Hazards in a Care Home - The Best Ways To Prevent Common Hazards

In this article I will show you some the most common examples of hazards in a care home that you will encounter. Then I will explain the best ways for you to prevent or mitigate those hazards and the risks they pose. After reading this article you should be well prepared to find, remove or mitigate hazards in your care home.

Examples of hazards in a care home

The most common types of hazards in a care home are:

• Trips, slips and falls
• Moving and handling incidents and injuries
• Medication errors
• Fire safety
• Temperature (hot water or hot surfaces typically)
• Hazardous substances
• Food hygiene, handling and preparation
• Equipment use
• Bedrails
• Water cleanliness (including Legionnaires disease)

Hazards in a care home – general prevention measures

Although some hazards in a care have may require measures specific to them to prevent or reduce risk, there are things you should do that can be applied to most, if not all of the most common hazards in care homes and nursing homes.

Firstly, undertake thorough and regularly updated risk assessments to identify potential hazards, reasonable precautions that can be taken and then develop action plans with regular reviews to put those precautions in place.

Many areas of hazard, such as moving and handling, or fire safety should also be covered by relevant Policies and Procedures to enable staff members to know what the best course of action is in any common scenario.

Learn from incidents and near misses.

When an incident is narrowly avoided due to any hazard to not treat this as a lucky break and move on. It should be obvious but you would be surprised how many near misses are not followed up on. Every near miss should be investigated to understand the cause or causes, and actions taken to prevent a recurrence.

Responsible culture

You should foster and maintain a culture in your care service where every member of staff knows it is there responsibility to help identify and notify others about hazards, and help find a solution to remove or mitigate a hazard if necessary. It should be part of everyone’s job and duties within your care home.

How to prevent falls in care homes

The leading cause of trip, slip and fall incidents in care homes across the world are what we call ‘contaminants’ Ironically, these can be cleaning liquids, soaps from dispensers and can of course also include spilled drinks or food.

You can help prevent slips on contaminants by:

• Ensuring all staff members know what contaminants to look for and where they typically occur
• Ensuring staff know the correct cleaning methods for different contaminants, areas and types of surface
• Tackling any slip hazards immediately
• Placing water absorbing mats by entrances (for rainy days) and under common areas of spillage or drips from dispensers, sinks, kitchens, and so on
• Having good supplies of cleaning equipment, wet floor signs, absorbent paper
• Ensure staff know where these are and have access to them
• Where possible use ‘dry mopping’ instead of ‘wet mopping’
• For staff, using appropriate, slip resistant footwear

Prevent falls in care homes with better lighting

Another leading cause of trips and falls is not having proper lighting in place. Poor lighting especially in dimly lit hallways can make obstacles less visible, you may trip over or even walk straight into a wall.

The first thing you should do is consider upgrading all your lighting. A study in the Journal of the American Medical Directors Association found that installing lighting that changed in intensity throughout the day reduced falls by 43% (between control and experimental sites).

Specifically, they tested circadian lighting, which increased short-wavelength (blue light) exposure during the day (6AM – 6PM) and decreased it overnight (6PM – 6AM).

Lighting like this, which better mirrors the body’s natural circadian rhythms, has also been shown to have a positive impact on sleep, mood and even reduce behavioral episodes (by 41% in one study).

So certainly look into a circadian/variable intensity lighting solution for your residents. However, even if that’s not something you can or would like to install at the present time, improving lighting quality in other ways can still help you reduce falls:

• Keep plenty of replacement lightbulbs stored at all times
• Use high quality lighting especially in common areas, hallways and areas most likely
• Don’t neglect outside areas, such as seating areas and car parks, this is especially relevant for staff and visitors too.
• Immediately upgrade any poor quality lighting that is dim
• Use lighting that is multi-directional to avoid black spots especially in hallways

Common trip hazards

Alongside lighting seriously and addressing slip hazards, you should also keep an eye out for these common causes of trips and falls and act to remove, fix, or mitigate the risk they case immediately. The most common trip hazards in a care home are:

• Uneven floor surfaces
• Worn parts or raised edges of mats, carpets and rugs
• Wires and cables (including from vacuum cleaners or other items plugged in temporarily)
• Objects left on floors
• Ill-fitting footwear/untied laces
• Low level drawers or cupboard doors left open

Your approach to mitigating each of these hazards will all vary of course.

Moving and Handling

Incidents during moving and handling can result in painful injuries for residents, but perhaps more common are injuries to care workers.

The best way to reduce hazards from moving and handling is to ensure care staff have proper, up-to-date training (i.e. regular refreshers are needed) in how to use equipment safely. At a minimum, training should include:

• Spinal care – what are the causes of back pain and how poor moving and handling techniques or equipment use can cause or worsen back pain or other musculoskeletal issues
• Ergonomics – how staff can evaluate the task, environment, load (weight), capability of the resident and ability of the staff member to ensure safe moving and handling.
• Using each piece of equipment safely
• How to cooperate with and reassure residents for safer moving and handling
• Proper manual handling techniques
• When to ask for additional assistance from colleagues
• How our own fitness, obesity, pregnancy, tiredness or other physical conditions should be factored in
• When it is not safe to work individually and how many people are optimal to assist with each moving and handling task/how to determine this yourself

Secondly, conduct regular checks on the quality, suitability and maintenance of your equipment (such as your hoists) used in moving and handling. Statutory inspections for equipment and accessories used to lift people are every six months. Obviously any issues with equipment could lead to serious injury for staff and or residents.

Hot water and surfaces

All of us are at risk from being burned or scalded occasionally, usually in very minor ways, but for many people living in our care homes the risks are much greater.

Whether due to mobility issues, cognitive impairment or issues with their sensitivity to heat or pain, many of the people we care for run the risk of sustaining serious, traumatic injuries from commonplace fixtures, fittings and devices in care homes.

Individual risk assessments should take these factors into account, for example whether a person can run a bath independently, can they get out of the bath independently (if it is too hot) and can they call for assistance. Here are some additional practical steps you can take to reduce hazards around heat in a care home:

Hot surfaces

If people are assessed as potentially coming into prolonged contact with hot surfaces, especially radiators and/or pipework (because they are unable or less likely to move for any reason) then equipment should be designed or covered so that the ‘maximum accessible surface temperate’ does not exceed 43°C.

You can also reduce such hazards by:

• Putting sources of heat out of reach
• Guarding the high temperature areas that people may come into contact with (using radiator covers and/or suitable covering on exposed hot pipework)
• Using low surface temperature heat emitters

Hot water

The best way to prevent people burning or scalding themselves with hot water is to fit controls that restrict the temperate of water that comes out of residents’ baths, sinks, or other water sources accessible to them. The water temperature should not exceed 44°C.

Examples of solutions include thermostatic mixing values (or TMVs) or instant water heaters that are temperature restricted. More information on these and the correct ones to use in care services like yours can be found via BEAMA.

There are other solutions you can use to keep the water available to residents at a safe temperature, but locking doors, or removing hot water taps is not recommended. This can prevent the flow of water (ensuring it is flushed out regularly) which can increase the risk of legionella.

Most modern electric showers include features to regulate temperature to a safe level. But these are not always effective when there are fluctuations in water pressure. A safer alternative is to install ‘healthcare standard’ showers that prevent unsafe hot water temperatures in all conditions. These are the showers that the NHS fit in all their healthcare settings.

Food hazards in care homes

When it comes to food in care homes there are four areas of hazard:

1. Biological (bacteria, viruses, fungi)
2. Physical (bones, dirt, foreign objects in food)
3. Allergenic
4. Chemical (typically the accidental admixture of cleaning products to food)

The best way to prevent food hazards in care homes is to have clear rules, guidance, policies and procedures You should ensure all members of staff have received training (and receive regular refreshers appropriate to their role and duties (typically either a level 1, level 2 or level 3 food safety certificate, depending on their responsibilities in relation to food).

Basic levels of assessment are also included in the Care Certificate, covering food safety in fluid and food, however this is not a substitute for a food safety certificate.

You also must implement and use a Food Safety Management System (FSMS), it is a legal requirement to do so. An FSMS is a written document that systematically explains and helps care home staff to control food safety.

An FSMS helps ensure staff follow the correct food safety and hygiene practices. Its important that the FSMS is easily accessible to staff at all times, it shouldn’t be a single printed folder tucked away in an office somewhere.

Small care homes could use a ready made FSMS from the Food Standards Agency called ‘Safer Food, Better Business’, which should be used I conjunction with the Residential Care Homes Supplement also produced by the Food Standards Agency.

Bed rails hazards

Bed rails are widely used in care homes to prevent some residents falling out of bed. However, bed rails introduce risks too. In some cases where bed rails have been incorrectly fitted they have led to fatalities, where a person’s chest, limbs or their neck has become stuck in gaps between the bed rails, or the rails and the bed, mattress or headboard.

Aside from bed rails being fitted incorrectly, other hazards include people rolling over or climbing over the rail or foot-board, violently shaking and damaging or dislodging the bed rails, and self-harm.

In any use of bed rails, an individualised risk assessment needs to be conducted for each person. As always training is important to mitigate this hazard too. It is important to remember that bed rails should not be your default option, they should only be used when they are deemed to be the best solution to prevent falls.

In addition you should also check:

• for gaps that could cause a person’s head, neck, chest or limbs to become trapped
• that the mattress fits snugly between the bed rails
• the bed rails are correctly fitted and as with all equipment regularly inspected and maintained

Legionella

Legionella is a bacteria commonly found in water and multiplies in temperatures between 20-45°C with suitable nutrients (such as rust). The bacteria remain dormant below 20°C and cannot survive above 60°C.

If someone inhales airborne water droplets containing viable Legionella bacteria they may contract Legionnaires’ disease, which is a form of pneumonia that can be fatal. Elderly people are especially at risk of developing the disease.

The best way for you to protect your care home and residents from this harmful bacteria is by controlling the temperature of your water and storing it at 60°C or higher. When water is distributed it should be above 50°C, with thermostatic controls in place at outlets to prevent burns or injury (as discussed in the section above on temperature based hazards)

Meanwhile cold water should be stored and distributed below 20°C.

Of course you need regular risk assessments and a competent person should regularly inspect (using water samples and checking for potential causes of future risk) and clean the system in line with your risk assessment. Legionella thrives in stagnant water too, so to reduce risk:

• remove dead ends and ‘dead legs’ in your pipework
• keep pipework as direct and short as possible
• de-scale shower heads and hoses (at least quarterly)
• flush out shower heads and taps (at least weekly)
• regularly drain and check hot water tanks for signs of corrosion or debris that could act as food for the bacteria and stimulate their growth
• insulate pipes and tanks to control temperature effectively
• fit water storage tanks with insect screens

Medication errors

We can all understand why medicine errors can be so serious. One of my colleagues has covered how to prevent medication errors in more depth than I can go into here. And we even have a selection of downloadable guides to help you understand the causes, consequences and solutions to medicine errors in care homes and nursing homes.

Fire hazards in a care home

Identifying and reducing fire hazards in a care home is a topic in its own right. We’ve covered it in more detail in an article on care home fire safety which I would recommend reading alongside this one.

Hazards in a care home – your next steps

I hope you found the information you were looking for to help mitigate the most common hazards in care homes. The advice here is of course limited and you should consult information from the relevant bodies (such as the Health and Safety Executive) for more detailed guidance.

Despite the specifics of each hazard you may encounter, there are three components that will impact your response to any hazard, any I can think of at least. These are:

Having detailed, accurate, up to date and (where relevant) personalised, individualized risk assessments are key to helping you identify and address or reduce the risks posed by any hazard in your care home. These should be used to mitigate risks and make decisions in how to maintain safety.

Comprehensive, high quality training for staff, with regular refreshers and check ups.

Culture of shared responsibility and openness. Staff should feel both responsible for identifying and reporting hazards in the care home. They should not feel any pressure to ignore or conceal hazards, however supposedly minor these are. They should be comfortable and confident reporting hazards, saying when they are concerned or unsure about something and when they feel they need more training or guidance.

Robust care policies and procedures can also help staff to identify potential hazards and take steps to address them. They also contain necessary guidance so staff know how to handle different potential hazards and risks that they encounter.

How software can help you manage and reduce hazards

Access Policies and Procedures is a digital policies and procedures platform that enables better management of your policies and procedures, helping you keep them all up to date, enabling ease of access and use via a mobile app and with useful dashboards to ensure staff members have read the policies you have allocated them.

This all means staff have access to the policies and procedures they need, at their fingertips when they need them, which should help reduce risk and prevent hazards.  

Electronic Medication Management software can also help reduce all kinds of medication errors, while care planning software for care homes - with digital risk assessments and automated follow up processes - helps make the process of assessing and mitigating risks more efficient and less prone to error or not being completed properly (from assessment, to actions, to reviews).

eLearning for care homes can make training more engaging, inclusive, affordable and easier to manage.

Finally software to assist with care auditing like our own care compliance software enables you to audit your care services in a more efficient and systematic way, to ensure all necessary audits are completed and follow up actions are taken by appropriate persons in a way you can track and easily monitor, across multiple locations from a single digital system.

Of course, as you’ve probably guessed, Access Group provides all of these systems. Delivered via one integrated platform, with one login and lots of easy to use dashboards and reports to help you keep on top of your workload, including managing hazards and risks.

Find out more about all our care home software, or get in touch now and we can talk through what your aims are and how we might be able to help.