Category Archives: Injury Prevention

Four simple steps to prevent food poisoning

Summer means picnics, buffets, barbecues and outdoor parties – and an increased risk of food poisoning. Getting sick from improperly prepared or stored food is more common and more serious than you might realize. In the United States, food poisoning sends more than 100,000 people to the hospital each year, and it can have long-term health consequences. Common symptoms include abdominal cramps, nausea, fever, joint/back aches and fatigue.

It is important to make sure that food served at picnics, buffets, barbeques and parties is safe. Four simple steps can help to protect you and your family and friends from food poisoning:

Clean it:

  • Wash hands with soap and water before preparing or eating food.
  • Wash kitchen surfaces, cutting boards and utensils with soap and hot water.
  • Wash all raw fruits and vegetables.

Separate it:

  • Don’t allow juices from meat, seafood, poultry or eggs to drip on other foods.
  • Use a separate cutting board and knife for raw meats, seafood and poultry.
  • Use different dishes for raw foods and cooked foods.
  • To avoid cross-contamination, don’t add more food to a dish or platter that already has food on it.
  • Always serve food on clean dishes.

Cook it:

  • Cook foods at a high enough temperature to kill bacteria. Use a food thermometer to be sure.
  • Cook meat and poultry until the juices run clear.
  • Don’t eat raw eggs or food items made with raw eggs, such as homemade mayonnaise, cookie dough, etc.

Chill it:

  • Keep cold foods cold and hot foods hot. Cold foods should be kept at 40° F or colder and hot foods should be kept at 140° or hotter. Use ice, ice packs, and coolers or chafing dishes, slow cookers and warming trays to keep foods at the correct temperature.
  • Refrigerate perishable foods quickly.
  • Don’t leave foods and leftovers at room temperature longer than two hours.

Additional resources:

U.S. Department of Health and Human Services

Minnesota Department of Health Food Safety Center

The silent killer: How a near drowning impacted two families

Cooper Whitfield

No one heard 4-year-old Cooper struggle, splash, or cry for help. That’s because he didn’t.

A year ago last June, Cooper’s mom, Christie Whitfield, took Cooper and his two siblings, Molly and Kendall who were 7 and 1 at the time, to a private neighborhood pool. What began as a joy-filled, sun-soaked afternoon nearly ended in tragedy.

The hot weather drew dozens to the pool. The chairs near the shallow end of the pool were taken, so Whitfield found a seat near the deep end where she could apply sunscreen on Kendall.

Meanwhile, her oldest, Molly, jumped into the pool with a family friend. Whitfield put goggles on her son and told Cooper, who didn’t know how to swim but could touch the 3-foot section of the pool, to wait for her by the stairs of the shallow end until she could join him.

“Buddy, wait for me by the steps,” she said.

Moments later, Whitfield turned around. Cooper was nowhere to be found.

“Where’s Cooper?” she shouted.

That’s when she saw him at the bottom of the pool. Maternal instincts kicking in, she jumped into the water and screamed to others to call 911. She pulled Cooper, blue and unconscious, out of the pool.

The following moments zoomed by in a blur.

“I just kept thinking, ‘Somebody please save my baby,’” she said. “It was an out-of-body experience, but I still kept thinking and believing he was going to be okay and that this wasn’t going to be the end.”

Whitfield was trained and had been certified in CPR. But in those moments, she couldn’t comprehend what to do, she said.

Leah Mickschl and Cooper Whitfield

Leah Mickschl did.

Mickschl, a mom of two and an RN at Midwest Children’s Resource Center, started performing CPR on Cooper. It took three rounds before he regained consciousness, she said.

“I think about it all the time,” Mickschl said.

Surveillance later showed that Cooper had jumped into the water and tried to reach a raft but missed it. He didn’t splash or gasp. Silently, he fell to the bottom of the pool. A pool that was full of adults and children who thought Cooper was just swimming underwater.

Within minutes of the rescue, police and emergency responders arrived. Mickschl stayed behind with Whitfield’s other two children so she could accompany him in an ambulance to Children’s Hospitals and Clinics of Minnesota in Minneapolis, where he was treated in the Emergency Department. While he was still in shock and remained quiet, he was breathing normally.

Cooper remained at Children’s overnight for observation so physicians could make sure there was no brain or lung damage. Today, he’s a healthy, happy 5-year-old who has returned to the water.

In a situation like a near drowning, every second counts. Police told Whitfield had it not been for Mickschl’s quick intervention, Cooper may have suffered brain damage.

“Leah is an absolute hero,” Whitfield said. “I can’t say enough about her and how calmly and quickly she handled the situation.”

Mickschl, who grew up around water, said the event has made her more aware of her surroundings when she is by water and when her two kids, 8 and 10, are in water.

She added that what happened to Whitfield could happen to anyone.

“It was an awful day that has changed my life – I look at everything differently now,” Whitfield said. “I have an appreciation for so much. Life is so precious and can change in the blink of an eye.”

The Whitfield Family

Whitfield and Mickschl share their tips for parents and caregivers:

  • Inches count. While Cooper was able to touch the bottom of the pool in the 3-foot section, he nearly drowned where the depth was only 3-and-a-half feet.
  • Always be aware and always be present. If you have to step away, ask someone to watch your child.
  • Register your child for swimming lessons.
  • Get CPR certified.
  • Always use a lifejacket. Cooper typically wore one at the pool, but it got left behind.
  • Drowning is a leading cause of death in kids ages 1 to 4. Boys are at a higher risk for drowning.
  • Drowning is silent.

Find more water safety tips here.

Read our original story about the rescue and the honor Mickschl received for her efforts.

Join Christie, Leah and our trauma team when they hand out life jackets at local parks on Wednesday, July 10.

Sun safety for your child

Credit: iStock

By Molly Martyn, MD

One of the great aspects of childhood is being outdoors.  Whether you are at the swimming pool, a soccer game, or the park, it is important for all family members to practice sun safety.  Much of our lifetime sun exposure happens in the first 18 years of our lives, and protecting the skin of infants and children will reduce their skin cancer risk as they grow older.

What are different ways to protect children’s skin from the sun?

The first and easiest way to protect children’s skin is to be thoughtful about sun exposure.   The sun’s UV rays are the strongest between 10 a.m. and 4 p.m., so it is safest to plan for time outdoors in the morning or late afternoon.

When possible, stay in the shade.  Keep sun hats and sun glasses easily accessible in the stroller or your car.  Children should be dressed in cool, comfortable, lightweight clothing to cover their skin.  Dark clothing with a tight weave is best (you can test this by holding the cloth up to a light and seeing how much light gets through).  Use swim shirts when at the swimming pool.  Clothing made to protect from the sun is given an ultraviolet protection factor (UPF) rating.

Finally, for the parts of skin that can’t be covered, there are sunblock and sunscreen.

What is the difference between sunscreen and sunblock?

Sunscreen chemically absorbs UV radiation and dissipates it as heat.  Sunblock provides a physical barrier that reflects UV radiation.  Sunblocks contain compounds like zinc oxide or titanium dioxide that make them thick and may leave a visible layer (or block) on the skin.  Many products for children contain a combination of both.

How important is SPF? The higher the better?

SPF stands for sun protection factor.  It measures how well sunscreen protects from UVB rays.  When applied correctly, SPF 15 absorbs 93 percent of the sun’s UVB rays, SPF 30 absorbs 97 percent, and SPF 50 absorbs 98 percent.

What should you look for in a sunblock or sunscreen?

Sunscreens and sunblocks are regulated by the FDA (Food and Drug Administration) and the labels contain helpful information.  Look for a product that is labeled:

  •  Broad-Spectrum: this means that it blocks both UVB and UVA sun rays
  •  SPF 30 or higher
  • “Water resistant” or “very water resistant”. That means that the SPF is maintained after 40 or 80 minutes in the water.

What is the best way to apply sunscreen?

Use a lot!  Most people only use about half of what they need.  Cover all exposed areas, paying special attention to the areas that people commonly miss like the ears, the tops of feet and the backs of hands, along the hairline, and even in parts in the hair.

Be careful when applying sunscreen around the eyes.  It may be helpful to use a sunscreen stick for easier application in that area.

Sunscreen should be applied to dry skin at least 15 minutes prior to sun exposure to allow it to absorb into the skin.  Reapply every two hours OR after being in the water or sweating heavily.

Is there anything special to know about protecting babies’ skin from the sun?

Babies younger than 6 months have very sensitive skin.  As much as possible, they should be kept out of direct sunlight.  Dress them in light, protective clothing and use wide-billed sun hats.  For areas of their bodies that can’t be covered (like their faces or the backs of their hands), use an infant sunblock with at least SPF 30.

What about getting enough vitamin D?  Will limiting sun exposure lead to a low vitamin D level?

Sunlight is important for vitamin D synthesis.  However, the risks of sunburn, damage to the skin, and skin cancer trump this.  Children can get vitamin D through their diet, and some people also choose to take additional vitamin D supplementation.

What are the best remedies for a sunburn?

You can care for sunburns by applying cool compresses and aloe vera gel.  Gentle moisturizers can be applied to intact skin.  Ibuprofen may help to relieve discomfort and can be used for children older than 6 months.

To read more about sun safety and protection, good resources include:

1.  The American Academy of Pediatrics

2.  American Academy of Dermatology

 

 

Five Question Friday: Mitch Peterka

 

Your job title is injury prevention program coordinator, so what is a typical day like for you at Children’s? On any given day I can be found doing one of two things: planning for an upcoming event or hanging out in the community spreading safety. If I am planning that means I am working with event organizers or other people here at Children’s to make sure we put on a fun, yet informative, time. If I am at an event that means I am out talking with kids and their parents about different ways to be safe, like wearing bike helmets, using the right car seat and taking the right precautions around the home.

Mitch Peterka

This summer, you’re involved in “Making safe simple: 100 ways in 100 days.” What is that about? Even though Children’s is now a level I pediatric trauma center, we don’t want kids and families to have to meet our Emergency Department staff and trauma team. That is why we are going out into the community all summer long to let kids and families know how they can keep from getting injured. We are visiting parks, swimming beaches and our own neighborhood to give simple advice in all different ways.

What drew you to Children’s? Easy: The opportunity to work with the most fun population in the world (kids) at the greatest place around (Children’s).

Do you have a favorite memory from working at Children’s? Being able to watch Children’s – Minneapolis become a level I trauma center. I started working as an EMT in the Minneapolis Emergency Department almost five and a half years ago and now I work with the Trauma Services, so I am lucky to have had a front row seat to the making of this big achievement.

How do you spend your time outside of Children’s? I love traveling, being outdoors and finding adventure. Whether it is hiking Wild River State Park, skiing in Summit County, Colo., or biking the 30 days of April around Minneapolis, if it is outside I enjoy it.

Preventing and treating dog bites

We love our four-legged friends. But, dog bites can and do happen.

Each year, about 4 million Americans are bitten by dogs, and nearly 800,000 need medical attention, according to the American Academy of Family Physicians. The most common victims are children.

At Children’s Hospitals and Clinics of Minnesota, we tend to see an uptick in the number of dog bite cases beginning in May through September. During those months in 2012, we treated 87 kids for dog bites. Don’t let your child be a statistic this summer.

“It’s all about prevention,” said Dr. Michelle London, an Emergency Department physician.

There are some measures you can take to reduce the possibility of your child being bitten. Teach your children not to approach a strange dog, never go face to face with a dog or go near a dog when it’s eating, London said.

Dog bites can occur over food, added Erin Dobie, a certified nurse practitioner who also works in Children’s Emergency Department. Even if the dog is eating and a child drops a toy near the dish and bends down to pick it up, the dog could snap thinking that the child is going for the food. Dogs can also be provoked by kids pulling on tails or climbing on them.

If your child is bitten, here’s what to expect:

  1. Get the child away from the dog as quickly as possible.
  2. Be aware of the owner or the identity of the dog. While it shouldn’t be your top priority, it will help you determine later whether the dog is vaccinated.
  3. Control bleeding and put pressure on the wound.
  4. If skin isn’t broken, washing the wound is usually sufficient.
  5. If it appears there may be a laceration, take your child to the Emergency Department.
  6. In general, smaller puncture wounds are not sutured because of high risk of infection, but all dog bites need to be cleaned out well and prophylactic antibiotic treatment given to prevent infection whether or not they are sutured.
  7. If a dog can be observed for 10 days after a bite (when it is not to the head, face or neck) and is well, then rabies vaccinations aren’t recommended. However, parents still have the option at any time to start rabies vaccinations.
This post also appeared in the Star Tribune kids’ health section.

Patient Safety Week: Are we safer this year?

By Melissa Hamlin

It’s Patient Safety Week, but for patients and their families every week is safety week. It’s an opportunity for all of us to think about how we can collaborate to eliminate all preventable harm. It’s also a time of reflection:  Are we safer at Children’s Hospitals and Clinics of Minnesota this year than we were last year?

  • In the spring of 2012, we began rolling out bar code medication administration. That continues and is now being implemented on our St. Paul campus.
  • Also in the spring, we joined forces with 33 other pediatric hospitals to address our collective patient safety priorities:  blood stream infections, surgical site infections, urinary tract infections, ventilator acquired pneumonia, pressure ulcers, venous thromboembolism, readmissions, patient falls and adverse drug events. This work will be a continuous process based on evidence and best practice, and we are making a concerted effort to reduce the incidence of these events at Children’s.
  • In early September, the organization began a Daily Leadership Huddle that has provided Children’s leaders with increased awareness of front-line operations, a forum to identify problems and assign ownership for issue resolution and ensure common understanding of the day’s priorities.
  • Our infection control department initiated the “Wash ‘Em Proud” campaign encouraging staff, family and visitors to be active participants in reducing the spread of germs by practicing good hand hygiene.  (Check out our “Wash ‘Em Proud” video here.) As a result of organizational emphasis and awareness on healthcare acquired infections (HAI’s), we saw a significant decrease in the rate of HAI’s at Children’s — a 28 percent decrease from 2011 to be exact.
  • Our Quality and Safety team has begun work to increase awareness and visibility with front-line staff.  Early work is focusing on regular attendance at unit council meetings, transparency around safety events and increased communication.

We’ve made great progress, but we must continue adjusting our strategies to ensure that the patients who come to us are provided with the best, safest care possible.  At Children’s, we are committed to this.

So to answer the question: Are we safer this year than we were last year?  Yes, we are, but we can always make improvements. Here’s to making 2013 even safer!

Happy Patient Safety Week!

Hamlin, MSN, RN, BC, is a patient safety consultant at Children’s. 

Safety first: Holiday shopping for the kids in your life

By Kristi Moline

We’re a few weeks into the holiday shopping season. That came fast, didn’t it? I don’t know about you, but I still have some shopping left. At the top of my shopping list are gifts for my two small children. They’re 3 years old and 6 months old.

Both as a mom and in my role as program manager for injury prevention at Children’s Hospitals and Clinics of Minnesota, I think about safety first when I decide what gets put in the shopping cart.

Like all parents, I want my children to enjoy their toys. I buy toys that are fun and stimulate learning and growth. But, safety rules. Sadly, I’ve seen first-hand what can happen when a child gets a potentially dangerous toy in his grip. It can lead to injury or worse.

While working on this blog post, I learned that 13 kids age 14 and under died from a toy-related incident, according to the U.S. Consumer Product Safety Commission. A startling 262,000 were treated for toy-related injuries in emergency departments in 2011. The usual suspects for causing injuries are non-motorized scooters, toy vehicles and toy balls.

If those of you reading this are anything like me, you probably haven’t finished shopping yet, either. I’ve collected some safety tips – with the help of the CPSC –that I hope will help guide what you put in your shopping cart this holiday season:

  1. Read the label. Buy age-appropriate toys that suit the child’s interest and skill levels.
  2. Small balls and toys with small parts can cause choking. For kids under 3, avoid these toys.
  3. If you give or your child gets anything with wheels – like a scooter, bike or in-line skates – make wearing a helmet a rule. A properly fitted helmet should be worn every time and everywhere. For more information on this, visit our Making Safe Simple website.
  4. Anything containing a magnet can be dangerous and kept away from kids under 14.
  5. Check that toys are of high quality design and construction.
  6. Make sure  instructions are easy to follow; discard toy packaging immediately so it doesn’t become a hazard.
  7. Once playing is underway, supervise children accordingly.

Here’s to a happy and safe holiday season.

Making safe simple booth visit helps prevent at-home emergency

For the past two years, we’ve taken our Making safe simple program to the Minnesota State Fair. For 12 days from dawn until after dusk, we educate fairgoers on ATV, bike, car seat, and household safety.

Our goal is to help families prevent injuries and, in the case of an emergency, how to best respond. We hope no family experiences an emergency. But reality tells us it will and does happen.

Each year, 5,000 children die and another six million are hurt because of unintentional injuries. One in four kids is hurt seriously enough to need medical attention. We believe that, together, we can make safe simple.

That became even more apparent after the fair when we received the following email from Sarah who had visited our Making safe simple booth. Hours within visiting the fair, her family had taken our advice and put it into action to prevent an emergency from escalating. Here’s her story:

THANK YOU for the great, life-saving, or at least, garage-saving safety information your team provided at the Fair. My family and I visited your booth today and took your safety quiz this year. We’ve gone in the past and had fun, but this year it was extra helpful.

I got a “hard” question in the Plinko area and was asked about how to operate a fire extinguisher. I had to think about it a bit, but came up with a passable answer. The volunteer then taught us the PASS acronym about pulling the pin, aiming, squeezing the trigger and sweeping back and forth.

Not eight hours later, I looked out the back window of our kitchen and saw our grill on fire, flames all over the front. My husband and I jumped to our feet, grabbed the extinguisher and knew EXACTLY what to do. The fire was put out safely in just a few seconds—before the flames could jump to the adjacent tree, our garage, fence or the neighbor’s house. Whew!

Please pass my heartfelt thanks along to your wonderful team of fair volunteers. The information they provided helped us calmly and effectively deal with a household emergency—before it became a real emergency. We are all safe and sound tonight because of your help!

Thanks, Sarah, for sharing your story.

 

Making a safety list and checking it twice

This is a post by Dr. Rod Tarrago, a pediatric intensive care physician at Children’s Hospitals and Clinics of Minnesota.  He is also the Chief Medical Information Officer and is proud to admit he’s a computer geek.  He’s been helping improve the care at Children’s through the use of technology and spends most of his time helping other clinicians improve their understanding of the computer system. He’s the proud father of two young boys and future computer geeks. 

For nearly three years, the Pediatric Intensive Care Unit (PICU) at Children’s has been using a time-tested technique to improve care of patients: a safety checklist. It’s well known that it’s very difficult — if not impossible – for the human brain to truly multitask.

Unfortunately, in an ICU environment, where patients are sick and their illnesses complex, clinicians have to integrate a lot of information and make many decisions on a daily basis. There are also many “typical” tasks that need to be accomplished for every patient, every day.

In order to help the team remember to address all of these items, we’ve been using a safety checklist as part of our work since 2010.  In St. Paul, we go through this checklist during patient rounds.  In Minneapolis, since the unit is larger and busier, we do special “Safety Rounds” later in the workday.

On both campuses, the entire care team, including physicians, nurses, pharmacists, respiratory therapists, and nutritionists, comes together every day to go through the “standard list” of 23 safety items. These include reminders to check the need for IV and bladder catheters, make sure that antibiotics are needed, and order new labs each day. Each clinician specialty “owns” individual items and then brings them to the group for daily discussion, making sure that everyone is on the same page. Initially, we started this project by using a laminated paper checklist that was placed at each bedside. After losing too many checklists, we moved to an electronic checklist that is embedded in each child’s electronic medical record or EMR.

We recently examined 21 months’ worth of data after using the checklists and found some exciting results:

  • By asking whether we really needed catheters, we reduced the use of these catheters by anywhere from 25 to 45 percent. We also found that we used those catheters less.
  • By asking ourselves whether any medications can be given either orally or through a feeding tube instead of through an IV, we cut costs to families. We examined one medication, a diuretic, and found that by using the checklist, we used an IV 46 percent of the time instead of 77 percent of the time.  By using IV catheters less often, we reduce the risk of catheter infections. It’s also less expensive to give a medication orally compared to through the IV.  We saved patients’ families more than $64,000 over the study period by making these changes.
  • By simply discussing the need for antibiotics each day making sure that we identified ahead of time how long the antibiotics should last, we lowered our use of antibiotics.  In fact, by entering this information into the patient’s EMR, we found that we gave one less dose per patient each day.
  • Prior to the checklist, we ordered labs several days in advance. Now, the checklist reminds us to order them each day and discuss the need for each lab.  By doing this,  we reduced the number of labs we ordered by almost six labs per patient per day. This saves a family $500 a day in lab charges.

You may use a checklist at home or to run errands. In medicine, it’s a relatively new concept that’s only beginning to grow in popularity. But in our PICU, it’s the standard.