AED	Automated external defibrillator
C	Centigrade
CDC	Centers for Disease Control and Prevention
CMS	Centers for Medicare & Medicaid Services
CO	Carbon monoxide
CPR	Cardiopulmonary resuscitation
EMS	Emergency Medical Services
F	Fahrenheit
FBAO	Foreign-body airway obstruction
HCS	Hazard Communication Standard
ID	Identification
MET	Medical Emergency Team
OSHA	Occupational Safety and Health Administration
PASS	Pull the safety pin, aim low, squeeze the lever, sweep back and forth
RACE	Rescue, alarm, confine, extinguish
RRT	Rapid Response Team
SDS	Safety data sheet

Safety is a basic need. Patients and residents are at great risk for accidents and falls. (See Chapter 14 for falls.) Some accidents and injuries cause death.

The health team must provide for safety. This includes you. Common sense and simple safety measures can prevent most accidents. Sometimes extraordinary measures are needed. You must protect patients, residents, visitors, co-workers, and yourself. The safety measures in this chapter apply to all health care settings and everyday life.

The goal is to decrease the person’s risk of accidents and injuries without limiting mobility and independence. The care plan lists other safety measures for the person. Measures to promote safety must not interfere with the person’s rights (Chapter 2).

See Focus on Surveys: Safety.

Focus on Surveys

Safety

A survey team will observe the agency setting and patient or resident rooms.

• For potential or actual hazards. A hazard is any thing in the person’s setting that could cause injury or illness. Examples include spills, loose hand rails, unanswered call lights, burnt-out bulbs, unsafe equipment, and other safety issues described in this chapter.

• For how staff respond to potential or actual hazards.

• If the care plan was followed on each shift for persons at risk.

• How staff supervise persons at risk.

• If the staff have removed or changed a hazard.

The survey team will interview staff. A surveyor may ask you:

• About measures in the person’s care plan to reduce the risk for an accident.

• When and how you report risks and hazards.

• When and how you correct an immediate hazard. A spill is an example.

• The agency’s procedures for removing or reducing a hazard.

You must provide for safety at all times. And you must know what to do if you find a hazard. Remember to give surveyors complete and honest answers. Surveys protect patients and residents.

A Safe Setting

In a safe setting, a person has little risk of illness or injury. The person’s setting is free of hazards to the extent possible. The person feels safe and secure physically and mentally. The risk for infection, falls, burns, poisoning, and other injuries is low. Temperature and noise levels are comfortable. Smells are pleasant. There is enough room and light to move about safely. The person and the person’s property are safe from fire and intruders. The person is not afraid and has few worries and concerns.

The person must receive the right care and treatment. To protect the person from harm, follow the person’s care plan. Also practice the safety measures in this chapter.

See Teamwork and Time Management: A Safe Setting.

Teamwork and Time Management

A Safe Setting

You may see something unsafe. Correct the matter right away if it is something you can do. For example:

• Wipe up spills right away. Do so even if you did not cause the spill.

• A person is sliding out of a wheelchair. Position the person correctly in the chair. Do so even if a co-worker is responsible for the person’s care.

• A person has problems holding a coffee cup. Offer to help the person.

• Food is left unattended in an oven. Turn off the oven. Then tell your co-worker the reason for your action.

You cannot correct some safety issues. Follow agency policy to report such problems. They include:

• Electrical outlets or switches coming out of the wall

• Electrical outlets that do not work

• Water leaks from windows, doors, ceilings, pipes, faucets, tubs, showers, toilets, water heaters, and other sources

• Toilets that do not work properly

• Water from faucets that does not warm up or that is very hot

• Broken or damaged windows or furniture

• Windows and doors that do not work properly

• Knobs and handles that are broken or do not work properly

• Hand rails and grab bars that are loose or need repair

• Odd smells, odors, and sounds

• Signs of rodents, flies, ants, or other pests

• Lights and lamps that do not work or have burnt-out bulbs

• Flooring (carpeting, tiles) needing repair

Accident Risk Factors

Some people cannot protect themselves. They present dangers to themselves and others. They rely on others for safety. Certain factors increase the risk of accidents and injuries. Follow the person’s care plan.

• Age. Children and older persons are at risk for injuries. See Focus on Children and Older Persons: Accident Risk Factors (Age).

• Awareness of surroundings. People need to know their surroundings to protect themselves from injury. Confused and disoriented persons may not understand what is happening to and around them. A coma can occur from illness or injury. Coma is a state of being unaware of one’s setting and being unable to react or respond to people, places, or things.

• Agitated and aggressive behaviors. Pain can cause these behaviors. So can confusion, decreased awareness of surroundings, and fear of what may happen.

• Vision loss. Persons with poor vision can fall or trip over toys, rugs, equipment, furniture, and cords. Some cannot read container labels. Poisoning can result. Harm can result from taking the wrong drug or the wrong dose.

• Hearing loss. Persons with hearing loss have problems hearing the spoken word. They may not hear warning signals or fire alarms. Some cannot hear approaching meal carts, drug carts, stretchers, or wheelchairs. They do not know to move to safety.

• Impaired smell and touch. Illness and aging affect smell and touch. The person may not detect smoke or gas odors. Burns are a risk from impaired touch. The person has problems sensing heat and cold. Some people have a decreased sense of pain. They may be unaware of injury. For example, Mrs. Parks does not feel a blister from her shoes. She has poor circulation in her legs and feet. The blister can become a serious wound.

• Impaired mobility. Some diseases and injuries affect mobility. A person may know there is danger but cannot move to safety. Some persons cannot walk or propel wheelchairs. Some persons are paralyzed.

• Paralysis means loss of muscle function, sensation, or both.

• Paraplegia is paralysis in the legs and lower trunk. (Para means beyond. Plegia means paralysis.)

• Quadriplegia (tetraplegia) is paralysis in the arms, legs, and trunk. (Quad and tetra mean 4. Plegia means paralysis.)

• Hemiplegia is paralysis (plegia) on 1 side (hemi) of the body.

• Drugs. Drug side effects may include loss of balance, drowsiness, and lack of coordination. Reduced awareness, confusion, and disorientation may occur. The person may be fearful and uncooperative. Report behavior changes and the person’s complaints to the nurse.

Focus on Children and Older Persons

Accident Risk Factors (Age)

Children

Infants are helpless. Young children have not learned safety and danger. They explore their settings, put objects in their mouths, and touch and feel new things. Falls, poisoning, choking, burns, and other accidents are risks. Practice the safety measures in Chapter 52 and Appendix D, p. 877.

Older Persons

Changes from aging increase the risk for falls and other injuries. Many older persons have decreased strength and move slowly. Some are unsteady. Often balance is affected. These changes prevent quick and sudden movements to avoid dangers and falls. Older persons also are less sensitive to heat and cold. They have poor vision, hearing problems, and a dulled sense of smell. Confusion, poor judgment, memory problems, and disorientation may occur (Chapter 49).

Some persons have dementia. Dementia is the loss of cognitive and social function caused by changes in the brain (Chapter 49). (Cognitive relates to knowledge.) Memory and the ability to think and reason are lost.

Persons with dementia are confused and disoriented. Their awareness of surroundings is reduced. They may not understand what is happening to and around them. Judgment is poor. They no longer know what is safe and what are dangers. They may access closets, cupboards, or other unsafe and unlocked areas. They may eat or drink cleaning products, drugs, or poisons. Accidents and injuries are great risks.

Identifying the Person

Each person has different treatments, therapies, and activity limits. Life and health are threatened from the wrong care.

The person may receive an identification (ID) bracelet when admitted to the agency (Fig. 13-1). The bracelet has the person’s name, room and bed number, birth date, age, doctor, and other identifying information.

You use the bracelet to identify the person before giving care. Your assignment sheet states what care to give. To identify the person:

• Compare identifying information on the assignment sheet with that on the ID bracelet (Fig. 13-2). Carefully check the information. Some people have the same first and last names. For example, John Smith is a very common name.

FIGURE 13-2 The ID bracelet is checked against the assignment sheet to accurately identify the person.

• Use at least 2 identifiers. An identifier cannot be the person’s room or bed number. Some agencies require the person to state and spell his or her name and give his or her birth date. Others require using the person’s ID number. Always follow agency policy.

• Call the person by name when checking the ID bracelet. This is a courtesy given as you touch the person and before giving care. Just calling the person by name is not enough for identification. Confused, disoriented, drowsy, hard-of-hearing, or distracted persons may answer to any name.

See Focus on Communication: Identifying the Person.

See Focus on Long-Term Care and Home Care: Identifying the Person.

See Promoting Safety and Comfort: Identifying the Person.

Focus on Communication

Identifying the Person

To identify the person, call the person by name. Ask to see the ID bracelet. For example: “Hello, Mr. Hall. May I see your ID bracelet?” Then ask for 2 identifiers. You can say: “Please tell me your full name and birth date.” Compare the identifiers with the information on the ID bracelet and your assignment sheet.

For some persons, identifying themselves is annoying. The person may say: “Do I have to say it again? You know who I am.” Be polite. Explain why you check the person’s identity. You can say: “It is important to check so I give care to the right person. It is for your safety.” Thank the person. Use his or her title and name. For example: “Thank you, Mr. Green.”

Focus on Long-Term Care and Home Care

Identifying the Person

Long-Term Care

Alert and oriented residents may choose not to wear ID bracelets. This is noted on the person’s care plan. Follow center policy and the care plan to identify the person.

Some nursing centers have photo ID systems (Fig. 13-3). The person’s photo is taken on admission. Then it is placed in the person’s medical record. If your center uses such a system, learn to use it safely.

FIGURE 13-3 The nursing assistant uses the photo to identify the person.

Promoting Safety and Comfort

Identifying the Person

Safety

Always identify the person before starting a task or procedure. Do not identify the person and then leave the room for supplies and equipment. You could go to the wrong room and give care to the wrong person. And the person for whom the care was intended would not receive it. This too could cause harm.

Sometimes ID bracelets are damaged from water, spilled food and fluids, and everyday wear and tear. If you cannot read the information on the ID bracelet, tell the nurse. The nurse can have a new bracelet made.

Comfort

Make sure ID bracelets are not too loose or too tight. You should be able to slide 1 or 2 fingers under a bracelet. If it is too loose or too tight, tell the nurse.

Preventing Burns

Burns are a leading cause of death among children and older persons. Smoking, spilled hot liquids, children playing with matches, barbecue grills, fireplaces, and stoves are common causes. So are electrical items and very hot water (sinks, tubs, showers). The safety measures in Box 13-1 can prevent burns.

Box 13-1

Preventing Burns

Smoke Alarms

• Have working smoke alarms.

• Have smoke alarms on every level of the home, in each bedroom, and outside each bedroom or sleeping area.

• Test alarms every month.

• Replace batteries when Daylight Savings Time changes in the spring and fall. Replace batteries even if alarms are hard-wired.

• Use alarms with flashing strobe lights if hard-of-hearing.

Children

• Do not leave children home alone.

• Supervise young children at all times.

• Do not leave children alone in the kitchen, bathroom, or a room with a fireplace.

• Secure fireplaces with door guards or heat-resistant gates.

• Install barriers around fireplaces, ovens, and furnaces. Avoid using glass screens that can become very hot and take a long time to cool down.

• Store matches, lighters, lamp oils, or other flammable materials in locked cabinets. Or store them out of the reach of children.

• Do not let children near stoves, space heaters, fireplaces, barbecue grills, radiators, registers, oil lamps, candles, curling irons, and other heat sources.

• Do not carry or hold a child while cooking.

• Keep space heaters and materials that can catch fire away from children.

• Teach children fire safety and fire prevention measures. Also teach the dangers of fire.

• Check metal playground equipment. Metal surfaces exposed to sunlight can heat to high temperatures. They can burn a child’s face, hands, arms, legs, and buttocks.

• Check car seats, seat belts, and seat-belt buckles. If hot, they can burn children.

• Cover car seats with towels if you park in the sun. Also use a sun visor for the windshield.

• Protect children from sun exposure.

• Use a sunscreen.

• Cover exposed areas.

• Limit time in the sun.

Kitchen and Cooking

• Do not let children help you cook at the stove, in a microwave oven, or on a barbecue grill.

• Use the back burners of stoves when cooking.

• Point pot and pan handles inward, toward the back. They point away from where people stand and walk.

• Do not leave cooking utensils in pots and pans.

• Do not wear clothes with long sleeves or that are loose-fitting when cooking.

• Keep things that can catch fire away from stoves. This includes paper towels, oven mitts, pot-holders, curtains, and so on.

• Do not put wet food into frying pans or deep-fryers. The water causes the oil to splatter.

• Use dry oven mitts and pot-holders. Water conducts heat.

• Stay near the stove, oven, microwave oven, and barbecue grill when cooking. Do not leave cooking unattended.

• Open or uncover microwaved foods slowly. Steam can burn your fingers, hands, or face.

• Keep hot food and liquids away from counter and table edges. Use the center of the counter or table.

• Turn the oven and stove burners off when not in use.

Eating and Drinking

• Assist with eating and drinking as needed. Spilled hot food or fluids can cause burns.

• Be careful when carrying hot foods and fluids, especially when near children and older persons.

• Do not pour hot liquids near a child or older person.

Water

• Set the hot water heater temperature no higher than 120°F.

• Have anti-scald devices installed on faucets and shower-heads.

• Turn on cold water first, then hot water. Turn off hot water first, then cold water.

• Measure bath or shower water temperature (Chapter 22). Check it before bathing a baby or before a person gets into the tub or shower.

• Check for “hot spots” in bath water. Move your hand back and forth.

Appliances and Other Electrical Equipment

• See “Preventing Equipment Accidents” (p. 169).

• Do not allow the use of space heaters. If used, they must be at least 3 feet away from items that can burn. Turn off the heater before leaving the room.

• Do not let the person sleep with a heating pad.

• Do not let the person use an electric blanket.

• Turn off and unplug irons, curling irons, electric rollers, and hair dryers when not in use.

Smoking

• Be sure patients and residents smoke only in smoking areas.

• Do not leave smoking materials at the bedside. They are left at the beside only if the person is trusted to smoke alone in smoking areas. Follow the care plan.

• Supervise the smoking of persons who cannot protect themselves.

• Do not allow smoking in bed.

• Do not allow smoking where oxygen is used or stored (Chapter 39).

• Be alert to ashes that may fall onto a person.

Other

• See “Preventing Fires” (p. 175).

• Follow safety guidelines when applying heat and cold (Chapter 38).

Burn severity (Chapter 54) depends on water temperature and length of exposure (Table 13-1). The person’s condition is also a factor.

• Superficial (first degree) burn—involves the epidermis (top layer of skin). Sunburn is an example. The skin is red and painful to touch. There may be mild swelling.

• Partial-thickness (second degree) burn—involves the epidermis and dermis. The skin appears deep red. The person has pain and blisters. The skin may appear glossy from leaking fluid.

• Full-thickness (third degree) burn—the epidermis and dermis, fat, muscle, and bone may be injured or destroyed. These burns are not painful. Nerve endings are destroyed. The skin appears charred or has white, brown, or black patches.

TABLE 13-1

Temperature and Time for a Third Degree Burn

Fahrenheit (F)	Centigrade (C)	Time Required for a Third Degree Burn to Occur
155°F	68°C	1 second
148°F	64°C	2 seconds
140°F	60°C	5 seconds
133°F	56°C	15 seconds
127°F	52°C	1 minute
124°F	51°C	3 minutes
120°F	48°C	5 minutes
100°F	37°C	Usually a safe temperature for bathing

See Focus on Children and Older Persons: Preventing Burns.

Focus on Children and Older Persons

Preventing Burns

Older Persons

Older persons are at risk for burns. Risk factors include decreased skin thickness, decreased sensitivity to heat, reduced reaction time, decreased mobility, communication problems, confusion, and dementia. Many of the measures in Box 13-1 for children apply to persons who are confused or have dementia.

Preventing Poisoning

A poison is any substance harmful to the body when ingested, inhaled, injected, or absorbed through the skin. If too much is taken, any substance can be poisonous. Poisonings are intentional or unintentional.

• Unintentional—the person takes or gives a substance without intending to cause harm. This includes drugs or chemicals used in excess amounts—an “over-dose.”

• Intentional—the person takes (suicide) or gives (assault or homicide) a substance intending to cause harm.

Poisoning can cause illness, brain damage, coma, and death. Children and older persons are at risk. Drugs and household products are common poisons. Poisoning in adults may be from carelessness, confusion, or poor vision when reading labels. As a result, a person may take too much of a drug.

Common poisons include:

• Drugs (legal and illegal) and vitamins

• Household products—detergents, soaps, sprays, furniture polish, window cleaners, bleach, paint, paint thinner, toilet bowl and other cleaners, gasoline, kerosene, glue, and so on

• Personal care products—soaps, shampoos, hair conditioners, bath oils, powders, lotions, nail polish removers, sprays, make-up, perfumes, after-shave lotions, deodorants, mouthwashes, and so on

• Fertilizers, insecticides, bug sprays, and so on

• Lead (p. 161)

• House plants

• Wild mushrooms

• Alcohol

• Carbon monoxide (p. 161)

The measures in Box 13-2 (p. 160) can prevent poisoning.

Box 13-2

Preventing Poisoning

All Ages

• Keep harmful products in high, locked areas (Fig. 13-4). Children and confused persons cannot see or reach them.

FIGURE 13-4 Harmful products must be kept in locked areas and out of the reach of children. A, Bathroom drawers and cabinets hold many harmful products. B, Household cleaners must be kept out of reach.

• Use prescription drugs correctly.

• Only take prescription drugs prescribed by a licensed health care professional.

• Take drugs as prescribed. Do not take larger or more frequent doses. This is especially important for pain-relief drugs.

• Do not share or sell prescription drugs.

• Keep all drugs in a safe place. Keep them where children cannot reach them.

• Read all directions and warning labels. Have good lighting.

• Follow all directions.

• Keep drugs in their original bottles or containers.

• Dispose of unused, no longer needed, and out-dated drugs.

• Buy products with child-resistant packaging.

• Keep child-resistant caps on all harmful products.

• Keep harmful products in their original containers. Do not store them in food containers.

• Leave the original label on harmful products (p. 171).

• Store personal care items according to agency policy. Soap, mouthwash, lotion, deodorant, and shampoo are examples. These items could cause harm when swallowed.

• Use and store harmful products according to the manufacturer’s instructions (p. 171).

• Do not sniff chemical containers.

• Read all labels carefully before using the product. Have good lighting.

• Do not leave harmful products unattended when in use.

• Do not mix cleaners or other household products together.

• Turn on fans and open windows when using cleaners and other household products.

• Point spray nozzles away from your face and other people.

• Do not store harmful products near food.

• Discard harmful products that are out-dated.

• Use safety latches on kitchen, bathroom, utility, garage, basement, and workshop cabinets and drawers.

• Discard poisonous household plants. Or place them where persons at risk cannot reach them.

• Keep emergency numbers by the phone: Poison Control Center (1-800-222-1222), police, ambulance, hospital, and doctor.

• Prevent carbon monoxide poisoning.

Children

• Keep children in your sight when using a harmful product.

• Teach children not to eat plants and unknown foods. Teach them not to eat leaves, stems, seeds, berries, nuts, or bark.

• Do not leave lamp oil, lamps with lamp oil, or candles containing lamp oil where children can reach them. Lamp oil is harmful if ingested.

• Practice safe drug use.

• Do not call drugs or vitamins “candy.”

• Do not take drugs in front of children.

• Do not put a dose on a counter or table where a child can reach it.

• Do not leave drugs unattended if you need to do something else when taking drugs. Take children with you.

• Secure child-safety caps on every drug.

• Put drugs away after taking them. Put them out of the sight and reach of children.

• Be aware that guests (including family and friends) may bring legal or illegal drugs into your home. Do not let children have access to purses, handbags, briefcases, backpacks, coat pockets, or similar items.

• Place warning stickers (“Mr. Yuk”) on harmful substances (Fig. 13-5).

FIGURE 13-5 The “Mr. Yuk” warning sticker is placed on harmful products. (Courtesy Children’s Hospital, Pittsburgh Poison Center, Pittsburgh, Pa.).

• Supervise children when visiting family and friends. Look for harmful products in and on counters, tables, bathrooms, and other areas and surfaces.

• Prevent lead poisoning.

See Focus on Long-Term Care and Home Care: Preventing Poisoning.

See Promoting Safety and Comfort: Preventing Poisoning, p. 161.

Focus on Long-Term Care and Home Care

Preventing Poisoning

Home Care

Provide good lighting when patients are taking their drugs. Make sure they read prescription labels correctly and are taking the correct drug and dosage (Chapter 53).

Bathroom medicine cabinets, drawers, and counters are checked for out-dated products and drugs. Also check for such items in kitchens and bedrooms. To safely dispose of out-dated items:

• Obtain permission from the person and the nurse.

• Follow agency policy for disposal.

Promoting Safety and Comfort

Preventing Poisoning

Safety

The Poison Control Center number is 1-800-222-1222. If you need to call the Poison Control Center, give the following information.

• The person’s age

• The person’s weight

• The person’s condition and health problems

• The substance, containers, or bottles involved

• How the substance entered the body

• Splashed into the eyes

• When the substance entered the body

• First aid given (Chapter 54)

• If the person has vomited

• Your location, name, and phone number

• Distance to the nearest hospital

Lead Poisoning

Lead is a metal. When in the body, it affects normal body functions. A very strong poison, it can injure the brain, nervous system, red blood cells, kidneys, liver, teeth, and bones. It can lower intelligence and cause learning and behavior problems. See Box 13-3, p. 162, for the sources of lead poisoning.

Box 13-3

Lead Poisoning

Sources of Lead Poisoning

• House paint before 1978. Children can swallow peeling paint and paint chips. When paint is stripped or sanded, lead dust is released into the air.

• Toys and furniture painted before 1976.

• Painted toys and decorations made outside of the United States.

• Lead bullets.

• Fishing sinkers.

• Curtain weights.

• Plumbing, pipes, and faucets. Lead can be found in drinking water if these devices contain lead.

• The soil near highways and houses. The soil may be contaminated with car exhaust and paint scrapings from houses.

• Hobbies that involve soldering, stained glass, making jewelry, pottery, and lead figures.

• Children’s paint sets and art supplies.

• Pewter pitchers and dinnerware.

• Storage batteries.

Lead Poisoning in Children: Signs and Symptoms

• Abdominal pain; cramping

• Activity: decreased

• Anemia

• Appetite: poor

• Attention and learning problems

• Behavior problems; aggressive behavior

• Bowel problems: constipation and diarrhea

• Language and speech problems

• Sensations: reduced

• Sleep problems

• Sluggishness

• Vomiting

• Walking problems; staggering

• Weight loss

Safety Measures to Prevent Lead Poisoning

• Prevent or discourage children from eating, chewing, or sucking on non-food items. They include:

• Toys and furniture painted before 1976

• Painted toys and decorations made outside the United States

• Paint chips

• Dirt

• Keys

• Pewter and lead-based figurines

• Fishing sinkers

• Other sources of lead as listed in this box

• Do not let children play in dirt. Have them play in grassy or sandy areas.

• Assist the child with hand-washing before eating, after playing outside, and before going to bed.

• Wash toys often.

• Rinse pacifiers, baby bottles, and other items that fall to the floor.

• Prevent exposure to lead-based plumbing.

• Do not use hot tap water for cooking or drinking. Let cold water run for 1 to 2 minutes before drinking water or using it for coffee or cooking. This helps flush the lead out of the plumbing.

• Do not use hot tap water to make baby formula.

• Prevent exposure to lead-based paint.

• Keep children away from paint chips.

• Keep children away from dust contaminated with lead paint.

• Do not sweep or vacuum lead-based paint dust or paint chips.

• Use a wet mop and wet cloths to clean up dust and paint chips.

• Use a wet mop and wet cloths to clean furniture, window sills, and dusty surfaces.

• Use duct tape to cover peeling or chipping paint. This is only a temporary measure. Peeling and chipping paint must be removed.

• Do not bump into walls or furniture that may contain lead-based paint. This prevents dust and paint chips.

• Do not open and close windows that have lead-based paint. This prevents dust and paint chips.

• Keep the home as dust-free as possible.

• Prevent exposure to food contaminated with lead.

• Do not use glazed pottery to cook food.

• Do not eat foods that are stored or served in glazed pottery.

• Do not eat foods that are canned outside the United States.

• Do not store wine, alcohol, or vinegar-based salad dressings in lead crystal decanters for long periods. Lead can get into the liquid.

• Prevent children from having contact with work or hobby materials that may contain lead. Welding, pottery, home building and repair, and automotive repair products and supplies are examples. So are children’s paint sets and art supplies.

• Store lead-based products where children cannot see or reach them.

• Take shoes off before entering the home.

• Shower and change clothes before contact with children.

• Wash and store clothes contaminated with lead separately from others.

• Do not let children handle or play with old newspapers, magazines, or comic books. The ink may contain lead.

Lead enters the body through:

• Inhaling dust. Windows may have lead-based paint. When windows are opened and closed, dust is created. Dust from soil may contain lead.

• Ingestion. Young children can eat, chew, and suck on non-food items containing lead. Toys and lead-painted surfaces—window sills and railings—are examples. They may eat paint chips. Water is a source of lead if plumbing materials contain lead.

Children between the ages of 6 months and 6 years are at risk for lead poisoning. Lead can affect almost every body system. Signs and symptoms are usually gradual in onset. They are not always obvious. See Box 13-3 for signs, symptoms, and safety measures.

See Focus on Long-Term Care and Home Care: Lead Poisoning.

Focus on Long-Term Care and Home Care

Lead Poisoning

Home Care

Household dust is a major source of lead. Window sills and window wells may contain high levels of leaded dust. The Centers for Disease Control and Prevention (CDC) recommends cleaning floors, window sills, window wells, and other surfaces every 2 to 3 weeks. The CDC recommends using a wet mop for floors and wet-wiping other surfaces.

The CDC also recommends keeping windows shut to avoid chipping painted surfaces. To open windows, the CDC suggests opening them from the top.

Carbon Monoxide Poisoning

Carbon monoxide (CO) is a deadly colorless, odorless, and tasteless gas. It is produced by the burning of fuel—gas, oil, kerosene, wood, charcoal (Box 13-4, p. 163). Fuel-burning devices must work properly and must be used correctly. Otherwise, dangerous levels of CO can build up in closed or semi-closed areas. Instead of breathing in oxygen, the person breathes in air filled with CO. Red blood cells pick up CO faster than oxygen. Oxygen does not get into the body. CO can quickly or slowly kill. If not fatal, brain and nervous system damage can result.

Box 13-4

Carbon Monoxide Poisoning

Sources of Carbon Monoxide: Examples