151. Study Notes: Accident Risk Factors and Injury Prevention in CCA Care

The Big Picture

Anyone might experience an accidental injury. Children, older persons, and people living with illnesses or disabilities face greater risks in many situations.

A person’s awareness, senses, ability to move, medications, age, and level of fatigue all affect injury risk. For a CCA, safety includes noticing risks, following the client’s care plan and agency safety rules, and using the specific reporting directions covered in these notes.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

Awareness and Accident Risk

People need awareness of their surroundings to protect themselves from injury. A person who does not recognize a hazard might not know to avoid it.

Children have not yet developed full awareness of many hazards. People who live with intellectual disabilities, some physical disabilities, or disorientation might also have trouble detecting or avoiding danger. Someone who is unconscious also depends on others for protection.

Distraction creates another risk. A person who focuses on something other than the task at hand has less awareness of the surroundings.

Some prescribed medications cause drowsiness and reduce awareness. People should always follow instructions from their health care providers and follow the warnings on prescription containers.

Drugs, alcohol, or both also affect reflexes, vision, balance, or coordination.

Distracted or Fatigued Caregivers

Children face a greater risk of accidental injury during stressful periods or changes in family routines. A caregiver whose attention is divided might provide less careful supervision.

Support workers provide care and support to clients and families during these stressful periods and times of change.

Fatigue also places caregivers at risk of injury.

Vision Challenges

Poor vision increases fall risk. A person might have trouble seeing obstacles such as:

• toys
• small rugs
• furniture
• electrical cords

Poor vision also affects distance and depth judgement. Difficulty reading labels on medicines, cleaners, or other containers creates a poisoning risk.

Some clients need eyeglasses but refuse to wear them. Others wear glasses but still have poor vision because their prescription is no longer up to date.

CCA action: Keep the client’s glasses properly cleaned and easy to access.

Report: Tell your supervisor if the client still does not see properly.

Hearing Challenges

A person with impaired hearing might struggle to hear explanations or instructions. The person might also miss warning signals or fire alarms.

Missing these warnings leaves the person unaware that danger is present or that movement to safety is needed.

Taste, Smell, and Touch Challenges

Reduced taste and smell create specific safety risks. A person might eat spoiled food or fail to notice a gas leak.

Reduced touch affects the ability to feel:

• heat
• cold
• pain
• discomfort

A person who does not feel an injury might not notice a problem such as a blister. The source example describes a blister developing into a serious wound when poor circulation prevents the person from feeling it.

Mobility Challenges

Mobility means the ability to move around.

Aging, disease, and injury affect mobility. Some people cannot walk or use wheelchairs.

A person who cannot move away from danger faces a serious safety risk. Even a small mobility change raises accident risk. A sore knee, for example, might prevent someone from recovering balance after a stumble and lead to a fall.

Medications and Accident Risk

Some medications have adverse effects ⓘ that increase accident risk. Supported effects include:

• loss of balance
• drowsiness
• lack of coordination
• reduced awareness
• confusion
• disorientation
• fearful or uncooperative behaviour

Report: These medication effects must be reported to the supervisor.

Fatigue and Health Care Worker Safety

Health care workers face injury risks from fatigue, especially when working changing shifts.

Losing as little as 2 hours of sleep negatively affects alertness and performance.

Sleep deprivation affects attentiveness and the ability to respond to an emergency. Effects include:

• decreased judgement
• poorer decision-making
• decreased memory
• slower reaction time
• lack of concentration
• worsened mood

Ways to Reduce Fatigue

1. Proper nutrition. Focus on complex carbohydrates, or starches, rather than simple carbohydrates, or sugar. Avoid fatty foods and nutrient-deprived foods.
2. Stress control. Healthy habits that reduce stress support concentration and sleep.
3. Regular exercise. Cardiovascular exercise, muscle strengthening, and flexibility exercise support concentration and reduce injury risk.
4. Employment that fits lifestyle and personal demands. Examples include flexible schedules, shorter shifts, and work rotations that progress from morning to afternoon to night.

Age and Injury Risk

People of any age who do not detect hazards face a greater injury risk.

When working with or around children, a support worker must stay aware of possible dangers. The support worker has a responsibility to use safety measures to prevent:

• falls
• burns
• poisoning
• suffocation

The CCA must follow agency safety rules and the client’s care plan ⓘ at all times.

Protecting Children From Injury

Support workers have a responsibility to protect children of every age from harm.

Injuries from accidents, falls, choking, burns, abuse, poisonings, and other causes are the leading cause of death in children over 1 year of age. They also account for more deaths and disabilities in children than all causes of disease combined.

A child’s developmental stage helps predict the types of injuries the child faces.

In Canada, accidents are one of the leading causes of death among children over age 1. Examples include:

• motor vehicle collisions
• falls
• poisoning
• drowning
• suffocation
• fire
• being struck by an object

Risk Factors for Childhood Injuries

Several personal and life factors increase childhood injury risk.

General Risk Factors

Gender: The majority of injured children are males. The supplied information links this mainly with behavioural characteristics such as aggression.

Temperament: Highly active children face greater injury risk.

Stress: Stress increases risk-taking and self-destructive behaviours and often reduces self-protection.

Alcohol and drug use: This factor is associated with higher rates of motor vehicle injuries, drownings, homicides, and suicides.

Previous injury: A child with a history of injury has a greater likelihood of future injury, especially when the earlier injury required hospitalization.

Developmental Characteristics

Development also affects injury risk. Important factors include:

• a mismatch between the child’s developmental level and the skill an activity requires
• natural curiosity and exploration
• a desire to assert independence and challenge rules
• a desire for peer approval and acceptance in older children

Cognitive Characteristics by Age

Infant: Infants explore through taste and touch. This raises the risk of accidental poisoning or burns.

Young child: Young children actively search for attractive objects. They lack awareness of cause-and-effect dangers. They might not connect one dangerous experience with another similar danger. They also do not fully understand dangers to themselves or others.

School-age child: School-age children generally do not fully understand cause and effect. They sometimes attempt dangerous activities without thinking through the consequences.

Adolescent: Abstract thinking and feelings of invulnerability ⓘ increase risk-taking. Examples in the supplied information include drowning and diving into shallow water.

Anatomical Characteristics

Certain body characteristics, especially in young children, affect injury risk:

• A large head increases risk of cranial injury.
• A large spleen and liver increase risk of trauma to those areas.
• A small, light body is more easily thrown, especially from a moving vehicle.
• Left-handed people face some environmental risks because many objects and settings are designed for right-handed people.

Other Childhood Risk Factors

Other supported factors include:

• poverty and substandard housing
• family stress, including maternal illness or a recent environmental change
• below-average alternative child care
• young maternal age
• low maternal education
• multiple siblings

Preventing Suffocation and Related Hazards in Children

Suffocation means a lack of oxygen that stops breathing.

The safety measures below cover eating, sleep, cords, water, and other hazards.

Eating and Feeding Safety

• Always supervise children while they eat.
• Grate, mash, blend, or chop a baby’s food into very small pieces.
• Do not give infants and young children hot dogs, raw carrots, peanuts, popcorn, whole grapes, raisins, hard candy, or gum.
• Do not prop a feeding bottle on a rolled towel or blanket.
• Hold the baby and bottle during feeding.
• Remove small objects such as coins, buttons, marbles, pins, and paper clips from the floor.
• Do not let children inflate balloons or put balloons in their mouths.
• Throw away broken balloon pieces immediately.
• Keep plastic bags and wrappings away from children.

Strings, Cords, and Clothing

• Do not let children wear necklaces, strings, cords, or similar items around their necks.
• Remove an infant’s bib before placing the infant in a crib.
• Remove or tie up cords and drawstrings on children’s clothing, including cords at the hood, neckline, and waist.
• Keep blind, curtain, and drape cords out of children’s reach.
• Tie cords up or use a cord shortener.
• Place cribs and playpens far from blinds, shades, and drapes.
• Do not hang objects with strings, cords, or elastic around cribs or playpens.

Safe Sleep

• Position infants on their backs for sleep.
• Use a snug-fitting, firm crib mattress.
• Crib rail slats must have spaces no wider than 6.3 cm (2½ in.).
• Never let an infant sleep on a waterbed.
• Infants should sleep on firm, flat surfaces.
• Do not use pillows to position infants or prevent them from falling from beds or furniture.
• Remove pillows, comforters, quilts, sheepskin, stuffed toys, and other soft objects from a sleeping baby’s crib.

Water Safety

Always supervise children in or near water. This includes:

• tubs
• toilets
• sinks
• buckets and containers
• wading pools
• swimming pools

Keep bathroom doors closed so children do not enter without supervision. Keep toilet seats down and use toilet safety locks.

Keep sinks, tubs, basins, and buckets empty when they are not in use. Keep diaper pails locked.

Vehicle Safety

Do not leave a child unattended in a vehicle.

High summer temperatures create a rapid suffocation risk. Extreme winter temperatures also place an unattended child at risk from severe cold.

Consumer Product-Related Injury Risks

The Consumer Product Safety Program, or CPSP, analyzes information about injuries involving consumer products in children and youth. It also develops industry standards aimed at protecting health and safety and enforces safety regulations.

Reported Canadian data from 2013 to 2017 included these product-related injuries:

Product	Common reported injuries or hazards	Reported severity
Telephones or accessories	Burns, electric shocks, irritation, allergic reactions	1% life-threatening or disabling
Laundry soap or detergent	Irritation, allergic reactions, poisoning	45% severe to fatal
Ranges or ovens, electric or gas unknown	Burns, cuts	23% moderate to fatal
Electric ranges or ovens	Burns, cuts	17% moderate to fatal
Chairs, excluding several specific chair types	Bruises, cuts	15% severe or fatal
Diapers	Irritation, allergic reactions	18% severe
Light bulbs, excluding Christmas tree bulbs	Burns from hot bulbs, carbon monoxide poisoning	6% fatal
Dishwashers	Cuts, poisoning, burns	24% moderate to fatal
Computers	Overheating and fires	16% moderate or fatal

Other Household Product Risks

Several household products also create injury risks for children and youth.

Trampolines: Falls from a trampoline onto the ground produce the most severe trampoline injuries. They account for almost two-thirds of all fractures and one in five hospital admissions described in the supplied data.

Bath seats: Drownings and near-drownings occur in connection with bath seats, especially when children are left unattended.

Blind and curtain cords: Dangling cords create a strangulation hazard.

Furniture, televisions, and large appliances: From 1990 to 2007, these products were linked with an average of about 9 000 injury cases per year. Children younger than 5 years accounted for 71% of those cases.

Falls and Accidents in Older Persons

Falls are a major injury concern for older persons.

Falls are the leading cause of injury among older Canadians.

One estimate states that about half of continuing care clients fall during any 1-year period. Among older people, 20% to 30% experience one or more falls each year.

Falls are associated with:

• 85% of injury-related hospitalizations among older persons
• 95% of all hip fractures
• $2 billion a year in direct health care costs
• more than one third of older people entering long-term care ⓘ after hospitalization for a fall
• hospital stays averaging 10 days longer for falls than for any other cause

Falls that do not produce an injury can still lead to post-fall anxiety that interferes with everyday activities. Older bodies also take longer to heal and recover. An injury that is minor for a younger person might become life-threatening for an older person.

Age-Related Changes That Increase Accident Risk

Older persons might experience changes that raise the risk of falls and other accidents:

• weaker muscles
• slower and less steady movements
• slower reaction time
• balance problems
• reduced sensitivity to heat
• decreased vision
• hearing impairment
• dulled smell, taste, and touch
• memory loss
• joint pain and stiffness
• low blood pressure

Other Fall Risk Factors in Older Persons

Other factors linked with a greater likelihood of falling include:

• a history of falls
• foot problems
• ill-fitting shoes
• incontinence or frequent urination
• dizziness or light-headedness, especially when standing
• depression
• poor judgement or dementia
• unfamiliar surroundings
• treatment equipment, including intravenous poles, drainage tubes, and bags
• improper use of wheelchairs, walkers, canes, or crutches

Key CCA Safety Responsibilities

Several CCA actions appear directly in this topic.

• Keep a client’s glasses clean and easy to reach.
• Report continued difficulty seeing to the supervisor.
• Report medication adverse effects that raise accident risk.
• Provide care and support to clients and families during stressful periods and changes.
• When working with or around children, stay alert for possible dangers.
• Use safety measures to prevent falls, burns, poisoning, and suffocation in children.
• Follow agency safety rules and the client’s care plan at all times.