Cultivate a Culture of Safety

Eliminating the Risks of Lifting

Ergonomics Across the Organization

Target Jobs for Hazards Analysis

Earlier this  year,  President  Bush signed  into law  S.J. Res. 6. This action repealed the Occupational Safety and Health Administration’s ergonomics standard and marked the first time the Congressional Review Act was implemented. Numerous reasons for the repeal were noted including the overall cost and compliance challenges for businesses. The President stated that his Administration would continue to work on a "comprehensive approach to ergonomics" that would respond to the concerns brought forth with OSHA’s standard. Regardless of one’s position on this issue, the nice thing is that many more people are talking about ergonomics and gaining a better understanding of what ergonomics is all about. Both sides of this issue can agree that even though OSHA’s ergonomics regulations were repealed, problems still exist and ergonomics has much to offer.

While many hospitals have an occupational program, physician and staff expertise for injury prevention is often underutilized by the parent organization. Widespread use of ergonomics and functional capacity exams to match applicants to high-risk healthcare jobs is generally lacking. This is readily apparent when one looks at industry data regarding injuries in healthcare where the average injury rates—8.5% for hospitals and 13.2% for nursing and personal care facilities—surpass those of general industry at 6.3%.¹

Safety and health statistics compiled by the Bureau of Labor Statistics continue to show a high number of musculoskeletal injuries, specifically sprains and strains among nursing aides, registered nurses, and orderlies.² The majority of these incidents involved the back. The problem for this predominately female population is that they are often exposed to physical demands that are the result of handling tasks unique to their industry. Traditional body mechanics principles are not always easily applied to positioning or transferring patients.³ Nurses, nurses’ aides, and orderlies often find themselves in situations requiring extended reaching with a load (as in reaching across the bed to position the patient or prepare for transfer), lifting loads with a flexed low back, and twisting with a load. All of these are risk factors for low back injury. Add to these awkward postures the possibility of an abrupt change in the load during a transfer, and it is easy to see why musculoskeletal injuries continue to be prevalent among these healthcare workers.

In any injury prevention program, it is important to focus on developing a safety culture within the facility. This safety culture differs from a safety program. A program usually denotes a process that has a beginning and end, while a culture is an ongoing way of life that permeates throughout the organization. This culture should consider all feasible means of avoiding injury, including the following hazard prevention controls:

• Engineering controls: use of equipment/technology

• Behavioral or work practice controls: training, body mechanics, or other joint protection principles

• Administrative controls: policies and procedures geared toward injury prevention, such as staffing ratios, job rotation, or job enlargement

• Use of personal protective equipment

Numerous studies exist that demonstrate the value of focusing our efforts on "engineering out" ergonomic risk factors through the use of available technology. Hospitals that have focused their efforts here have realized significant reductions in injuries associated with the noted risk factors. In a study conducted over a three-year period at a large long-term care facility, back injuries were reduced approximately 74% with a prevention program using mechanical lifting devices.⁴

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A variety of assistive devices are available that can control some risk factors associated with patient handling: 1) Sling lifts work well for maximum assist-type transfers. These can be on portable units or ceiling mounted. 2) Standing assist lifts have a sling that is looped under the patient’s arms. It is a useful device for chair transfers and toileting where the patient can weight-bear to some degree. 3) Sliding assists such as air flow mattresses and sliding sheets reduce the coefficient of friction so that less force is required to perform the task. There are also stretchers with built-in transfer devices. 4) Bed design—a number of advances in this area allow such things as converting a bed to a chair with the touch of a button. This eliminates the handling required with bed to chair transfers. This is of particular benefit with those patients requiring maximum assistance.

Naturally, there is additional cost associated with the purchase of such specialized equipment. This investment, however, often pales in comparison to the true cost of lost-time injuries, when medical, disability, and productivity costs are considered. Ergonomic equipment purchases often pay for themselves exponentially over time and can improve employee morale and retention, which is increasingly becoming an issue with today’s nursing shortage.

The amount of equipment and training required can be controlled by considering the concept of lift teams. These teams are trained in the use of special equipment and techniques. They respond throughout the hospital and can reduce risk to the larger caregiver population. These teams can also free up nursing staff to attend to other responsibilities. Given the current state of nurse staffing, this is an intriguing concept for some hospitals. A six-month pilot program at an Ohio hospital demonstrated a 100% reduction in nursing injuries on one unit using this concept.⁵

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This entire process of developing a safety culture must begin with a firm commitment to resolving and preventing the real problems, which will require the support of senior administration, risk management, and department managers. High-risk job tasks throughout the organization must be identified through job hazard analysis. Recommendations based on this analysis must be made. High-risk jobs must be re-designed to "engineer out" risk factors associated with them. Finally, a method must be in place to measure the effectiveness of the abatements selected. Emphasis must be placed on management commitment and employee involvement in the process.

There should also be an understanding that ergonomic principles can be applied to all areas within the hospital setting, not just those at risk for lifting-associated injuries. Given the large number of registrars, billers and secretarial support staff, hospitals also have a large number of computer workstations that pose a risk for repetitive motion injuries if not properly designed. Proper ergonomic analysis and design of computer/workstations for nursing units, food service areas, maintenance, laundry, and transport areas should also be a priority and can yield significant health benefits for those employees and reduce the overall injury rate for the parent organization.

Suggested job areas to consider for analysis:

• Nursing, Nurses’ Aides

• Orderlies, Patient Transporters

• Unit Clerks, Registrars, Billers

• Secretaries, Administrative Support Staff

• Food Service, Maintenance, Laundry

A good way to get your hospital-based ergonomics program started is to perform a job hazard analysis of tasks that have a high injury correlation. Data can be gathered from OSHA 200 logs, staff input, and incident/injury reports. Or, if the occupational health facility where workers are treated is computerized, the facility’s software may be able to provide a list of injuries and the jobs where they have occurred. Once positions have been identified, select the abatement measures that will have the greatest likelihood of reducing or eliminating the problem. A pilot study involving the abatements selected for a chosen high-risk area is an excellent way to demonstrate effectiveness and cost/benefit factors. The results of your study may serve as motivation for other departments or other healthcare organizations in your community.

Footnotes

1. 1999 Annual Survey of Nonfatal Injuries & Illnesses, Bureau of Labor Statistics; December 12, 2000.
2. Lost-Worktime Injuries and Illnesses: Characteristics and Resulting Time Away from Work, Bureau of Labor Statistics-Safety and Health Statistics; 1999.
3. St. Vincent M., Tellier, C. "Training in Handling: An Evaluative Study." Ergonomics. 1989; 32:2, 191-210.
4. Fragala, G. "Ergonomics: The Essential Element for Effective Back Injury Prevention for Healthcare Workers," American Society of Safety Engineers, March, 1995: 23-25.
5. "Lifting Teams can Help Hospitals Eliminate Costly Back Injuries to Nurses," Hospital Employee Health, July, 1994: 81-87.

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