11.1.1: Types of Injuries

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, such as falls, drownings, poisonings, and fires (CDC, 2014a). 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 and suddenly moves from a higher to a lower position, in which injury may or may not occur (Leahy, Fuzy & Grafe, 2013). Worldwide falls are the second leading cause of accidental injury (WHO, 2012). Each year approximately 424,000 people die from a fall globally, with about 80% of these falls occurring in low to middle income countries (WHO). 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. Deaths from falls are highest for adults over the age of 60 years across the globe (WHO, 2012). Adults over 65 years, young adults aged 15-29 years, and children 15 years and younger have the highest morbidity rates across the world (WHO).

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 which 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 cause the patient to trip.
• 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. This is called orthostatic hypotension.
• 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.

Self Check Activity \(\PageIndex{1}\)

True or False:

1. It is okay for the Home Health Aide to move a patient when they have fallen. True or False? _______________

Multiple Choice

2. Which of the following are ways to prevent a fall?

a). Keep the home clutter free

b). Ensure patient uses their walker correctly.

c). Tell patients to stand quickly when they are seated.

d). Have patients wear non-skid shoes and ensure laces are tied.

Answer

1. False

2. A, B, & D

FEEDBACK:

1. Home Health Aides/Personal Care Aids should never move a patient when they have fallen without informing a supervisor to ensure that the patient is appropriately assessed.

2. Preventing falls is an important task of the HHA/PCA. Keeping the home clutter free, ensuring ambulatory devices such as canes and walkers are used properly, and encouraging patients to wear non-skid shoes and that shoe laces are tied are ways to prevent falls. HHA/PCAs should have patients rest in a sitting position for a couple of minutes prior to standing to prevent orthostatic hypotension, which can cause a 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 fire, irons, hair dryers, curling irons, and stoves (American Institute for Preventive Medicine, 2012; Leahy, Fuzy & Grafe, 2013). Burns from wet or moist heat occur from hot liquids, such as hot water or steam (American Institute for Preventive Medicine; Leahy, Fuzy & Grafe). These types of burns are called scalds. Scalds can occur within seconds and cause serious injury.Chemical burns occur from chemical sources and 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. Radiation burns can also occur from sources of radiation such as sunlight (American Institute for Preventive Medicine).

Types of Burns

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

First degree burns affect only the outer layer of the skin (epidermis). 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 (MedlinePlus, 2014). Blisters do not occur with this type of burn. They should heal within a couple of days (American Institute for Preventive Medicine, 2012).

Second degree burns affect the top layer of the skin and the second layer of skin underneath (dermis). These are more serious than first degree burns. The skin may appear very swollen, red, moist, (MedlinePlus, 2014) and may have blisters or look watery and weepy (American Institute for Preventive Medicine, 2012).

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 (MedlinePlus, 2014). The person may deny pain because the nerve endings in their skin have been burned away (American Institute for Preventive Medicine, 2012). 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. Chemical burns may also occur if a chemical is swallowed. These burns can cause serious injury and emergency services should be contacted. If a person receives a chemical burn, the chemical should be removed from the skin by using a gloved hand to brush it off and then wash the area with plenty of cool water. 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.

Never use oils such as butter or vegetable oil on any type of burn as this can cause further injury. For first or second degree burns flush the area with plenty of cool (not ice cold) water for about 15 minutes or until the pain decreases and cover with a clean, dry bandage. Using ice or ice cold water can cause frostbite (American Institute for Preventive Medicine, 2012). For major burns remove any clothing that is not stuck to the skin, cover the burned area with a dry, clean cloth, and seek emergency assistance.

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 (MedlinePlus, 2014).
• 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.

Self Check Activity \(\PageIndex{2}\)

True or False:

1. First degree burns are the worst types of burns to have. True or False? _______

2. It is okay to use oils on a burn to help soothe the pain. True or False? _______

3. If a chemical burn occurs, you should flush the area of the burn with water. True or False? _______

4. It is okay to stand on a wet floor and use a hair dryer, as long as it is not a big puddle. True or False? _______

Answer

1. False

2. False

3. True

4. False

FEEDBACK:

1. First degree burns are the least serious type of burn, although the person should always be assessed and treated if necessary as these types of burns can be serious. The HHA/PCA should always inform a supervisor for any burn that has occurred, regardless of how serious they believe the burn to be. Second degree burns are the second most serious type of burn as these burns go through the epidermis and dermis. Third degree burns are the most serious type of burn, going through all layers of the skin and affecting structures and organs below the skin.

2. Never use oil, butter, or margarine to treat a burn. These can cause further injury. Wash a burn with cool water and seek assistance from a supervisor or from emergency services, if necessary.

3. You should immediately wipe away any chemical residue and flush the area with plenty of water. Seek assistance from emergency services and inform a supervisor.

4. Never stand in any water no matter how small it appears while using an electrical appliance. This can result in electrocution which can cause serious injury and even death.

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. Always cut with the blade facing 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. Poisons come in many forms including plants, cleaning supplies, spoiled food, and medications. 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. Some medications become toxic when they are past their expiration date.
• 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.

Self Check Activity \(\PageIndex{3}\)

True or False

1. The best way to prevent poisoning is to keep cleaning supplies and medications locked and out of the reach of children and confused adults. True or False? ______

2. You should keep the phone number to Poison Control near the telephone. True or False? _____

Answer

1. True

2. True

FEEDBACK:

1. Keeping cleaning supplies and medications locked and out of reach of children and confused adults is the best way the HHA/PCA can prevent poisonings.

2. The number to Poison Control should be kept in an easily accessible place, such as near a telephone.

Choking

• Keep small objects out of reach of children.
• Use age appropriate toys for children. Avoid those with small pieces with young children.
• Cut

  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. Some signs of choking include a bluish skin color, inability to talk, cry, or to make any sounds, a weak, ineffective cough, soft or high-pitched sounds while inhaling, ribs and chest pulling inward as the person is having difficulty breathing, and loss of consciousness if left without air (MedlinePlus, 2015). 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:

  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. Infants can die from a condition called Sudden Infant Death Syndrome (SIDS). Placing a baby on their back while asleep reduces this risk.
• 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.

Self Check Activity \(\PageIndex{4}\)

True or False

1. It is okay to let kids have a lollipop in the car as long as you are watching them. True or False? _______

2. Babies should be placed face down in their crib to get the most rest. True or False? _______

Answer

1. False

2. False

FEEDBACK:

1. Never let children have lollipops in the car. If the car stops suddenly, the lollipop can lodge into the child’s throat and cause choking. This could cause a serious injury or even death.

2. Babies should always be placed on their backs during sleep. Stuffed animals, pillows, and a lot of bedding should be removed from a crib or where the infant is sleeping. Infants can die from a condition called Sudden Infant Death Syndrome (SIDS). Placing a baby on their back while asleep reduces this risk.