Introduction

The home is a common place for many unintentional injuries. Unintentional injuries are injuries that happen accidentally and are not on purpose. Over 11,000 people die each year in the United States from unintentional injuries. The most common household injuries include: falls, burns, cuts, poisoning, and choking. We will discuss each of these common injuries and focus on how to prevent them.

Falls

A fall is a situation in which a person accidentally moves from a higher to a lower position. Worldwide, falls are the second leading cause of accidental injury. Falls can be caused by many different things. Poor mobility, cognitive impairment, the ingestion of alcohol or drugs, poor balance and coordination, vision loss, and unsafe environments are some of the many possible causes of falls. Side effects from medications, neurological and cardiovascular diseases, and physical disabilities are other reasons why people may fall in the home. Confusion and improperly using assistive devices, such as walkers and canes, also put people at risk for an unintentional injury from a fall. Developmental changes that occur as children grow and as adults age are also important contributing factors for unintentional injuries from falls. Injuries from falls can range from relatively mild (such as a bruise) to life-threatening (such as suffering from a hip fracture or brain injury). Fall prevention strategies are the best way to prevent accidental injury from falls. Home Health Aides/Personal Care Aides play a crucial role in preventing falls in the home.

Guidelines for Fall Prevention:

• Keep walkways free of clutter, throw rugs, and loose cords.
• Wipe or mop up spills immediately. Close off areas with wet floors until dry to prevent people from walking on wet areas.
• Do not use wax or use other floor cleaners that will leave the floor slippery.
• Ensure all carpeting is tacked down securely and all rugs have non-skid backing.
• Use non-skid mats in the tub.
• Ensure handrails and grab bars are installed in the shower. Home Health Aides/Personal Care Aides should teach patients how to use them.
• Use good lighting in all rooms of the home. Replace light bulbs that have dimmed or are no longer working.
• Ensure stairwells are properly lit and stairs are sturdy.
• Have patients wear non-skid shoes with tied laces.
• Ensure clothing fits and that pant or dress hems are not so long as to possibly trip the patient.
• Teach patients how to properly use ambulatory devices, such as walkers and canes.
• Have patients use glasses and hearing aids in order to better see and hear what is going on in their surroundings.
• Check for disorientation frequently and report any concerns to a supervisor immediately.
• Allow the patient to slowly rise to a standing position by first sitting at the edge of the bed to prevent falls that result from dizziness due to rapid changes in position.
• Always lock wheelchair, chair, and bed brakes before completing transfers.
• Keep beds in their lowest position and ensure side rails are up in proper position.
• Frequently ask the patient if they need to use the bathroom and stay close while they are in the restroom to quickly respond to requests for help.
• Assist the patient with muscle strengthening exercises and walking as prescribed by the Care Plan to improve balance, coordination, and strength.
• Keep the home picked up and do not allow shoes, toys, or other items to be left on the floor.
• Keep items such as tissues, the phone, remote controls, and drinks within close reach of the patient so they do not have to reach far to retrieve them.

If a fall does happen, Home Health Aides/Personal Care Aides must report it immediately to their supervisor. The patient needs to be checked for medical issues prior to helping them up from the floor. Home Health Aides/Personal Care Aides should NOT move their patient until they have been thoroughly checked for injury and their supervisor has given them permission to move them.

Home Health Aides/Personal Care Aides may be asked to complete an incident report if their patient falls. If this occurs, remember to only report the facts. Report the situation in a matter of fact manner, without being judgmental or emotional. The agency will provide with specific training as to their requirements in the event of a patient fall.

Burns

Burns are another common unintentional household injury. Burns can be caused by dry or wet heat, chemicals, or electricity. Burns from dry heat can occur from irons, hair dryers, curling irons, and stoves. Burns from wet or moist heat occur from hot liquids, such as hot water or steam. These types of burns are called scalds. Scalds can occur within seconds and cause serious injury. Chemicals can also cause serious burns when exposed to skin, or if swallowed, whether intentionally or unintentionally. Electrical burns can cause very serious injury as they can burn both the outside and inside of the person’s body, causing injury that cannot be seen, and which can be life threatening. Never use oils such as butter or vegetable oil on any type of burn.

Types of Burns:

Burns are divided into first, second, and third degree burns.

First degree burns affect only the outer layer of the skin. These types of burns are the least serious as they are only on the surface of the skin. First degree burns usually appear red, dry, and slightly swollen. Blisters do not occur with this type of burn. They should heal within a couple of days.

Second degree burns affect the top layer of the skin and the second layer of skin underneath. These are more serious than first degree burns. The skin may appear very swollen, red, moist, and may have blisters or look watery and weepy.

Third degree burns are the most serious burn. A third degree burn affects all layers of the skin and may affect the organs below the surface of the skin. The skin may appear white or black and charred. The person may deny pain because the nerve endings in their skin have been burned away. Third degree burns require immediate medical treatment. If Home Health Aides/Personal Care Aides suspect their patient has a third degree burn, they should immediately call 911. Emergency services should also be called anytime a patient was exposed to smoke. They need to have their airway checked for possible injury.

Chemical burns can occur anytime a liquid or powder chemical comes into contact with skin or mucous membranes that line the eyes, nose, or throat.

Electrical burns can occur if a person has been using an electrical appliance and is exposed to water or if an electrical short occurs while using the electrical appliance. Using faulty or frayed cords on electrical appliances can result in electrical burns. Electrical burns are a serious injury. Emergency medical services (EMS) should be immediately activated.

Guidelines to Prevent Burns:

• Never allow children or confused adults to use electrical appliances unsupervised.
• Never use electrical appliances near water sources.
• Never use electrical appliances in which the cord appears to be damaged or frayed.
• Never pull a plug from the cord. Always remove a cord from an outlet by holding the base of the plug.
• Electrical appliances should NEVER be used in the bathtub, sink, or near running or standing water.
• Cover electrical outlets with child-proof plugs. Never allow children to put anything inside an electrical outlet.
• Never place a metal object inside an electrical appliance while it is plugged in.
• Ensure stoves and other appliances are turned off when finished with them.
• Turn pot handles inward so that a person cannot accidentally bump a handle and spill hot liquids.
• Check water temperature prior to bathing or showering a patient.
• Take care that any hot liquids served are cooled to the point where a patient can safely drink them. Burns can very easily happen from spilling or drinking liquid that is too hot.
• Do not keep hot drinks, soups, or other liquids at the edges of tables or countertops.
• Always inform a patient when giving them something hot to drink or eat.
• Do not allow patients to walk with hot beverages or food in their hands. Have them seated while consuming hot liquids.
• Do not use space heaters and other personal heaters close to a patient where they could accidentally touch or fall against it.
• Check to be sure the hot water heater is not set too high. To avoid scalds from hot tap water, hot water heaters should be set to 120 degrees or less.
• Do not allow children or confused adults to use lighters or matches.
• Discourage smoking in the home, and especially in bed, where a person is at more risk of falling asleep with a lit cigarette.
• Keep chemicals and cleaning solutions securely locked and out of reach of children and confused adults.

Cuts

Cuts can occur whenever a sharp object pierces through the surface of the skin. Some cuts may be minor and only pierce the surface layer of the skin. An example of a minor cut would be a paper cut. Other cuts can be so deep as to reach muscle, bone, or even an organ. These types of cuts can result in serious injury, and possibly death due to blood loss or internal injury.

Guidelines for Preventing Cuts:

• Keep sharp objects such as knives, razors, blades from kitchen appliances (such as blender or food processor blades), scissors, nail clippers, food graters, and household items that slice and prepare foods (such as a mandolin), out of reach of children and confused adults.
• Teach children how to use scissors and knives safely.
• Never hand a person a sharp object, such as scissors or a knife, with the blade pointing toward them.
• When preparing food using a knife, use a sturdy cutting board that will not slip.
• Ensure your hands are not wet or oily when using knives. Cut with the blade away from you.
• Keep your fingers away from the knife’s edge while chopping and cutting foods.
• Put knives toward the back of the counter when you step away from the prepping area.
• Do not throw away metal can lids, broken glass, or other sharp items without first carefully wrapping them in a container that will prevent accidental cuts.
• Never push garbage down in a garbage pail with your hands. Teach others to avoid doing the same.

Poisoning

There are many hazards in the home which put people at risk for accidental poisoning. Poisoning can occur any time a harmful substance is intentionally or unintentionally ingested. Children, who are naturally curious and like to explore, are in particular at risk for poisoning. Adults who may be confused or who have vision problems are also at risk for accidentally ingesting a substance that could potentially be poisonous. Never allow children or confused adults to have access to potentially harmful chemicals or medications.

Guidelines to Prevent Poisoning:

• Keep all cleaning supplies and chemicals locked. All medications should be kept in a locked storage area, out of reach.
• Check medications periodically for expiration dates and properly dispose of expired medications.
• Do not tell children that medication is “candy” as this makes it look more attractive to them.
• Ensure all medications and chemicals are properly labeled. Childproof caps should be on medicine bottles.
• Ensure the patient uses visual aids, such as glasses, when taking their medications and any time they use a household cleaner or chemical.
• Check the refrigerator weekly and dispose of spoiled, moldy, or otherwise compromised food.
• Never use cans that have bulges or deep dents in them.
• Keep poisonous plants out of reach of children and pets.
• Keep the number for Poison Control near a telephone and ensure the family knows who to call in case of an emergency.

Choking

Choking can occur while a person is eating, drinking, taking medications, or if an object is put into the mouth and accidentally swallowed. Choking means the person’s airway is compromised and they are unable to breathe. If a person is unable to talk, cough, or breathe, they are choking. Young children and infants, who love to explore their environment, are especially prone to choking as they often place small objects in their mouth.

Guidelines to Prevent Choking:

• Keep small objects out of reach of children.
• Use age-appropriate toys for children. Avoid those with small pieces with young children.
• Cut food into bite-sized pieces for children and those with chewing or swallowing difficulties.
• Prepare food that is of appropriate consistency (such as pureed or special diets), and as according to the Care Plan.
• Ensure patients eat, drink, and take medications in a fully upright position.
• Keep patients who are at risk for choking in an upright position for 30-60 minutes after eating to prevent aspiration of food or liquids.
• Encourage patients to completely chew and swallow food and to eat slowly.
• Discourage patients from talking while eating, as this puts them at risk for choking.
• Do not allow children to play, run, or walk while eating.
• Do not let children have lollipops and other candy with sticks in their mouths while playing or while riding in a car.
• Place babies on their backs while sleeping. Do not allow excessive bedding, pillows, or any stuffed animals in the crib to prevent suffocation.
• Avoid food items such as popcorn, nuts, pretzels, gum, and hot dogs with small children and those with swallowing difficulties.
• Never allow children to play with plastic bags, and other small items that can easily be swallowed, like soda bottle caps, rubber bands, balloons, and paper clips.

Contributing Factors to Injuries

Factors contributing to injuries among older adults

As people age, they may experience physical, sensory, and cognitive changes that make them more likely to suffer an injury. Adults over the age of 65 are the most likely age group to fall. Older adults tend to have more physical diseases and take more medications. The more medications a person takes, the more they are at risk for potential medication interactions and side effects. Muscle weakness, injury, disability, coordination, or balance problems also put older adults at risk for falls. Home Health Aides/Personal Care Aides should teach patients to properly use ambulatory aids such as walkers and canes. Encourage good non-skid footwear while ambulating.

Older adults who experience confusion, as a result of dementia or illness, may not be completely aware of their surroundings and may not be as cautious while moving about as they normally would. Sensory impairments, such as vision problems and hearing loss, also put older adults at risk for falls as they may not adequately see or hear what is going on in their surroundings. As we age, we also have a reduction in our ability to taste and smell. This makes us more likely to not smell smoke if there is a fire, or to eat food that is spoiled without being aware.

Factors contributing to injuries involving young children

Children are another high risk group for falls. Their natural curiosity, and the developmental tasks they are experiencing, in which independence and risk-taking behaviors come about, makes them prone to accidents involving falls. Ensure that stairways are blocked off from small children with gates. Do not allow children to climb stairs, ladders, or other surfaces unsupervised. Teach them to tie their shoelaces and ensure they wear good non-skid shoes.

Children are also especially prone to choking as they like to put items into their mouth as they explore the world. Ensure that toys are age appropriate and that very young children are not allowed to play with toys and games with very small pieces. Keep medications and cleaning solutions locked and out of reach. Use child-proof covers for outlets, child-proof locks for cabinets which hold cleaning supplies, and child-proof caps on medications.

Children are also developing their gross motor skills and may not have very good balance and coordination. Teach them to use rails when walking on stairs. Teach children to hold your hand and to look both ways when crossing a street. Supervise children while they are playing outdoors and in activities such as bike riding, skating, or skateboarding. Never allow young children to bathe or swim unsupervised in order to prevent possible drowning.

With infants, keep in mind that they must always be supervised. Never leave a baby unattended. Never walk away from a baby while giving a bath as they do not have the muscle development to keep their head out of water and could potentially drown. Feed babies with their heads higher than their bodies and burp them in between feedings to prevent choking. Do not keep stuffed animals and excessive bedding in a baby’s crib. Keep babies on their backs while sleeping to prevent possible suffocation.

As children tend to lack a sense of fear and have a strong desire to explore their world, Home Health Aides/Personal Care Aides must always be watching for potential hazards in their environment. Keep the environment clutter free and teach children to pick up their toys and shoes.

Where Household Injuries Commonly Occur

Two areas in the home, the kitchen and the bathroom, are the places where most household injuries occur. People tend to spend a lot of time in both of these areas in the home. They are also places where many dangers lie.

In the kitchen, using appliances improperly or near water could result in electrical injury. Other hazards in the kitchen include walking on a wet or greasy floor, improperly using knives, fire hazards while using the stove, and ingesting spoiled food or dangerous chemicals.

In the bathroom, potential hazards involve slipping on a wet floor or in the bathtub, using appliances such as hair dryers near water, unsafe use of razors or scissors, and the ingestion of medications and other potentially dangerous substances.

Home Health Aides/Personal Care Aides should take special precautions in the kitchen and bathroom to ensure that floors are dry, non-skid rugs and bath mats are utilized, handrails and grab bars are available, and sharp objects are put away when not in use. Cleaning solutions, chemicals, and medications should be kept in locked cabinets and out of reach of children and confused patients.