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Ergonomics Module  


    

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*Note: OSHA is currently involved in rulemaking concerning employee protection against Ergonomic hazards which may influence the following recommendations.

Many residents are totally dependent on staff members to provide for their activities of daily living (ADL), such as dressing, bathing, feeding, and toileting. Each of these activities involve multiple interactions with handling or transferring of residents and could result in employee injury. In addition, recent trends are seeing hospitals sending sicker, more dependent patients, to nursing homes for care, in an attempt to cut rising hospital costs.  

Click on the area for more specific information.
Shower Chair Level Floor Surface Mechanical Lift Equipment Patient Lift Requirements Slips/Falls - Lighting Slips/Falls - Lighting Walking Belt with Handles Wheelchair Sliding Board Trapeze Lift Adjustable Bed Adjustable Bed Possible Awkward Postures Possible Awkward PosturesHazards found in an Ergonomics Room  

Common safety and health topics: 



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 (WMSDs) disorders can result.

Hazard

Ergonomic hazards are not effectively addressed in the safety and health program.

  • Resulting in musculoskeletal disorders, increased injury costs, higher turnover rates, increased sick/injured days, and staffing shortages.

Example Controls

OSHA recommends that employers address ergonomic issues in their facility's Safety and Health Program, see Nurses Station Safety and Health Program Section.

OSHA is currently involved in rulemaking for Ergonomics which also addresses ergonomic programs.

Additional Information

 

 

Resident Handling Program

According to the Bureau of Labor Statistics in 1994, nursing home workers suffer most injuries (51.2 percent) when handling residents. Fifty-eight percent of their injuries are strains and sprains. While back injuries account for 27 percent of all injuries in the private sector, in nursing homes they account for 42 percent of all injuries. 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.

Hazard

Potential risk factors for ergonomic injuries in resident handling include:

  • Overexertion; trying to stop a patient from falling or picking patient up from floor or bed.
  • Multiple lifts per shift (more than 20; ref. OSHA Framework Document).
  • Lifting alone/no available staff to help.
  • Lifting un-cooperative, confused patients.
  • Lifting patients that cannot support their own weight.
  • Patient weight.
  • Expecting employees to perform work beyond their physical capabilities. 
  • 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).
  • Awkward postures required by the activity.
  • Ineffective training of employees in body mechanics and proper lifting techniques.

Example Controls

It is recommend that resident handling injuries be addressed in the nursing home safety and health program. 

Areas that should be addressed in a resident handling safety and health program are:

Management Leadership/Employee Participation:

  • Management Leadership should demonstrate a commitment to reduce or eliminate resident handling hazards through establishing a written program that addresses issues, such as:
    • Continued training of employees in injury prevention.
    • Methods of transfer and lifting to be used by all staff.
      • Compliance with transfer and lift procedures.
    • Procedures for reporting early signs and symptoms of back pain and other musculoskeletal injuries.
  • Employee Participation should include:
    • Complaint/suggestion program which includes employee reports of unsafe working conditions.
    • Prompt reporting of signs and symptoms as well as injuries.

Workplace Analysis to identify existing and potential resident handling hazards and find ways to correct these hazards. Changes are then implemented to correct the most stressful of resident 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.

  • Administrative controls: Provide for adequate staffing, assessment of resident needs, and restricted admittance policies. 
  • 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 Resident 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:

  • Accurate injury and illness recording.
  • Early identification and treatment of injured employees.
  • "Light duty" or "no lifting" work restrictions during recovery periods.
  • 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:

  • The opportunity to ask questions of the trainer.
  • An overview of the potential risks, causes, and symptoms of back injury and other injuries.
  • Ways to prevent and treat these injuries.
  • Encouragement of staff physical fitness.
  • Lifting guidelines for health care workers (nurse assistants, licensed practical nurses, registered nurses) which should include:
    • Never transfer residents when off balance.
    • Lift loads close to the body.
    • Never lift alone, particularly fallen residents, use team lifts or use mechanical assistance.
    • Limit the number of allowed lifts per worker per day.
    • Avoid heavy lifting with spine rotated.
    • Training in when and how to use mechanical assistance. 

 

 

Resident Handling Controls

Hazard

Nursing home 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 resident handling tasks if they:

  • Repeat the same motion throughout their workday (i.e., repeatedly cranking manual adjustments for beds).
  • Do their work in an awkward position (i.e., reaching across beds to lift residents). 
  • Use a great deal of force to perform their jobs (i.e., pushing chairs or gurneys across elevational changes or up ramps).
  • Repeatedly lifting heavy objects (i.e., manually lifting immobile residents).
  • Face a combination of these risk factors.

Example Controls

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. 

  • Provide employees with assist devices and equipment to reduce excessive lifting hazards. 
    • Proper equipment selection depends on the specific needs of the facility.

For example, implement the use of:

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  • Devices such as shower chairs that fit over the toilet, using this device can eliminate multiple transfers, saving health care workers multiple lifts. A patient can be moved to the shower chair, toileted, showered, and transferred back to the wheelchair.
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  • Shower stalls that allow for shower chairs to be pushed in and out on level floor surfaces. This is a standard shower without the front lip to allow for easy access.
  • Toilet seat risers: Use toilet seat risers on toilets to equalize the height of wheelchair and toilet seat, making it a lateral transfer rather than a lift up and back into wheelchair.
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  • Mechanical lift equipment to help lift patients who cannot support their own weight. Choose a lift that does not require manual pumping to avoid possible repetitive motion disorders to workers' arms or shoulders. Lift equipment can be categorized into 2 main categories: 
  • Lateral transfer devices: Devices used to laterally transfer a resident for example from bed to gurney. They usually involve multiple staff members to help do the lifting. This is often done with the help of a draw sheet, or similar device. Some new lateral transfer systems do not require any lifting by staff, and are totally mechanical. This type of device helps prevent staff back injuries. 
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  • Height adjustable electric beds that have height controls to allow for easy transfers from bed height to wheelchair height. These beds can be kept low to the ground for patient safety and then raised up for interaction with staff. Avoid hand cranked beds, which can lead to wrist/shoulder musculoskeletal disorders such as strain or repetitive motion injuries. 
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  • Trapeze lifts: A bar device suspended above the bed which allows residents with upper muscle strength to help reposition themselves. This device is particularly useful with adjustable beds and armless wheelchairs.
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  • Walking belts or gait belts (with handles) that provide stabilization for ambulatory patients by allowing workers to hold onto the belt and support residents when walking. Not designed for lifting patients.
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  • Wheelchairs with removable arms to allow for easier lateral transfers. Especially useful with height adjustable beds.
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  • Sliding boards: A slick board used under residents to help reduce friction during transfer of resident from bed to chair or when changing position in bed.
    • Hazards of tearing or burning skin if board is not functioning properly.  
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  • Resident care plans: A written care plan that describes specific resident needs, degree of assistance required, special treatments etc. Possible scenarios include:
    • Color coding of patient lift requirements for posting at bedside. By simply looking at displayed color coding system an employee can know what kind of assistance the resident will need with moving or transfers.
    • Segregation of residents based on need so equipment and trained staff are appropriately assigned.
    • Staggered staffing to provide additional manpower for peak periods.
  • Wheelchair Scale or Roll on weight scale: Patients who cannot stand can be weighed in their wheelchairs.

Back belts: The effectiveness of back belts in reducing the risk of back injury among healthy workers remains unproven.

  • If workers falsely believe that they are protected when wearing belts they may attempt to lift more weight than they would have without a belt, risking potential injury (See Backbelts: Do They Prevent Injury? (DHHS) (NIOSH) Publication No. 94-127).

For more ergonomic information see the Nursing Home Whirlpool/Shower Module.

Additional Information

 

 

Trips/Slips/Falls

Hazard

Trip/slips and falls from spills or environmental hazards.

  • Environmental hazards such as:
  • Slippery or wet floors.
  • Uneven floor surfaces.
  • Lifting in confined spaces.
  • Cluttered or obstructed work areas/passageways.
  • Poorly maintained walkway or broken equipment.
  • Inadequate staffing levels to deal with the workload, leading to single person lifts and greater chances of falls.
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  • Inadequate lighting, especially during evening shifts.

Example Controls

Good work practice includes implementing engineering and work practices controls to help prevent slips/falls such as:

  • Eliminate uneven floor surfaces.
  • Create non slip surfaces in toilet/shower areas.
  • Use of no skid waxes and surfaces coated with grit or waterproof footgear may also help decrease slip/fall hazards.
  • Immediate clean-up of fluids spilled on floor.
  • Safely working in cramped working spaces-avoiding awkward. positions, using equipment that makes lifts less awkward.
  • Eliminate cluttered or obstructed work areas.
  • Provide adequate lighting especially during night hours. Flashlights or low level lighting could be used when entering resident rooms.
  • Provide adequate staffing levels to deal with the workload.

 

 

Awkward Postures


Twisting while lifting
Twisting while lifting

Awkward postures occur with twisted, hyper-extended or flexed back positions. They are unsafe back postures for resident lifting. More information about awkward postures can be found in: 

Back flexion
Back flexion
Hazard

Increased potential for employee injury exists when awkward postures are used when handling or lifting residents. Awkward postures include: 

  • Twisting while lifting.
  • Lateral or side bending.
  • Back hyperextension or flexion.
  • Forces on the spine increase when lifting, lowering or handling objects with the back bent or twisted. This occurs because the muscles must handle your body weight in addition to the weight of the resident being lifted.
  • More muscular force is required when awkward postures are used because muscles cannot perform efficiently.
  • Fixed awkward postures (i.e., holding the arm out straight for several minutes) contribute to muscle and tendon fatigue, and joint soreness.
  • To be considered a risk factor, awkward postures need to last more than 1 hour continuously or for several hours in the workshift.
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  • Reaching forward or twisting to support a patient from behind to assist them in walking.

Example Controls

Good work practice recommends avoiding awkward postures while lifting or moving residents.

  • Educate and train employees about safer lifting techniques. 
  • Use assist devices or other equipment when possible.
  • Team lifting based on assessment.

 

 


 

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