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Home%20Safety%20for%20Public%20Health%20Professionals

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Title: Home%20Safety%20for%20Public%20Health%20Professionals


1
Home Safety for Public Health Professionals
  • Supporting evidence-informed practice

WRHA Injury Prevention Program (IMPACT) Dr.
Lynne Warda Medical Consultant, Injury Prevention
and Child Health Injury Prevention Champion
Meeting September 30, 2015
2
Objective
  • Consider evidence and strategies for home safety
    in public health practice

3
  • WHAT GUIDES PRACTICE?
  • Burden
  • Evidence
  • IMPACT activities
  • Resources

4
What Guides Practice?
  • Policy context legislation, standards, policies,
    guidelines
  • Priorities vs. other tasks/topics
  • Severity of the hazard? (fire/drowning)
  • Likelihood of the injury occurring? (suffocation)
  • Time, resources required? (smoke alarm)
  • Evidence for effectiveness of interventions
  • Ability to implement effective interventions

5
Standards, Policies, Guidelines
  • Legislation SAFT assessment home/property
    hazards
  • National Standards Accreditation Canada Required
    Organizational Practices (ROP)
  • Fall prevention, Home safety
  • Regional guidance (safety topics) Clinical
    Practice Guidelines, Care maps, Home Visitor Log
    (CHEERS), Service Delivery Standards, Healthy
    Beginnings Manual, etc.

6
Home Safety ROP
  • The team conducts a safety risk assessment for
    clients receiving services in the home.

7
Home Safety Assessment Tools
  • Key safety issues can be identified using
    structured assessment tools
  • Occupational/Personal Safety SAFT
  • Home safety assessment (staff) WRHA Safety
    Teleform
  • Home safety checklist (parent) Give Your Child a
    Safe Start
  • Documentation care map safety section
  • Policy guidance CPG, operational guidelines,
    service delivery standards, Healthy Beginnings
    safety section

8
Home Safety Approach?
  • Integrated in daily practice (SAFT, care map,
    checklist, parent handout)
  • Practical, reasonable
  • One visit vs. ongoing relationship
  • Appropriate for degree/nature of hazards
  • Focus on serious injury (fire, suffocation,
    falls)
  • Supports families safer homes/practices
  • Documented, feedback loop (client, system)

9
  • What guides practice?
  • BURDEN
  • Evidence
  • IMPACT activities
  • Resources

10
Burden-injury death
  • Children under 1 year of age sudden infant
    death, suffocation, assault, burns, drowning
  • Causes over-heating, soft bedding, unsafe sleep
    surfaces, adult beds, bedsharing

11
Burden-injury death
  • Children 1-4 years of age strangulation/choking
    and suffocation, drowning, MVC, assault
  • Causes of suffocation food, coins, batteries,
    balloons, gel candies and certain types of foods
    like whole hot dogs and whole grapes

12
Burden-adult fatal injury
  • The leading causes of injury death occurring in
    the home are falls, poisonings, fire and burn
    injuries
  • Combined 78.6

13
Burden-injury and hospitalization
  • Children under 1 year of age falls (81 cases),
    assault (48 cases) and burns (26 cases)
  • Children 1-4 year of age falls (247 cases),
    burns (92 cases) and poisoning (85 cases)

14
Burden-injury and hospitalization
  • FALLS
  • Leading cause of injury and more than half of all
    injury hospitalization
  • From furniture, down stairs, windows and
  • one level to another
  • Half of injuries are to the head and face

15
Burden-injury and hospitalization
  • BURNS
  • Caused by hot liquids and tap water
  • Lengthy hospital stays (average 13 days)
  • Recurrent hospitalizations and lifelong treatment
  • Intense pain and suffering, disfigurement,
    permanent physical disability, emotional
    adjustments and family disruption

16
Burden-injury and hospitalization
  • POISONING
  • Toxic symptomatic ingestions
  • Cardiovascular agents (e.g. clonidine)
  • Oral hypoglycemics (e.g. glyburide)
  • Sedative/hypnotics (e.g. benzodiazepines)
  • Hydrocarbons (e.g. paint thinner, lamp oil)
  • Anticonvulsants (e.g. carbamazepine)

17
Burden- Emergency Department Data
  • 5 years and younger majority of injury visits
    result from injuries occurring in the home (80)
  • Most severe causes being scalds, poisoning,
    animal bites, electrical burns and ingesting or
    choking on small objects

18
Burden-adult hospitalizations
  • The leading causes of injury hospitalization
    occurring among older adults are falls (61.6),
    and struck by/against, or motor vehicle crash
    (15)
  • Combined 76.6

19
Burden-ED
  • In a study conducted by Runyan and colleagues,
    falls were the leading cause of injury occurring
    within the home
  • Falls (46)
  • Being struck by or against an object or cuts and
    piercing injuries within the home occurred
    frequently

20
CHIRPP Case Studies
  • What patterns of injury do we see?
  • Winnipeg CHIRPP data 2004-2008
  • Age lt 5 years
  • Home injuries
  • Variables child characteristics, injury
    circumstances, nature of injury, disposition
  • Ranking by severity (using disposition)
  • Analysis by safety teleform category

21
CHIRPP Injuries Age lt 5
Year Number of Injuries () Total Injuries Home Injuries ()
2004 1,683 (17.4) 6,113 1,285 (17.2)
2005 1,838 (19.0) 5,602 1,426 (19.1)
2006 1,817 (18.7) 5,754 1,383 (18.5)
2007 2,117 (21.8) 6,085 1,663 (22.3)
2008 2,234 (23.1) 6,097 1,707 (22.9)
Total 9,689 (100) 29,651 (100) 7,464 (100)
(X2112.67, plt.0001).
22
CHIRPP study results
  • Children in this age group account for 36 of
    CHIRPP injuries
  • Home injuries 77 in this age group
  • Age mean age 2.0 years
  • Gender 57 of injuries were to boys
  • Body Part 53 to head and face
  • Nature of Injury 31 were open wounds, 17 minor
    head injury, 11 fractures

23
CHIRPP disposition after injury
Disposition Number () Severity
Left without being seen 23 (0.2) Unknown
Short stay observation in ED 59 (0.6) Minor
Advice only 2,822 (29.1) Minor
Treated, follow-up as needed 3,659 (37.8) Minor
Treated, follow-up required 2,884 (29.8) Moderate
Admitted to hospital 239 (2.5) Severe
Direct admission to ICU 2 (0.02) Severe
Total 9,688 (100)
24
CHIRPP results
  • Context 45 playing, climbing or dancing 25
    walking, running or crawling
  • Mechanism 1/3 were falls
  • Location 77 in own/other house/apartment, 5 at
    daycare or preschool
  • Months August, July, April, May
  • Time 4-8pm (34), 12-4pm (27)

25
CHIRPP top 5 severe injuries
Injury N Mean Age (years) Moderate Severity Severe
Hot Liquids 159 1.2 81 10
Poisoning 202 1.9 1 5
Pets 110 2.6 44 4
Small Objects 114 2.5 14 3.5
Elevated Furniture 755 1.7 26 2.4
See complete list of teleform-coded injury, mean
age and severity in the CHIRPP report.
26
CHIRPP top 5 moderately severe
N Mean Age (years) Moderate Severity
Electrical Cords 6 2.2 83
Hot Liquids 159 1.2 81
Meal Preparation 9 Injury 56
Bathing 56 1.8 54
Electrical Sockets 4 2.0 50
27
CHIRPP hot liquids
  • 159 cases, mean age 1.2 years
  • 9 minor severity, 81 moderate, 10 admitted to
    hospital
  • 33 of hot tap water cases were admitted
  • Pulled bowl of hot soup onto herself while
    eating

28
CHIRPP toxic substances
  • 202 cases, mean age 1.9 years
  • 93 minor severity, 1 moderate, 5 admitted to
    hospital (1 left unseen)
  • Playing with 2 y.o. sister, sister fed her
    extra strength Tylenol, Tylenol overdose

29
CHIRPP pets
  • 110 cases, mean age 2.6 years
  • 52 minor severity, 44 moderate, 4 admitted to
    hospital
  • Playing with cat, bit and scratched by cat

30
CHIRPP small objects
  • 114 cases, mean age 2.5 years
  • 83 minor severity, 14 moderate, 3.5 admitted
    to hospital
  • Playing with marbles, put marble in mouth and
    swallowed it

31
CHIRPP elevated furniture
  • 755 cases, mean age 1.7 years
  • 72 minor severity, 26 moderate, 2.4 admitted
    to hospital
  • Fell from change table onto floor while being
    changed

32
CHIRPP Cases summary
  • Injuries in preschool children and home injuries
    in this age group increased
  • There were 2884 moderate and 241 severe injuries
    captured by the CHIRPP system
  • Injury severity ranking by teleform topic can
    validate and identify priority topics to target
    for prevention efforts (scalds, poisoning, pets,
    electrical cords/sockets, small objects)

33
  • What guides practice?
  • Burden
  • EVIDENCE
  • IMPACT activities
  • Resources

34
Evidence-strategies
  • Comprehensive injury prevention projects employ
    strategies that include
  • Environment
  • Education
  • Enforcement
  • Economics

35
Evidence home based interventions
  • Home-based interventions and low cost/free safety
    devices can improve home safety and reduce
    injuries involving
  • Infant sleep practices
  • Home hazards
  • Lack of caregiver supervision

36
Evidence effective interventions
Injury Prevention strategies
Fires Smoke alarm distribution, installation
Child-resistant lighters
No smoking in the home
Fire escape planning
Burns Hot tap water temperature reduction
Anti-scald devices
Electrical outlet covers
Fireplace guards

37
Evidence effective interventions
Injury Prevention Strategies
Suffocation Safe sleep locations
Back to sleep/supine positioning
Firm sleep surface
No soft objects/loose bedding
Choking Food safety/preparation
Small parts, balloons, plastic bags, button batteries out of reach
Poisoning Safe medication storage
Medication packaging -child resistant -bubble packs
38
Evidence effective interventions
Injury Prevention Strategies
Falls Stair gates
Window guards
Use straps/harnesses/restraints on baby equipment
No baby walkers
Avoid putting child on elevated surfaces

39
Evidence compliance and uptake
  • Many prevention strategies are effective
  • BUT most require action by the parent
  • One time action install stair gate, smoke alarm
  • Frequent action close the gate
  • Occasional action test alarm/change battery
  • How can we assist in changing behaviour
  • Use passive strategies whenever possible
  • Develop routine habits, designate safe spaces

40
Evidence- passive strategies
  • Require one-time action
  • Smoke alarms (long-life battery, hardwired)
  • Reducing hot tap water temperature
  • Install window guards
  • Install stair gate at top of stairs
  • Purchase a crib or playpen for newborn
  • Purchase nontoxic cleaning products
  • Disposal of medications not in use

41
Evidence-active strategies
  • Supervise proximity, attention, continuity
  • Safe storage of small parts, choking hazards
  • Hot liquids carrying, accessible to child
  • Medications close and store after using
  • Solutions? Designate one child-safe area and keep
    it tidy, baby-gate a safe room, use playpen or
    high chair as safe place during meal preparation

42
Research Evidence
  • Many studies have documented improvements in home
    safety using
  • Education (individual/group/public)
  • Home visiting
  • Pediatric office-based interventions
  • Free/low-cost safety devices
  • Standards/legislation
  • Limitations study design, injury outcomes

43
Cochrane Systematic Review
  • 98 studies (2.6 million people), 35 RCTs
  • home safety education with or without the
    provision of safety equipment
  • Injury reductions for interventions
  • delivered in the home (IRR 0.75, 95 CI 0.62 to
    0.91), with no safety equipment (IRR 0.78, 95 CI
    0.66 to 0.92)

Home safety education and provision of safety
equipment for injury prevention. Cochrane
Database of Systematic Reviews 2012, Issue 9.
44
Cochrane - Results
  • Safety behaviours/safety equipment
  • safe hot tap water temperatures (OR 1.41, 95 CI
    1.07-1.86), functional smoke alarms (OR 1.81, 95
    CI 1.30-2.52), fire escape plan (OR 2.01, 95 CI
    1.45-2.77)
  • storing medicines (OR 1.53, 95 CI 1.27-1.84)
  • storing cleaning products (OR 1.55, 95 CI 1.22
    -1.96), having syrup of ipecac (OR 3.34, 95 CI
    1.50-7.44), poison control numbers accessible (OR
    3.30, 95 CI 1.70-6.39)
  • having fitted stair gates (OR 1.61, 95 CI
    1.19-2.17)
  • having socket covers on unused sockets (OR 2.69,
    95 CI 1.46-4.96)

45
Evidence HOME Study
  • Prospective RCT
  • Enrolled expectant mothers, followed at 12 and 24
    months
  • 355 families randomized
  • Baseline hazard assessment
  • Installation of safety devices
  • Outcomes medically attended injuries, modifiable
    injuries, hazards

46
Evidence HOME Study
  • Hazards number and density of hazards 15 less
    than controls at 12 months (plt0.005), mean number
    of hazards lower than controls at 24 months
  • Safety devices Table 3 (at 12 /24 months)
  • Stair guards OR 9.26/8.68
  • Smoke alarm OR 3.02/1.85
  • CO detector OR 6.5/3.23
  • Hot water less than 49 degrees OR 1.7/1.3

47
Evidence HOME Study
  • Injuries all medically attended injuries reduced
    by 31 during 24 month follow-up, compared to
    controls (NS)
  • Modifiable injuries 70 reduction in modifiable
    medically attended injuries in the intervention
    group over 24 months of follow-up (p.03)

48
Evidence HOME Study
49
  • What guides practice?
  • Burden
  • Evidence
  • IMPACT ACTIVITIES
  • Resources

50
IMPACT Activities
  • Injury Surveillance and Data
  • Leadership and Collaboration
  • Communication
  • Strengthening Capacity
  • Policy and Advocacy
  • Health Equity Promotion
  • Applied Injury Prevention Research

51
  • What guides practice?
  • Burden
  • Evidence
  • Impact activities
  • RESOURCES

52
IMPACT Resources
Resources for the public, community, and
professionals
  • Give Your Child a Safe Start (parent home safety
    illustrated handout and checklist)
  • Quick Reference Guide (key injury messages by
    ages/stages for public health staff)
  • Keeping You and Your Family Safe In and Around
    the Home Checklist
  • Home Safety Services and Programs
  • Safe Sleep Easy Read
  • Home Safety Teleform
  • Soothing a Crying Baby
  • Staying Calm with Baby is Crying
  • Keeping Baby Comfortable (temperature control)
  • How to Prevent Playground Injuries (Poster and
    Pamphlet)
  • Safe Sleeping for Baby and A Babys Safe
  • Sleep Environment hang tags and brochure (Health
    Canada)
  • Crying Banner stand
  • Safe Sleep banner stand
  • Safe Swaddling
  • Choosing Safe Sleep Sacks

53
IMPACT Resources

NEW! Parent home safety illustrated handout and
checklist
54
Home Safety Assessment?
  • Occupational/Personal Safety SAFT
  • Home safety assessment (staff) WRHA Safety
    Teleform
  • Home safety checklist (parent) Give Your Child a
    Safe Start
  • Home safety checklist (client) handout, online
  • Documentation care map safety section
  • Policy guidance CPG, operational guidelines,
    service delivery standards, Healthy Beginnings
    safety section

55
IMPACT References
56
Questions?
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