7.2 Risk prevention

3. RISK PREVENTION

 3.1. USER/PATIENT RISK PREVENTION 

Whatever the case, we can state that the key to risk prevention is to create spaces called "safe environments", adapted to the people who live and work in them.
Accordingly, a safe environment has the following aspects :

• To have support materials and products suitable for the person's needs: articulated bed, crane, bathtub bed, etc.
• To have protection systems (handrails) on the beds when the person's condition requires it.
• Ensure that there are handles in the bathroom.
• Make sure that the furniture (chairs, tables, shelves...) has rounded edges, that it is sufficiently robust and that its height is adequate for each user.
• Place handrails in the corridors at an appropriate height and handrails on the stairs.
• Keep the floor free of obstacles that make it difficult to walk.
• Avoid elements on the floor that could cause tripping and falling, such as carpets that are not well attached or loose cables without fixing. Tiles or steps that move must also be repaired.
• Mark the steps with brightly colored adhesive tape and place some anti-slip material. Also, point out any protruding edges.
• Keep the floor in the right conditions, with the anti-slip floor, which must be cleaned immediately when any liquid is spilled. Do not use waxes as they are slippery.
• Condition all spaces with adequate lighting, avoiding dark areas that reduce visibility or cause dazzle.
• Insist that users do not leave drawers or cabinets open.
• Store products that can cause poisoning in safe places and in their original packaging.

The Residential Centers are also equipped with the following structural safety elements:

• An evacuation plan that both staff and clients should be aware of, so that they know how to act in case of an emergency. 
• A preventive maintenance program, which includes conservation measures and reparation of floors, furniture, appliances and facilities.
• A system of signaling and emergency lighting, illuminated light switches and fire detection installation. 
• An access control to dangerous elements: knives, scissors, toxic products, if the center treats people with severe cognitive impairment.
• Elevators with doors that close automatically and equipped with photoelectric cells that prevent entrapment.

In addition, they must comply with the legislation regarding the distances between the different elements of furniture in the different rooms, including the bathroom.

* Environmental conditions:
Regardless of whether it’s a center or a home, it is necessary to make sure that the environmental conditions are pleasant, safe and that everything is sanitized. The elements to consider are:

• Temperature
  Households: sufficient equipment must be available to obtain the desired temperature (heating in winter and air conditioning in summer), and the user or the caretakers must be in charge of its regulation.
  Residential centers: the temperature regulation will be in the range between 20°C and 23°C. In rooms with sick people it will be a little higher, about 24°C, so these people should have a bathrobe to put on over their pyjamas if they have to wander through the corridors. 
• Lighting
  It is an element of comfort that plays a basic role in the room. It is also used to achieve stimulating environments suitable for the performance of different activities and will be of great importance as an element of safety.
  It is necessary to take advantage of the solar light that besides being natural, activating and economic, helps the person keep the contact with the outside, which favors to conserve the temporary orientation. When there is no solar light we will have an artificial illumination. Regarding this lighting as a safety element, some principles must be taken into account:
  In any place the illumination must be sufficient, even and without projection of shadows, reflections or dazzle.
  In areas where activities that require a visual effort (such as cooking, sewing, etc.) are carried out, the lighting should be increased.
  All areas of normal traffic should be illuminated and sudden changes in light intensity should be avoided.
  In darker places, there should be pilot lights in strategic places and lights with movement sensors.
  The mechanisms for activating the light must be easy to distinguish and accessible, that is, at the right height and located near the entrances and exits.
  At the side of the bed there should be a light point for reading, with an easily accessible switch.

• Ventilation
  Good ventilation is essential both in a home and in a residential center to: 
  -Renew the air.
  -Reduce the concentration of germs in the environment. 
  -Dilute bad odors
  All this is necessary to preserve the health of the person and to increase his well-being. 
  Natural ventilation is the most appropriate and hygienic. It can be done by opening doors and windows and it is enough to do it for a few minutes a few times a day when the room is empty.
  Artificial ventilation systems are used in areas where natural ventilation is more difficult, for example, in indoor areas or when bad weather prevents it (extractors).

• Thermo-acoustic insulation
  Noise is a factor to be considered since it affects many people, causing them irritability and discomfort, in addition to hindering the relaxation and rest that these people need. Therefore, measures should be taken to avoid or reduce unnecessary noise. Control the volume of televisions and radio sets.
  -Control the use of cell phones.
  -Wear shoes with rubber soles.
  -Move furniture carefully.
  -Put rubber heels on chairs so that they do not make noise when dragging.
  -Use a moderate tone of voice among working personnel, the sick and family members.
  -Enforce "quiet" signs, especially during visiting hours, by requiring an appropriate tone of voice and reasonable presence of people in the room.
  -Soundproof rooms used for activities that can produce loud sounds.
  -Bedrooms should be kept away from common areas and other traffic areas.
  -Windows and doors should provide acoustic and thermal insulation, etc.
  
  
• Order
  It is essential, both in the common areas and in the personal areas to facilitate the orientation of the user and to allow him to function safely in his environment.
  In any institutional center where different people live together, all of them must know where things are and must acquire the habit of leaving them in the same place once they have been used.
  The same goes for the individuals in their rooms and with their personal belongings, keeping things in order and organized. For example, we can use transparent boxes to store things, which can be classified by pasting pictograms or photographs to identify what they contain.

Questions for reflection:

Below you can see several images of a residence of the region. Reflect on which elements in the images favour a safe and accessible environment.