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Ergonomics 101: A primer in safe clinic practices


February 1, 2019

 As the new year gets underway and winter weather throughout the country starts to take hold, injuries to both healthcare workers and patients will begin to mount.

According to OSHA, musculoskeletal disorders (MSD) are one of the biggest sources of injuries to healthcare workers. They’re usually related to slips, trips, and falls, or to unsafe patient handling practices.

Statistics show that in 2010, nursing aides, orderlies, and attendants had the highest rates of MSDs. There were 27,020 cases, which adds up to about 249 for every 10,000 workers—more than seven times the average for all industries. 

In 2010, the average incidence rate for MSD cases with days away from work increased 4%, while the MSD incidence rate for nursing aides, orderlies, and attendants increased 10%.

These injuries are largely due to overexertion related to repeated manual patient handling activities, OSHA says; such activities often involve the heavy manual lifting associated with transferring patients from one place to another, repositioning patients, and working in extremely awkward postures. Some examples of patient handling tasks that may be identified as high-risk include:

  • Transferring patients from toilet to chair
  • Transferring patients from chair to bed, or from bathtub to chair
  • Repositioning a patient from side to side in bed, lifting a patient in bed, repositioning a patient in his or her chair, or making a bed with a patient in it

Sprains and strains are the most often reported nature of injuries, and the shoulders and low back are the most affected body parts. The problem of lifting patients, OSHA says, is compounded by patients’ increasing weight (due to the country’s obesity epidemic) and the rapidly growing number of older people who require assistance with activities of daily living.

In addition to the large workforce and the large number of injuries generated, the healthcare industry also has a much higher than average rate of slips, trips, and falls on the same level. In 2007, the Bureau of Labor Statistics (BLS) reported that the incidence rate of lost workday injuries from slips, trips, and falls on the same level in hospitals was 35.2 per 10,000 full-time equivalents (FTE), which was 75% greater than the average rate for all other private industries combined (20.2 per 10,000 FTEs).

Slips, trips, and falls due to liquid contamination (water, fluid, and slippery, greasy, and slick spots) were the most common cause (24%) of claims for the entire study period of 1996–2005. Food service, transport and emergency medical service, and housekeeping staff were at the highest risk of slip, trip, and fall claims in the healthcare industry, while nursing and office administrative staff generated the largest numbers of slip, trip, and fall claims.

Recent BLS data indicates that total slips, trips, and falls accounted for 22% of all nonfatal occupational injuries and illnesses involving days away from work in 2006.

Finally, U.S. Department of Health and Human Services data shows that total slip-, trip-, and fall-related injuries account for the second greatest proportion (30%) of all work-related emergency department visits requiring hospitalization. 

The silent injury

Ergonomics injuries are known in some healthcare safety circles as the “silent injury” because of how the effects can appear over many years from repetitive tasks in the healthcare environment. Seemingly mundane actions such as typing on the computer, hunching over a laboratory microscope, or lifting a box to put it on a shelf don’t seem particularly sinister on their own, but years of doing these tasks the wrong way can result in painful injuries later on in life. Even strong and flexible people can suffer musculoskeletal injuries to bones, muscles, and ligaments that can leave them not only in pain, but unable to perform tasks at work.

And if these injuries haven’t shown up yet in your employees, they likely will soon. By some accounts, the working population over the age of 55 will grow by 38% in the next decade, and by 75% in the next 25 years.  

The consequences of work-related musculoskeletal injuries among nurses are substantial. Along with higher employer costs due to medical expenses, disability compensation, and litigation, nurse injuries also are costly in terms of chronic pain and functional disability, absenteeism, and turnover. As many as 20% of nurses who leave direct patient care positions do so because of risks associated with the work. Back injuries alone are estimated to cost the healthcare industry $20 billion annually in both direct and indirect costs. In addition, healthcare employees who experience pain and fatigue may be less productive, less attentive, more susceptible to further injury, and more likely to affect the health and safety of others.

Safe lifting practices

Ergonomic injuries from lifting heavy weights and  from transferring loads from one place to another are also major causes of healthcare worker injuries. Think of the nurses and assistants who help your patients out of their cars, or from a chair to a bed. As we get older, muscles can’t handle the stress they previously could, and something as routine as getting a box from a high shelf can cause a strain or broken bone.

Given the increasingly hazardous biomechanical demands on caregivers today, it is clear the healthcare industry must rely on technology to make patient handling and movement safer. OSHA says patient transfer and lifting devices are key components of an effective program to control the risk of injury to patients and staff associated with lifting, transferring, repositioning, or moving patients. Essential elements of such a program include management commitment to implement a safe patient handling program and to provide workers with appropriate measures to avoid manual handling; worker participation in the assessment and implementation processes and the evaluation and selection of patient handling devices; a thorough hazard assessment that addresses high-risk units or areas; investment in equipment; care planning for patient handling and movement; training for staff; and program review and evaluation processes.

The education and training of healthcare employees should be geared toward assessment of hazards in the healthcare work setting, selection and use of the appropriate patient lifting equipment and devices, and review of research-based practices of safe patient handling.

Assistive patient handling equipment and devices benefit not only healthcare staff, but patients as well. Explaining planned lifting procedures to patients prior to lifting, and enlisting their cooperation and engagement, can increase patient safety and comfort and enhance their sense of dignity.

But without the use of mechanical lifts and other technology available for healthcare workers today (because, let’s face it, budgets don’t allow for everything), what can be done? There are many things that can help save your workers’ backs, and it can start with simple education or an in-service training session.

Modify workloads. Heavy loads need not be moved or lifted all at once. If your clinic gets a shipment of heavy items, encourage workers to take several trips to stock shelves, for instance, or recruit coworkers to help. Lifting should be done using the legs, close to and directly in front of the body, and people should never lift objects above their head or do any lifting while the body is twisted. Stretching breaks should always be encouraged, and employees should use machines (e.g., wheelchairs, patient lifts, mechanized beds, forklifts, levers) whenever possible to help take the brunt of weight when lifting.

Employees should be taught to push heavy equipment as opposed to pulling it, and when feasible use carts to move things such as medications, cleaning supplies, and equipment, and to use handles on things such as gas cylinders to help transport them. Also, they should make sure to remove unnecessary objects on items being transported to minimize the weight of those items.

Monitor the work environment. According to NIOSH, many healthcare injuries occur from changes in the workplace environment caused by environmental issues that were either improperly maintained or were changes workers didn’t see coming. Take, for instance, a slippery floor that occurs from visitors tracking in moisture from a quick snowstorm, an uneven walking surface such as a change in elevation from one room to another, or an obstruction on the floor (such as a box or other object) that can cause a worker to trip. As a safety professional, you must mitigate these work hazards and post signs to areas that could pose a hazard, or restrict access to those areas.

Insist on proper footwear. One of healthcare safety professionals’ pet peeves is employees routinely wearing footwear that is inappropriate for the work being performed. Think of the lab assistant that wants to wear sandals to work in the summer, or the nurse who wears open-toed Crocs to her job. This is not only hygienically discouraged, but it can also be dangerous. A chemical can spill and burn exposed skin, and shoes with improper tread can lead to a slippery situation when lifting a patient. Any of these situations can lead to an injury resulting in missed work, workers’ compensation claims, or even a lifetime of pain and disability.

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