Background Injury in the home is a leading cause of morbidity and mortality for US children.

Objective Test the efficacy of the installation of safety measures on injury hazard reduction in homes of high-risk mothers and infants.

Methods Of the 1,589 mothers referred by the Every Child Succeeds home visitation program, 650 (41%) were eligible. Block randomization was used to assign households to the safety product installation intervention or control group. At the baseline home visit (BHV), a survey of 4 rooms (kitchen, main activity room, child’s bathroom and bedroom) was conducted using a validated instrument. Inter-rater reliability of research assistant assessment of hazards was undertaken on a random sample of 100 homes. The number and density (number of hazards per 100 sq. ft.) of hazards were quantified at baseline, 12- and 24-month follow-up visits. Statistical analysis included Pearson correlation, analysis of variance, and Kappa statistics.

Results We randomly assigned homes of mother-child dyads to experimental, (N = 324) or control (N = 326) groups. Most homes were single story (60%) and had a mean of 958 sq.ft. (s.d. 529) and 9 rooms (s.d. 3); 238 were single family (37%), 276 were apartments (43%) and the remainder multi-family homes (21%).

Inter-rater reliability for the mean number and density of injury hazards was 0.81 and 0.93 respectively, for the 4-rooms assessed within hours of each other. For individual hazards, kappa scores ranged from 0.69 for visible sharps on accessible surfaces <1 metre from the floor to 0.96 for fire escape ladders available and accessible on 2^nd floor, and 0.99 slats of infant cribs >0.6 cm apart.

At the BHV there were no significant differences in the mean number (p = 0.28) or density of injury hazards (p = 0.31) by group assignment. At the 12- and 24-month follow-up there were significant differences in the number (p < 0.001) and density (p < 0.002) of injury hazards by group assignment. In the intervention arm, the mean number of hazards for the 4-room sample was reduced from 41.8 (95% CI: 41.0, 42.6) to 33.6 (95% CI: 32.7, 34.6) at 12-months (p < 0.001) and 32.5 (95% CI: 31.5, 33.5) at 24-month home visit (p < 0.001).

Conclusions An intervention to reduce exposure to injury hazards in the homes of low-income mothers and their infants recruited from a home visitation program significantly reduced the number and density of injury hazards through 24-months of follow-up.