses are allowed-
Recruitment for a total of 120 participants.
Random trial statisticians use Stata22 to generate a random schedule with a replacement block design and a random block size.
The same number of voluntary families were allocated to weapons.
No layering is used.
Assignments are placed in sequential numbered, opaque, sealed envelopes opened by independent researchers.
Blind people cannot blindly assign therapeutic arms to participants, plumbers or researchers.
The analysis was conducted blindly, but analysts correctly guessed the distribution of 100% and 84% of cases in 3 and 12 months, respectively.
At any stage, the test can be withdrawn freely.
The data is included in the analysis until it exits.
The statistical method doubles the data into the Access database and discovers and corrects the differences.
According to the pre-determined analysis plan, participants performed the analysis in the group in which they were randomly assigned, regardless of the intervention received.
Bath hot water temperature is described using medians and IQR.
The main analysis compares the use of Mann-
Whitney U tested and used Bonett-to estimate the difference between median and 95% CIPrice CI method.
These analyses are based on families with the following situations
Temperature measurement.
Two sensitivity analyses were conducted.
First of all, where the family is missing
Rising temperatures, we assume no changes from baseline and subsequent
The rising temperature is replaced by the baseline temperature of the family or, where the baseline temperature is not available, is replaced with the median baseline temperature of the treatment arm.
Second, since the possibility of temperature reduction depends on the baseline temperature, we adjusted the baseline temperature (
If baseline temperature is missing, the median temperature of the treatment arm)
Change scores by calculation.
By estimating relative risk and 95% CI, secondary outcomes were compared between treatment groups.
When the prevalence of baseline results varies by more than 10% between treatment groups, we estimate Mantel-
Hensel adjusted relative risks and 95% times.
The ethics and organizational recognition ethics committee review is conducted by the Nottingham National Health Insurance Research Ethics Committee.
NHS Nottingham county design pragmatic (
That is, to measure the benefits of intervention in normal practice)
A randomized controlled trial.
Extensive inclusion and minimum exclusion criteria are used to maximize the general competence of participants.
Families of children under 5 years of age living in Glasgow Housing Association (GHA)housing (
Largest provider of social housing in Europe)
Eligible for inclusion.
The exclusion criteria are from the property, pipe works that are not suitable for installation of the TMV, and participation in other water scalding prevention programs.
Recruitment is a written invitation from GHA to tenants of the East District children's safety program database, a family database participating in previous child safety programs, it is also the database of tenants aged 18-40 identified in the GHA tenant database; or by face-to-
Engage with local housing organizations.
Families were randomly assigned to either the intervention group or the control group.
Interventions include:▶A study-specific educational leaflet mailed before installation of the TMV, provides information about the way the bath water burns occur, the time when the burns occur at different temperatures, the usual bath temperature What is the TMV, the true story of 2-year-
The child was scalded with hot water.
▶TMV installed by qualified plumbers of urban buildings at a maximum temperature of 45 °c (Glasgow)
Limited liability partnership (LLP).
Accessories usually include removing the bathtub panel, connecting the TMV to the hot and cold water supply pipe, replacing the bathtub panel;
And▶The plumber hangs a waterproof guide on the faucet.
This provides information about the bathtub with the installation of the TMV, reiterates some information on the flyer, and recommends continuing to check the temperature of the bath water and not leaving the child alone in the bath.
Families randomly assigned to the control group received intervention after Collection follow-upup data.
Objective: to evaluate the effectiveness of TMVs in reducing the temperature of Bath hot water;
TMVs acceptability of the family and its impact on safety practices in bath time.
Definition of primary and secondary outcome measurement the primary outcome measurement is 3-month and 12-month post-TMV fitting (
Intervention Group)or post-randomisation (control arm)
It is considered to be the most interesting result for decision makers.
Secondary outcomes in the intervention group include TMV issues (
For example, failure, replacement)
, Adjustment of the TMV settings and satisfaction with the TMVs and installation process.
Secondary outcomes of both weapons include Bath hot water temperature ≤ 46 °c, satisfaction with Bath hot water and bath time safety practices selected to reflect family with housing providers, young children
They were measured 12-month post-
Accessories for TMV and 12-month post-
Straight line data from a random baseline database collected through a postal or telephone questionnaire includes socio-demographic and economic features, bath time safety practices, and satisfaction with hot water supply.
Reward the family (
Bath mat or first aid kit available free of charge)
Improve the response rate of baseline questionnaires.
GHA reports that it is difficult for them to enter the home of the tenants and often requires multiple attempts.
In view of this, after completing the water temperature measurement, the family received a £ 10 gift certificate for use by the local store, and we plan to require participants to measure the water temperature only once during the study, select the top 50% to recruit to each arm for baseline measurements.
Qualified plumbers from urban buildings (Glasgow)
LLP measures the temperature using a K-type thermocouple thermometer and a circular immersion probe.
The hot water temperature of the bathroom sink was also measured to detect other ways to reduce the water temperature
Reduce thermostat settings, for example. Follow-
Families who did not choose to perform baseline temperature measurements were randomly assigned to 3-according to the treatment group-month or 12-
Measure the monthly water temperature using a random number list.
Plumbers go home many times but can't find anyone at home (
Cannot access properties for short)
, Family with baseline measurements were randomly selected for follow-up
Up temperature measurement until measurement results are obtained on at least 15 families
There is a point in time on each arm.
After completing the water temperature measurement, families can get a £ 10 gift voucher for use by local shops.
Secondary outcome measurement data is collected via a postal or telephone questionnaire and a £ 5 gift voucher is provided to the family upon completion of the follow-up
Questionnaire to improve response rate.
Issues with TMVs can also be identified from maintenance requests or complaints to GHA.
The main results of baseline temperature measurements were not selected. The family was randomly assigned to 3-month or 12-
Measure the monthly water temperature using a random number list.
Plumbers go home many times but can't find anyone at home (
Cannot access properties for short)
, Family with baseline measurements were randomly selected for follow-up
Up temperature measurement until measurement results are obtained on at least 15 families
There is a point in time on each arm.
After completing the water temperature measurement, families can get a £ 10 gift voucher for use by local shops.
Secondary outcome measurement data is collected via a postal or telephone questionnaire and a £ 5 gift voucher is provided to the family upon completion of the follow-up
Questionnaire to improve response rate.
Issues with TMVs can also be identified from maintenance requests or complaints to GHA.
The sample sizeTen family of each arm was asked to detect a reduction in the average bath hot water temperature from 60. 4°C (SD 9. 1°C)
19 the recommended temperature in the control arm to the intervention arm is 46 °c 20 (90% power, two-
Sided 5% meaning level).
However, baseline measurements indicate that SD in the control arm is larger than this (mean 60. 8°C, SD 10. 25°C)
The temperature after the valve fitting is not distributed normally with a very small SD (mean 45. 5°C, SD 0. 51°C).
Therefore, the sample size was recalculated based on reducing the average temperature from 60 °c. 8°C to 46°C (SD 10. 25°C), (90% power, two-
Sided 5% meaning level)
, Assuming the asymptotic relative efficiency of Mann-
The Whitney U test is never less than 0 relative to the t test. 864.
According to these assumptions, 14 families are required for each arm.
Random sampling continued until measurements were obtained from 15 households per arm at 3 and 12 months.
For the secondary outcome measure, at the significance level of 80%, 50 households per arm provided 5% of the electricity (two-sided)
The difference in the proportion of households satisfied with the water temperature was detected, from 90% of the control arm to 67% of the intervention arm.
50 households in the intervention group provided 80% of the electricity (one-
Meaning of edge 5%)
Test the assumption that the TMVs ratio removed, disabled, or adjusted does not exceed 6.
If the real percentage of deletion, disable, or adjustment is 5%, it is 1%.
Subsequent losses are allowed-
Recruitment for a total of 120 participants.
Random trial statisticians use Stata22 to generate a random schedule with a replacement block design and a random block size.
The same number of voluntary families were allocated to weapons.
No layering is used.
Assignments are placed in sequential numbered, opaque, sealed envelopes opened by independent researchers.
Blind people cannot blindly assign therapeutic arms to participants, plumbers or researchers.
The analysis was conducted blindly, but analysts correctly guessed the distribution of 100% and 84% of cases in 3 and 12 months, respectively.
At any stage, the test can be withdrawn freely.
The data is included in the analysis until it exits.
The statistical method doubles the data into the Access database and discovers and corrects the differences.
According to the pre-determined analysis plan, participants performed the analysis in the group in which they were randomly assigned, regardless of the intervention received.
Bath hot water temperature is described using medians and IQR.
The main analysis compares the use of Mann-
Whitney U tested and used Bonett-to estimate the difference between median and 95% CIPrice CI method.
These analyses are based on families with the following situations
Temperature measurement.
Two sensitivity analyses were conducted.
First of all, where the family is missing
Rising temperatures, we assume no changes from baseline and subsequent
The rising temperature is replaced by the baseline temperature of the family or, where the baseline temperature is not available, is replaced with the median baseline temperature of the treatment arm.
Second, since the possibility of temperature reduction depends on the baseline temperature, we adjusted the baseline temperature (
If baseline temperature is missing, the median temperature of the treatment arm)
Change scores by calculation.
By estimating relative risk and 95% CI, secondary outcomes were compared between treatment groups.
When the prevalence of baseline results varies by more than 10% between treatment groups, we estimate Mantel-
Hensel adjusted relative risks and 95% times.
The ethics and organizational recognition ethics committee review is conducted by the Nottingham National Health Insurance Research Ethics Committee.
The NHS Nottingham county organization approved the organization process and follow-up process
The process of the participant is shown in Figure 1.
A total of 124 participants were randomly assigned.
Data for participants excluded after randomization and collection of baseline data are included in the baseline data analysis.
Subsequent losses 23-
And the reasons for subsequent losses-
Figure 1 gives up.
Download figure 1 participants in the new tabDownload powerpoint through the trial process.
GHA, Glasgow Housing Association.
Baseline questionnaire data were collected from June 2006 to January 2007, and TMV fitting and temperature measurement were conducted from July 2006 to February 2007.
The intermediate time from recruitment to baseline temperature measurement was 59.
The intervention group was 5 days and the control group was 48 days. Three-
Month temperatures were collected from February to April 2007, as follows
Questionnaire data for the period August 2007 to April 2008
Monthly temperatures between November 2007 and April 2008.
Median time between TMV fit and 12-
The monthly temperature measurement in the intervention group was 467 days at random and 12-
The monthly temperature measurement in the control arm is 449 days.
The baseline description of hot water temperature, satisfaction and bath time safety practices in Tables 1 and 2 shows the features of the analyst.
Control arm participants are more likely to live in single adult families, using cold water to take a shower first, and they are also less likely to leave the child alone in the bathtub or bathroom when taking a shower.
The median Bath hot water temperature in the intervention arm at baseline was 55 °c (IQR 54–58°C)and 58°C (IQR 55–62°C)
In the control arm.
Most families are happy with their hot tub temperature and describe it as hot.
All people who are not satisfied with the temperature say the temperature is very hot.
The water temperature, the lack of frequent use of cold water in the shower, and the number of households leaving children alone in the bathtub or bathroom indicate that a considerable number of households are at risk of burns.
View this table: view the features of participants at baseline by treatment arm (%)
Look here: check the water temperature of the inlineView popupTable monthly hot faucet, and satisfy the benchmark of the safe practice of water temperature bathing time to handle the arm (
Unless specified)
Figure 2 shows the distribution of Bath hot water temperature at baseline and at 3 and 12 months.
Table 3 shows that in two subsequent
Follow-up time-
During the intervention, the hot water temperature in the bathtub was significantly lower than that of the control arm.
The results were robust for adjusting the baseline tap water temperature and replacing the missing temperature with baseline values.
At any point in time, there was no significant difference in the hot water temperature in the bathroom sink between the two arms.
Table 4 shows that in 12-month follow-
Families in the Up intervention group were more likely to have a hot tub temperature of 46 °c or less than those in the control group and were satisfied with the temperature.
They are unlikely to report that their tub hot water is too hot, or they are unlikely to check the tub water temperature for each tub.
Download figureOpen in the new tabDownload powerpoint figure 2 box, showing the distribution of hot water temperature in the bathtub of the treatment group at baseline, 3-month and 12-month follow-up.
The bottom and top of the box represent 25 and 75 percentile, and the line in the box is the median.
The line drawn from the box represents the range, and the peripheral value is indicated separately.
View this table: In 3-month and 12-month follow-
This table: view the inlineView pop-up table 4 times result measurement at 12-12 pointsmonth follow-
Upward arm of treatment (percentage)
Few families are not satisfied with the hot water temperature at the age of 12month follow-up (nine (23%)
In the control arm and five (13%)
Intervention arm).
Most unhappy people (n=10)
It is reported that the temperature is very hot or hot, only two people reported that the temperature is not hot enough.
However, secondary results measured only in the intervention group (table 5)
Display 12 (36%)
The family agrees or strongly agrees that their bath water is not hot enough, 9 (27%)
They can't fill the tub with hot water while taking a shower.
Most families in the intervention group with TMV are satisfied with the valve and installation process and will recommend TMVs to friends.
7 out of 46 families (15%)
Who installed TMVs, there is a problem with their TMV;
4 families reported lower water pressure
In these three cases, no issues were found to be related to the TMV.
A tmv was replaced due to a fault, a home reported a leak after installation, a home reported that their hot water faucet had no hot water and the valve was cleaned.
View this table: View the inline View pop-up table 5 at 12-month follow-
Upfamily without any follow-up-
Up water measurements are either because their attributes are inaccessible or because they are excluded, and there is no significant difference on any baseline feature with those who do have the following
Hot water measurement.
Compared to those lost
Families completing follow-up work
The Up questionnaire was significantly more satisfied with their hot tub temperature (
70% to 45%, the difference between the percentages (
25%, 95% CI 7% to 42%)
And their current at baseline (
50% to 30%, 20% difference between percentages, 95% CI 3% to 38%)
The possibility of receiving state benefits is greatly reduced (
81% to 95%, 14% difference between percentages, 95% CI 25% to 4%)
Participate in the process and follow-up-
The process of the participant is shown in Figure 1.
A total of 124 participants were randomly assigned.
Data for participants excluded after randomization and collection of baseline data are included in the baseline data analysis.
Subsequent losses 23-
And the reasons for subsequent losses-
Figure 1 gives up.
Download figure 1 participants in the new tabDownload powerpoint through the trial process.
GHA, Glasgow Housing Association.
Baseline questionnaire data were collected from June 2006 to January 2007, and TMV fitting and temperature measurement were conducted from July 2006 to February 2007.
The intermediate time from recruitment to baseline temperature measurement was 59.
The intervention group was 5 days and the control group was 48 days. Three-
Month temperatures were collected from February to April 2007, as follows
Questionnaire data for the period August 2007 to April 2008
Monthly temperatures between November 2007 and April 2008.
Median time between TMV fit and 12-
The monthly temperature measurement in the intervention group was 467 days at random and 12-
The monthly temperature measurement in the control arm is 449 days.
The baseline description of hot water temperature, satisfaction and bath time safety practices in Tables 1 and 2 shows the features of the analyst.
Control arm participants are more likely to live in single adult families, using cold water to take a shower first, and they are also less likely to leave the child alone in the bathtub or bathroom when taking a shower.
The median Bath hot water temperature in the intervention arm at baseline was 55 °c (IQR 54–58°C)and 58°C (IQR 55–62°C)
In the control arm.
Most families are happy with their hot tub temperature and describe it as hot.
All people who are not satisfied with the temperature say the temperature is very hot.
The water temperature, the lack of frequent use of cold water in the shower, and the number of households leaving children alone in the bathtub or bathroom indicate that a considerable number of households are at risk of burns.
View this table: view the features of participants at baseline by treatment arm (%)
Look here: check the water temperature of the inlineView popupTable monthly hot faucet, and satisfy the benchmark of the safe practice of water temperature bathing time to handle the arm (
Unless specified)
Figure 2 shows the distribution of Bath hot water temperature at baseline and at 3 and 12 months.
Table 3 shows that in two subsequent
Follow-up time-
During the intervention, the hot water temperature in the bathtub was significantly lower than that of the control arm.
The results were robust for adjusting the baseline tap water temperature and replacing the missing temperature with baseline values.
At any point in time, there was no significant difference in the hot water temperature in the bathroom sink between the two arms.
Table 4 shows that in 12-month follow-
Families in the Up intervention group were more likely to have a hot tub temperature of 46 °c or less than those in the control group and were satisfied with the temperature.
They are unlikely to report that their tub hot water is too hot, or they are unlikely to check the tub water temperature for each tub.
Download figureOpen in the new tabDownload powerpoint figure 2 box, showing the distribution of hot water temperature in the bathtub of the treatment group at baseline, 3-month and 12-month follow-up.
The bottom and top of the box represent 25 and 75 percentile, and the line in the box is the median.
The line drawn from the box represents the range, and the peripheral value is indicated separately.
View this table: In 3-month and 12-month follow-
This table: view the inlineView pop-up table 4 times result measurement at 12-12 pointsmonth follow-
Upward arm of treatment (percentage)
Few families are not satisfied with the hot water temperature at the age of 12month follow-up (nine (23%)
In the control arm and five (13%)
Intervention arm).
Most unhappy people (n=10)
It is reported that the temperature is very hot or hot, only two people reported that the temperature is not hot enough.
However, secondary results measured only in the intervention group (table 5)
Display 12 (36%)
The family agrees or strongly agrees that their bath water is not hot enough, 9 (27%)
They can't fill the tub with hot water while taking a shower.
Most families in the intervention group with TMV are satisfied with the valve and installation process and will recommend TMVs to friends.
7 out of 46 families (15%)
Who installed TMVs, there is a problem with their TMV;
4 families reported lower water pressure
In these three cases, no issues were found to be related to the TMV.
A tmv was replaced due to a fault, a home reported a leak after installation, a home reported that their hot water faucet had no hot water and the valve was cleaned.
View this table: View the inline View pop-up table 5 at 12-month follow-
Upfamily without any follow-up-
Up water measurements are either because their attributes are inaccessible or because they are excluded, and there is no significant difference on any baseline feature with those who do have the following
Hot water measurement.
Compared to those lost
Families completing follow-up work
The Up questionnaire was significantly more satisfied with their hot tub temperature (
70% to 45%, the difference between the percentages (
25%, 95% CI 7% to 42%)
And their current at baseline (
50% to 30%, 20% difference between percentages, 95% CI 3% to 38%)
The possibility of receiving state benefits is greatly reduced (
81% to 95%, 14% difference between percentages, 95% CI 25% to 4%)
Discussion of the installation of the main equipment and accompanying educational leaflets in the homes of families in vulnerable communities can effectively reduce the hot water temperature of the bathtub to the currently recommended "safe" level, at least after 12 monthsinstallation.
Most families are satisfied with the temperature and flow rate of hot water after installation and the installation process.
People with TMV are unlikely to check the tub temperature for each bath, but we did not find a negative impact on other safety measures.
Advantages and disadvantages of TrialAs this is the first randomized controlled trial to assess the effectiveness of TMVs and accompanying educational leaflets in severely disadvantaged groups, due to the small proportion of minority families, our findings should apply to similar communities in the UK.
Our findings should be carefully extended to all families with young children, as we cannot estimate due to the lack of information about families with children included in the GHA record.
In addition, our findings may not apply to families who need to pay for the installation of the TMV.
Nor can we assume that the absorption levels, satisfaction and TMVs problems found in our trials must be replicated in a wider population.
In addition, our trial was conducted at a large social housing provider with the potential to gain more resources, skills and economies of scale.
Smaller housing providers may find it more difficult to implement TMVs.
More than 25% of participants were tracked
Mainly due to family migration.
However, high Follow
Response Rate of questionnaire and number of follow-up required
Temperature measurement is realized, and sensitivity analysis shows that the discovery of the main results is unlikely to be biased due to subsequent lossesup.
Those who lost
For measurements of secondary results, the bath water temperature and water flow at baseline were significantly unsatisfactory compared to the measurements that continued in the trial, so satisfied with the subsequent hot water temperature and water flow
In both treatment groups, the up may be lower than we reported.
As with many public health interventions, it is impossible for participants and plumbers to blindly allocate treatment equipment.
In addition, the analyst was able to correctly guess the distribution of the treatment arm for the main outcome of most participants, effectively unblocking the analysis.
Our trial did not have enough power to detect a decrease in the incidence of scalding in tap water in the bathtub, and a very large trial was required for this.
However, we have shown that TMVs are effective in keeping the hot water temperature of the bath at 46 °c or below, where it takes more than 9 minutes for the water to cause local thickness burns, therefore, temperature may be a good alternative to scalding tap water in the bathtub.
Compared to previous studies, we found that TMVs had higher satisfaction than previous studies, probably because 95% of valves in earlier studies failed.
24 We are not aware of any public research that reports the impact of TMV accessories on bath time safety practices.
Impact on injury prevention practices and further studies our trial shows that TMVs and the accompanying educational flyers are effective in reducing the temperature of hot tub water and are acceptable to families.
TMVs may benefit from a wider range of people than those used in our trial, especially the elderly and the disabled.
The current revision of the UK building code involves new homes or major renovations, such as the addition of bathrooms as part of the expansion, which may protect a small percentage of the population, not protecting the richer members of the community in proportion may expand inequality in heat damage.
Housing providers should consider installing TMVs in their properties, and lawmakers should consider asking for TMVs as part of a bathroom renovation, such as a bathroom with a new bathtub, these may not be included in the current amendments to the building regulations.
We did not find that educational leaflets used as part of the intervention improved safety practices for bath time, and it was unlikely that the intervention group would test bath water temperatures in follow-up
More important than family control.
Further research is needed to explore ways to improve safety measures for bath time.
There's one TMVs
A safety mechanism has been established to cut off the flow of hot water to prevent burns when cold water supply is interrupted.
Therefore, even if the family is unlikely to test the bath water temperature, TMV failure if the cold water supply is interrupted at the same time, this will only increase the risk of burns.
As always, in considering the wider implementation of its findings, the limitations of a single trial must be kept in mind.
While expanding implementation, supervision and monitoring, including programme components, should also be carried out; TMV uptake;
Tap water temperature for a long time;
Satisfaction, acceptability and TMV issues;
Maintenance requirements and impact on safety practices for other bath times.
Experience with other injury prevention initiatives suggests that a range of promotional activities such as media advocacy, incentives and education may be beneficial before legislation is implemented.
25 A similar approach may be required for successful large-scale implementation of TMVs.
Finally, the cost is a frequently cited argument against the installation of the 26-year-old TMVs, which we are conducting an economic assessment of and the findings will be presented elsewhere.
The main findingvs vs installed in homes in vulnerable communities and the accompanying educational flyers effectively reduce the temperature of Bath hot water to the currently recommended "safe" level, at least after 12 monthsinstallation.
Most families are satisfied with the temperature and flow rate of hot water after installation and the installation process.
People with TMV are unlikely to check the tub temperature for each bath, but we did not find a negative impact on other safety measures.
Advantages and disadvantages of TrialAs this is the first randomized controlled trial to assess the effectiveness of TMVs and accompanying educational leaflets in severely disadvantaged groups, due to the small proportion of minority families, our findings should apply to similar communities in the UK.
Our findings should be carefully extended to all families with young children, as we cannot estimate due to the lack of information about families with children included in the GHA record.
In addition, our findings may not apply to families who need to pay for the installation of the TMV.
Nor can we assume that the absorption levels, satisfaction and TMVs problems found in our trials must be replicated in a wider population.
In addition, our trial was conducted at a large social housing provider with the potential to gain more resources, skills and economies of scale.
Smaller housing providers may find it more difficult to implement TMVs.
More than 25% of participants were tracked
Mainly due to family migration.
However, high Follow
Response Rate of questionnaire and number of follow-up required
Temperature measurement is realized, and sensitivity analysis shows that the discovery of the main results is unlikely to be biased due to subsequent lossesup.
Those who lost
For measurements of secondary results, the bath water temperature and water flow at baseline were significantly unsatisfactory compared to the measurements that continued in the trial, so satisfied with the subsequent hot water temperature and water flow
In both treatment groups, the up may be lower than we reported.
As with many public health interventions, it is impossible for participants and plumbers to blindly allocate treatment equipment.
In addition, the analyst was able to correctly guess the distribution of the treatment arm for the main outcome of most participants, effectively unblocking the analysis.
Our trial did not have enough power to detect a decrease in the incidence of scalding in tap water in the bathtub, and a very large trial was required for this.
However, we have shown that TMVs are effective in keeping the hot water temperature of the bath at 46 °c or below, where it takes more than 9 minutes for the water to cause local thickness burns, therefore, temperature may be a good alternative to scalding tap water in the bathtub.
Compared to previous studies, we found that TMVs had higher satisfaction than previous studies, probably because 95% of valves in earlier studies failed.
24 We are not aware of any public research that reports the impact of TMV accessories on bath time safety practices.
Impact on injury prevention practices and further studies our trial shows that TMVs and the accompanying educational flyers are effective in reducing the temperature of hot tub water and are acceptable to families.
TMVs may benefit from a wider range of people than those used in our trial, especially the elderly and the disabled.
The current revision of the UK building code involves new homes or major renovations, such as the addition of bathrooms as part of the expansion, which may protect a small percentage of the population, not protecting the richer members of the community in proportion may expand inequality in heat damage.
Housing providers should consider installing TMVs in their properties, and lawmakers should consider asking for TMVs as part of a bathroom renovation, such as a bathroom with a new bathtub, these may not be included in the current amendments to the building regulations.
We did not find that educational leaflets used as part of the intervention improved safety practices for bath time, and it was unlikely that the intervention group would test bath water temperatures in follow-up
More important than family control.
Further research is needed to explore ways to improve safety measures for bath time.
There's one TMVs
A safety mechanism has been established to cut off the flow of hot water to prevent burns when cold water supply is interrupted.
Therefore, even if the family is unlikely to test the bath water temperature, TMV failure if the cold water supply is interrupted at the same time, this will only increase the risk of burns.
As always, in considering the wider implementation of its findings, the limitations of a single trial must be kept in mind.
While expanding implementation, supervision and monitoring, including programme components, should also be carried out; TMV uptake;
Tap water temperature for a long time;
Satisfaction, acceptability and TMV issues;
Maintenance requirements and impact on safety practices for other bath times.
Experience with other injury prevention initiatives suggests that a range of promotional activities such as media advocacy, incentives and education may be beneficial before legislation is implemented.
25 A similar approach may be required for successful large-scale implementation of TMVs.
Finally, the cost is a frequently cited argument against the installation of the 26-year-old TMVs, which we are conducting an economic assessment of and the findings will be presented elsewhere.
The author thanked the participants in the study and the staff of the East End Child Safety Project for their suggestions on the design of the questionnaire and for their help in recruiting participants;
Professor David Stone of the University of Glasgow gave support throughout the project and commented on the papers submitted; PACT team (
Parents and children together)
Help recruit participants;
Jim Sorden of GHA, facilitating research within GHA;
Angela mcmuran, Bob McGuire, Charlie Thomas, Janet McDonald, Jenny rolls, Linda Neil of the local housing organization facilitate local research;
Plumber at Alan Skimins and the city construction law firm (Glasgow)
Coordinate and install TMVs, tap water measurements and contacts with the central maintenance team of the Glasgow Housing Association;
Michelle Hubbard and Ross krasey are members of the consumer research advisory group in Nottingham county who teach PCT to develop research invitations and information leaflets;
Angus horn of Horne engineering, to advise and demonstrate the work of TMVs;
Brian Hancock and John Slater of the Nottingham county Professor PCT designed bath faucet hangers and learning information leaflets;
Mark Stevenson of the Scottish burn children's club facilitates access to parents of children with bath water burns and provides a true life story for research information leaflets.
Ministry of Trade and Industry.
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Final research design, data collection and analysis, interpretation of results and writing of papers are the sole responsibility of the author.
The views and opinions expressed in this paper do not necessarily reflect the views and opinions of the funding agencies.
MH is an employee of the Child Accident Prevention Trust Fund (CAPT)
Registered charity.
A tmv manufacturer has previously sponsored a CAPT publication.
CAPT has the potential to benefit in the future by obtaining sponsorship from TMV manufacturers for other publications.
National Council on Ethics for medical services
Reference number 05/Q2403/37)
Uncommissioned source and peer review;
External peer review. wed.
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