Hazards and Solutions
Mechanical wheelchairs help patients move from a sitting position to a standing position.
Providing care to nursing home residents is physically demanding work. Nursing home residents often require assistance to walk, bathe, or perform other normal daily activities. In some cases residents are totally dependent upon caregivers for mobility. Manual lifting and repositioning residents increase the risk of pain and injury to caregivers, particularly to the back.
These tasks require high physical demands due to factors such as:
- the heavy weight of patients;
- awkward postures when leaning over a bed or working in a confined area; and
- shifting weight that may occur if a resident loses balance or strength while moving
These tasks can entail high physical demands due to the large amount of weight involved, awkward postures that may result from leaning over a bed or working in a confined area, shifting of weight that may occur if a resident loses balance or strength while moving, and many other factors.
The risk factors that workers in nursing homes face include:
- Force - the amount of physical effort required to perform a task (such as heavy lifting) or to maintain control of equipment or tools.
- Repetition - performing the same motion or series of motions continually or frequently.
- Awkward postures - assuming positions that place stress on the body, such as reaching above shoulder height, kneeling, squatting, leaning over a bed, or twisting the torso while lifting.
The hazards that cause slips, trips, and falls include ergonomic stressors during handling, transferring and repositioning patients/residents, and environmental hazards. click the button to see examples of these hazards.
Slip, trip, and fall hazards include:
- 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
- inadequate lighting, especially during evening shifts
In order to prevent slips, trips, and falls, effective equipment design (engineering controls) and safe work practices should be implemented. The engineering and work practice controls below can help in these efforts.
Engineering controls include:
- Removing uneven floor surfaces.
- Installing Non-slip surfaces in toilet/shower areas.
Safe work practices include:
- Immediately cleaning-up of fluids spilled on floor.
- Safely working in cramped working spaces by avoiding awkward positions and using equipment that makes lifts less awkward.
- Clearing cluttered or obstructed work areas.
- Asking for help when moving heavy patients.
For more training on identifying and controlling hazards in the workplace go to your dashboard and check out OSHAcademy Course 153, Ergonomic Hazards in General Industry.
Awkward postures occur with twisted, hyper-extended, or flexed back positions.
Awkward postures occur with twisted, hyper-extended or flexed back positions. More muscular force is required when awkward postures are used because muscles cannot perform efficiently.
They are unsafe back postures for patient/residents lifting.
Increased potential for employee injury exists when awkward postures are used when handling or lifting patients/residents. Click the button to see some examples.
- Twisting or bending forward, backward or to the side to lift or lower. This occurs because the muscles must handle your body weight in addition to the weight of the
patient/residents being lifted. Injuries are most likely if twisting is required to move patients.
- Holding the arm out straight to support objects or patients for several minutes. This contributes to muscle and tendon fatigue, and joint soreness.
Safe work practices help to avoid awkward postures while moving patients/residents. Click the button to see some examples.
- Position patients to avoid twisting and bending during a lift
- Use assist devices or other equipment whenever possible
- Use a team lifting techniques for heavier objects or patients
OSHA does not consider using a back/safety belt to lift as a safe work practice. However, safety belts may reduce the probability of injuries by helping employees remember to use safe lifting techniques (i.e., lifting with the legs, not the back).
Other Ergonomic Hazards
Employee exposure to ergonomic stressors can occur anytime a task requires employees to lift, lower, push, or pull. In healthcare, employee exposure to ergonomic stressors occurs most frequently when performing patient handling tasks. However, ergonomic hazards are also present when performing tasks in the kitchen, laundry, engineering, and housekeeping areas of facilities.
Click the button to see other tasks that may expose employees to ergonomic stressors.
- transporting equipment
- moving food carts or other heavy carts
- pouring liquids out of heavy pots or containers
- reaching into deep sinks or containers
- using hand tools, and during housekeeping tasks
We'll discuss solutions to these hazards in more detail in the remaining sections of this module.
Strains and sprains can occur if an employee is transferring equipment like IV poles.
Strains and sprains can occur if employee is transferring equipment like IV poles, wheelchairs, oxygen canisters, respiratory equipment, dialysis equipment, x-ray machines, or multiple items
at the same time. To reduce the hazards of transferring equipment:
- Place equipment on a rolling device if possible to allow for easier transport, or have wheels attached to the equipment.
- Push rather than pull equipment when possible. Keep arms close to your body and push with your whole body not just your arms.
- Assure that passageways are unobstructed.
- Attach handles to equipment to help with the transfer process.
- Get help moving heavy or bulky equipment or equipment that you can't see over.
- Don't transport multiple items alone. For example, if moving a patient in a wheelchair as well as an IV pole and/or other equipment, get help. Don't overexert yourself.
Reaching into Deep Sinks or Containers
If washing dishes, laundry, or working in maintenance areas and using a deep sink, limit excessive reaching and back flexion by:
- Placing an object such as a plastic basin in the bottom of the sink to raise the surface up while washing items in the sink.
- Remove objects to be washed into a smaller container on the counter for scrubbing or soaking and then replace back in the sink for final rinse.
Limit reaching or lifting hazards when lifting trash, laundry or other kinds of bags by:
- Use handling bags for laundry, garbage, and housekeeping when possible that have side openings to allow for easy disposal without reaching into and pulling bags up and out. The bags should be able to slide off the cart without lifting.
- Limiting the size and weight of these bags and provide handles to further decrease lifting hazards.
- Use garbage cans that have a frame versus a solid can to prevent plastic bags from sticking to the inside of the can or use products that stick to the inside of the garbage can that prevent the bag from sticking.
- Limit the size of the container to limit the weight of the load employee must lift and dump.
- Place receptacles in unobstructed and easy to reach places.
Use the following engineering and safe work practices when working with spring-loaded platforms:
Use spring-loaded platforms to help lift items such as laundry.
- Install chutes and dumpsters at or below grade level.
- Use spring-loaded platforms to help lift items such as laundry.
- Keep work at a comfortable uniform level.
Limit reaching and pushing hazards from moving heavy dietary, laundry, housekeeping or other carts by:
- Keep carts, hampers, gurneys, or other carts well maintained to minimize the amount of force exerted while using these items.
- Use carts with large, low rolling resistance wheels. These can usually roll easily over mixed flooring as well as gaps between elevators and hallways.
- Keep handles of devices to be pushed at waist to chest height
- Use handles to move carts rather than the side of the cart to prevent the accidental smashing of hands and fingers.
- Keep floors clean and well maintained.
- Push rather than pulling whenever possible.
- Remove from use all malfunctioning carts.
- Get help with heavy or bulky loads.
Using Hand Tools in Maintenance Areas
A tool belt can be used to carry hand tools.
Limit strains and sprains of the wrists, arms, and shoulders, of maintenance workers by choosing hand tools carefully. Hand tools should:
- be properly designed, and fit to the user
- have padded non-slip handles
- allow wrist to remain straight while doing finger intensive tasks (select ergonomic tools such as ergonomic knives or bent-handled pliers)
- have minimal tool weight
- have minimal vibration or use vibration dampening devices and vibration-dampening gloves
- use trigger bars rather than single finger triggers
- not be used when performing highly repetitive manual motions by hand (e.g., use power screwdrivers instead of manual screwdrivers)
Frequently change mopping styles when mopping to alternate stress on muscles.
To decrease ergonomic stressors when performing cleaning tasks, employees should:
- Alternate leading hand.
- Avoid tight and static grip and use padded non-slip handles.
- Clean objects at waist level if possible, rather than bending over them (e.g., push wheelchairs up a ramped platform to perform cleaning work, or raise beds to waist level before cleaning).
- Use knee pads when kneeling.
- Use tools with extended handles, or use step stools or ladders to avoid or limit overhead reaching.
- When sweeping or dusting, use flat head dusters and push with the leading edge; sweep all areas into one pile and pick up with a vacuum.
- Use chemical cleaners and soaks to minimize force needed for scrubbing.
- Frequently change mopping styles when mopping (e.g., push/pull, and rocking side to side) to alternate stress on muscles.
- Be sure buckets, vacuums, and other cleaning tools, have wheels or are on wheeled containers with functional brakes.
- Alternate tasks or rotate employees through stressful tasks.
- Avoid awkward postures while cleaning (e.g. twisting and bending).
- Use carts to transport supplies rather than carrying.
- Use buffers and vacuums that have lightweight construction and adjustable handle heights.
- Use spray bottles and equipment that have trigger bars rather than single finger triggers.
Check your Work
Read the material in each section to find the correct answer to each quiz question. After answering all the questions, click on the "Check Quiz Answers" button to grade your quiz and see your score.
You will receive a message if you forgot to answer one of the questions. After clicking the button, the questions you missed will be listed below. You can correct any missed questions and check your