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Click on the area for more specific information.
Common safety and health topics:
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Ergonomics
Ergonomics is the science of fitting the job to the worker. When there is a mismatch between the physical requirements of the job and the
physical capacity of the worker, work-related musculoskeletal disorders (MSD) can result.
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Potential Hazard
Ergonomic hazards that are not effectively addressed in the safety and health program.
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Resulting in
musculoskeletal disorders, increased
injury costs, higher turnover rates, increased sick/injured
days, and staffing shortages.
Possible Solutions
OSHA recommends that
employers address ergonomic issues in their facility's Safety and
Health Program, see Administration
- Safety and Health Program.
Additional Information
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Patient Handling Program
According to the Bureau of Labor Statistics in 1994,
of the 10 occupations with the largest number of injuries and illnesses, nursing aides and orderlies are exceeded only by truck drivers and
non-construction laborers. Back injuries average more than $8,400 each, in Worker's Compensation expenses.
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Potential Hazard
Potential risk factors for ergonomic injuries in patient handling include:
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Overexertion; trying to stop a patient from falling or picking patient up from floor or bed.
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Multiple lifts per shift (more than 20; ref. OSHA
Framework Document).
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Lifting alone, no available staff to help.
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Lifting un-cooperative, confused patients.
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Lifting patients that cannot support their own weight.
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Patient weight.
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Expecting employees to perform work beyond their physical capabilities.
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Distance to be moved, and the distance the patient is from the employee, (it is more stressful to reach away from the body to lift or pull a
patient).
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Awkward postures required by the activity.
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Ineffective training of employees in body mechanics and proper lifting techniques.
Possible Solutions
It is recommend that patient handling injuries be addressed in the facility's safety and health program.
Areas that should be addressed in a patient handling safety and health program are:
Management Leadership/Employee Participation:
Workplace Analysis to identify existing and potential
patient handling hazards and find ways to correct these hazards. Changes are then implemented to correct the most stressful of
patient transfers. These changes are continually evaluated to reduce risk of injury. Periodic screening surveys are used to help
identify stressful tasks and hazards.
Accident and Record Analysis:
Records of injuries and illnesses should be analyzed to identify patterns of injury that
occur over time, enabling the hazards to be addressed and prevented. This includes reviewing OSHA 200 logs, OSHA 101 forms
and Workers' Compensation reports.
Hazard Prevention and Control including implementing
administrative and engineering controls.
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Administrative controls: Provide for adequate staffing, assessment of patient
needs, and restricted admittance policies.
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Engineering controls: Help to isolate or remove the hazards from the workplace, for example providing proper selection
and use of assist devices or equipment (see Patient Handling Controls Section).
Medical Management: A medical management program, supervised by a person
trained in the prevention of musculoskeletal disorders, should be in place to manage the care of those injured. The program should:
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Accurate injury and illness recording.
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Early identification and treatment of injured employees.
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"Light duty" or "no lifting" work restrictions
during recovery periods.
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Systematic monitoring of injured employees to identify when they are ready to
return to regular duty.
Training:
A training program, designed and implemented by qualified persons, should be in place to provide continual
education and training about ergonomic hazards and controls to managers, supervisors and all healthcare providers, including
"new employee" orientation. Training should be at a level of understanding appropriate for those individuals being
trained, and should also include:
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The opportunity to ask questions of the trainer.
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An overview of the potential risks, causes, and symptoms of back injury and
other injuries.
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Ways to prevent and treat these injuries.
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Encouragement of staff physical fitness.
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Lifting guidelines for health care workers (nurse assistants, licensed practical nurses, registered nurses) which should include:
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Never transfer patients when off balance.
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Lift loads close to the body.
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Never lift alone, particularly fallen patients,
use team lifts or use mechanical assistance.
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Limit the number of allowed lifts per worker per day.
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Avoid heavy lifting with spine rotated.
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Training in when and how to use mechanical assistance.
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Patient Handling Controls
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Potential Hazard
Hospital health care workers (especially nursing assistants, who do a majority of the lifting in many facilities) may develop musculoskeletal injuries
such as sprains and strains from patient handling tasks if they:
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Repeat the same motion throughout their workday (i.e., repeatedly cranking manual adjustments for beds).
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Do their work in an awkward position (i.e., reaching across beds to lift patients).
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Use a great deal of force to perform their jobs (i.e., pushing chairs or gurneys across elevational changes or up ramps).
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Repeatedly lifting heavy objects (i.e., manually lifting immobile patients).
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Face a combination of these risk factors.
Possible Solutions
Good work practice includes continually identifying the most hazardous tasks and implementing engineering and work practice controls to help
reduce or prevent injuries in those tasks.
For example, implement the use of:
Back belts:
The effectiveness of back belts in reducing the risk of back injury among healthy workers remains unproven.
For additional information, see
the Nursing Home
eCAT - Whirlpool/Shower Module.
Additional Information
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Trips/Slips/Falls
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Potential Hazard
Trip/slips and
falls from spills or environmental hazards.
Possible Solutions
Good work
practice includes implementing engineering and work practices
controls to help prevent slips/falls such as:
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Eliminate uneven
floor surfaces.
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Create non slip
surfaces in toilet/shower areas.
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Use of no skid
waxes and surfaces coated with grit or waterproof footgear
may also help decrease slip/fall hazards.
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Immediate clean-up
of fluids spilled on floor.
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Safely working in
cramped working spaces-avoiding awkward positions, using
equipment that makes lifts less awkward.
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Eliminate cluttered
or obstructed work areas.
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Provide adequate
lighting especially during night hours. Flashlights or low
level lighting could be used when entering patient
rooms.
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Provide adequate
staffing levels to deal with the workload.
For additional information, see HealthCare Wide
Hazards - Slips/Trips/Falls.
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Awkward Postures
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Twisting
while lifting
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Awkward
postures occur with twisted, hyper-extended or flexed
back positions. They are unsafe back postures for patient
lifting. More information about awkward postures
can be found in:
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Back
flexion
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Potential Hazard
Increased
potential for employee injury exists when awkward postures are
used when handling or lifting patients. Awkward
postures include:
Possible Solutions
Good work
practice recommends avoiding awkward postures while lifting or
moving patients.
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Educate and train
employees about safer lifting techniques.
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Use assist devices or
other equipment when possible.
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Team lifting based on
assessment.
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