Worker wellness: Tips for promoting safe lifting practices
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January 19, 2020
Excerpted from Medical Environment Update
Despite healthcare workers’ inherent mission of healing others, they are still among the most commonly injured of any industry in the U.S.—a fact that has not escaped OSHA.
Unsurprisingly, most of those injuries are ergonomic injuries resulting from lifting heavy weights and improperly transferring loads from one place to another, usually while caring for patients.
According to OSHA’s latest statistics, the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector—up to 582,800 cases, according to the Survey of Occupational Injuries and Illnesses conducted by the Bureau of Labor Safety. That’s 153,900 more cases than the next highest industry sector, manufacturing.
According to OSHA, nursing assistants had some of the highest rates of musculoskeletal disorders of all occupations in 2017. The incidence rate of work-related musculoskeletal disorders for these occupations was 166.3 per 10,000 workers. This compares to the average rate of 30.5 for all workers in 2017.
Though they may seem high, the numbers have actually gone down since previous numbers were released in 2010. Back then, healthcare workers were injured at the alarming rate of about 653,900 cases, most of them from bloodborne pathogens and biological hazards, chemical and drug exposures, respiratory hazards, ergonomic hazards from lifting and repetitive tasks, workplace violence, lab hazards, and radioactive material and x-ray hazards.
Nursing aides, orderlies, and attendants had the highest rates of musculoskeletal disorders of all occupations in 2010. The incidence rate of work-related musculoskeletal disorders for these occupations was 249 per 10,000 workers compared to the average rate of 34 for all workers in 2010.
Back and lifting injuries
Injuries sustained by healthcare workers while lifting and moving patients have decreased in recent years, mainly due to improvements in techniques and equipment, but also because of less tolerance for a culture that treats injuries as “part of the job.”
Still, injuries are frighteningly commonplace. Many are due to overexertion from repeated patient-handling activities that often involve heavy manual lifting, as well as working in extremely awkward postures. Some examples of high-risk tasks include common jobs such as:
- Transferring a patient from toilet to chair
- Transferring a patient 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 a chair
- 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, and the problem is made worse due to the obesity epidemic in the United States and the rapidly increasing number of older people who require assistance with the activities of daily living,” according to OSHA literature. Plus, as we get older, our muscles grow weaker and simple routines like getting a box from a high shelf can result in a strain or broken bone.
The consequences of work-related musculoskeletal injuries among nurses are substantial—higher employer costs due to medical expenses, disability compensation, and litigation. Nurse injuries are also costly in terms of chronic pain, functional disability, absenteeism, and turnover.
OSHA says that as many as 20% of nurses who leave direct patient care positions do so because of risks associated with the work. Direct and indirect costs specifically associated with back injuries in the healthcare industry are estimated to be about $20 billion annually. In addition, healthcare employees experiencing pain and fatigue may be less productive or attentive. They may also be more susceptible to further injury, and more likely to affect the health and safety of others.
What can be done?
There are many things that can be done to help prevent injuries, from changing physical techniques to using equipment designed to ease the burden of heavy loads.
Modify workloads. There is nothing that says heavy loads have to be moved or lifted all at once. If your clinic gets a shipment of heavy items, encourage staff to take several trips to stock shelves or recruit help from coworkers. Lifting should be done using the legs, close to and directly in front of the body, never above the head or while the body is twisted. Employees should be encouraged to take breaks for stretching, and taught to push rather than pull heavy equipment.
Whenever possible, use machines (wheelchairs, patient lifts, mechanized beds, forklifts, levers) to help take the brunt of a heavy weight, and use carts to move things such as medications, cleaning supplies, and equipment. Use carry handles on gas cylinders to help transport them. Also, make sure to remove unnecessary objects on items being transported to minimize weight.
Monitor the work environment. According to the National Institute of Occupational Safety and Health (NIOSH), many healthcare industry injuries that occur in the workplace are caused by environmental issues that were either improperly maintained or changes workers didn’t anticipate. For instance:
- A slippery floor that occurs from visitors tracking in moisture from a quick snowstorm
- An uneven walking surface caused by a change in elevation from one room to another
- A tripping hazard, such as boxes or other objects placed on the floor
As a safety professional, it is your job to mitigate these work hazards and to post signs (or restrict access) to areas that could pose a hazard.
Insist on proper footwear. One of the perennial pet peeves of healthcare safety professionals is employees wearing footwear that is not appropriate for their work tasks.
Consider the lab assistant who wants to wear sandals to work in the summer, or the nurse who wears open-toed Crocs™ to work. This is not only discouraged for hygienic reasons but can also be dangerous. A chemical can spill and burn exposed skin, or shoes with improper tread can create a slipping hazard when lifting a patient. Any of these situations can lead to an injury resulting in missed work, workers’ compensation claims—or even worse, a lifetime of pain and disability.
Of course, it’s up to employers to continually identify the most hazardous tasks and implement engineering and work practice controls to help reduce or prevent injuries. Therefore, OSHA recommends that employers provide their employees with the proper assistance devices and equipment. There are many on the market, and what’s right for your facility will depend on the specific needs of the facility, patients, staff, and management.
Shower chairs. These devices can fit over a toilet and eliminate multiple transfers, saving healthcare workers multiple lifts. A patient can be moved to the shower chair, toileted, showered, and transferred back to a wheelchair. Shower stalls without a front lip can also be installed, which allow shower chairs to be pushed in and out on level floor surfaces.
Stair chairs. Also known as descent control systems, these devices allow patients to be moved up or down stairs or across rough terrain. They are commonly seen in ambulances or in other conditions where patients must be moved quickly, and can be attached to any ambulance cot currently on the market. When not in use, stair chairs fold up and out of the way.
Mechanical lifts. There are many types of mechanical lifts on the market designed to help lift patients who cannot support their own weight. OSHA recommends choosing one that does not require manual pumping to avoid possible repetitive motion injuries to the arms or shoulders.
- Overhead track-mounted patient lifters feature a track system built into the ceiling where sling lifts can be attached. This system provides patients/residents mobility from room to room without manual lifting.
- Sliding boards are used under patients to help reduce lifting needs during transfers from bed to chair, or chair to car. Patients slide rather than being lifted, but care needs to be taken that the board doesn’t slip out from under the patient, causing injury to either the patient or caregiver.
- Height-adjustable electric beds 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 for staff interaction.
- Trapeze lifts provide a bar suspended above the bed, allowing patients with enough upper body strength to reposition themselves. This device is particularly useful with adjustable beds and armless wheelchairs.
- Sitting-standing wheelchairs provide a sitting-to-standing option for patients and healthcare workers.
For more information on lifting hazards and safe lifting equipment, visit OSHA’s ergonomics website at https://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html#residenthandlingprogram.
Medical Environment Update is a sibling publication to Healthcare Safety Leader. For more information, go to http://hcmarketplace.com/medical-environment-update-1