Burns Sustained From Body Heating Devices

An Integrative Review

Rachel Kornhaber, PhD, RN; Denis Visentin, PhD; Sancia West, PhD, RN; Josef Haik, MD, MPH; Michelle Cleary, PhD, RN


Wounds. 2020;32(5):123-133. 

In This Article

Abstract and Introduction


Background: Heating devices can provide relief from muscular pain and the cold, however they may result in burn injuries when used inappropriately.

Objective: This review article synthesizes the incidence, risk factors, outcomes, treatment, and prevention of burns sustained from body heating devices in order to better understand how these burns are sustained.

Methods: PubMed, CINHAL, EMBASE, and Scopus databases were systematically searched from inception up until January 13, 2020, for studies/case reports on burns sustained from body heating devices that were published in the English language.

Results: Medical records from 10 retrospective studies yielded 1343 patients with burns, of whom the majority were women (63.4%) with a mean age of 27.7 years (range, 0–92 years). Devices included hot water bottles, hot wheat bags, and heating pads. Sites of injury were predominantly in the lower limbs and feet, with other sites reported (ie, abdomen, pelvis, buttocks, perineum, and upper limbs). Burns sustained typically had low total burn surface area (TBSA) but often involved partial-thickness to full-thickness burn injury. The proportion of patients requiring surgery ranged from 15% to 87.4% for hot water bottle injuries and 91% for wheat bag injuries. Women were predominately represented in the case series/reports. Burns had low TBSA with hot water bottles, and heating pads were the most common mechanism of injury, predominately women following breast reconstructive surgeries.

Conclusions: Burns from body heating devices are often preventable. Community education and improved manufacture labelling on the appropriate use and potential risks should be required. The patient's cognitive ability and physiology must be considered to minimize incidence and severity of injury.


Heating devices used to provide warmth or relieve discomfort caused by muscle and joint pain are often utilized during colder periods, such as the winter months.[1] Across Australia and New Zealand for the period of July 2016 to June 30, 2017, adult cases accounted for approximately half of the burns (47%) caused by hot water bottles during the winter months.[2] This reflects the higher levels of exposure to these items in the cooler months that can result in scalds and contact burns.[2] Specific subpopulations are at greater risk of sustaining burns from body heating devices, including the elderly and those with comorbidities that reduce sensation, such as diabetes mellitus and peripheral vascular disease.[3] Burns sustained by those with diabetes may have different characteristics from those without diabetes, and the frequency of burns sustained from hot water bottles is higher in the population with diabetes.[3] For these at-risk groups, heating devices present a clear danger, including electrocution, fire, and cutaneous burns. However, these injuries remain largely preventable when appropriate measures are in place.

Burns from devices (eg, electric heating pads) are often sustained due to improper utilization. Correct usage of heating pads can be compromised by placing a cover over the pad, covering the pad with another surface (eg, pillow), or placing the pad under the body against a seat or mattress.[4] The improper use confines the heat generated to the area of application on the skin that increases the quality and rate of heat transfer.[4] Correct use of such a device requires the consumer to place only 1 surface against the skin, therefore allowing the opposing surface to be exposed to the outer atmosphere. This permits the total rate of energy transfer out of the heating pad to be divided so only about half of the energy will be transferred into the body and the rest of the heat is converted or convected away from the exposed side.[4] Incidence of burns from body heating devices are on the rise, with the US Consumer Product Safety Commission estimating the annual number of burns due to electric heating pads has increased by 33.9%, from 1600 in 1995 to 2142 in 2008.[4] Similarly, the use of hot water bottles also has attracted attention due to the risk burns pose to consumers. Hot water bottles are primarily made from either rubber or polyvinyl chloride and may be imprinted with a manufactured date.[5] The bottle has a ferrule, which provides a watertight seal.[6]

Some modern hot water bottles are manufactured using silicone-based materials instead of natural rubber. Materials such as silicone rubber can withstand high temperatures better than organic rubbers with less deterioration.[7] Burns due to hot water bottles can be caused by spillage, rupture of the hot water bottle itself, and misuse by leaning, rolling, lying, or pressing the surface of the hot water bottle. Importantly, the hot water bottle may appear intact, but the rubber can breakdown from the inside, making it vulnerable to cracking or bursting.

Wheat or grain-filled heat packs are another device that have been reported to cause significant burns to individuals.[8,9] These bags are traditionally made of fabric and filled with wheat or some other grain, which are heated in a microwave. Burn injuries from heated wheat or grained-filled heat packs may result from placing the heat pack on or in bedding, being heated in a microwave for longer than the time specified by the manufacturer, being reheated before it is allowed to cool sufficiently, and deteriorating of the bag itself, causing the heated beads to dry out and become combustible.[8,9]

Manufacturers have attempted to minimize the danger of burns related to heating devices with printing the manufacturer's instructions-for-use and warnings on the product labels that have been publicized by various government bodies. The Australian Competition and Consumer Commission and institutions such as Fair Trading have compiled a hot water bottle safety checklist/tips and alerts in an attempt to reduce the incidence of burns that provides consumers with information on the correct use and storage.[10,11]

Even with such preventative measures in place, the incidence of burns from various heating devices continues to rise. Therefore, the aim of this integrative review is to synthesize the incidence, risk factors, outcomes, treatment, and prevention of burns sustained from body heating devices in order to better understand how these burns are sustained.