1 / 56

Home Safety for Public Health Professionals

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. Objective.

hay
Download Presentation

Home Safety for Public Health Professionals

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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 < 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 < 5 (X2=112.67, p<.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

  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 See complete list of teleform-coded injury, mean age and severity in the CHIRPP report.

  26. CHIRPP: top 5 moderately severe

  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% admittedto 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

  37. Evidence: effective interventions

  38. Evidence: effective interventions

  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 (p<0.005), 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

More Related