Hazards and Solutions
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 other tasks involving the repositioning of residents are associated with an increased risk of pain and injury to
caregivers, particularly to the back.
Mechanical wheelchairs help patients move from a sitting position to a standing position.
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.
- employee exposure to injury from ergonomic stressors during handling, transferring and repositioning of patients/residents
- 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
- inadequate lighting, especially during evening shifts
In order to prevent slips and falls, effective equipment design and safe work practices should be implemented. The engineering and work practice controls below can help in these efforts.
- Eliminate uneven floor surfaces.
- Create non-slip surfaces in toilet/shower areas.
- Immediately clean-up of fluids spilled on floor.
- Safely work in cramped working spaces by avoiding awkward positions and using equipment that makes lifts less awkward.
- Eliminate cluttered or obstructed work areas.
- Provide adequate staffing levels to deal with the workload.
Awkward postures occur with twisted, hyper-extended or flexed back positions. 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. Awkward postures include:
- twisting or bending over to lift
- 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 patient/residents being lifted.
- lateral or side bending
- back hyperextension or flexion
- 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.
- Reaching forward or twisting to support a patient/residents from behind to assist them in walking.
Good work practice recommends avoiding awkward postures while lifting or moving patients/residents.
- Educate and train employees about safer lifting techniques.
- Use assist devices or other equipment whenever possible.
- Team lifting based on assessment.
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 in healthcare workplaces occurs not only during patient handling tasks but while performing other tasks as well in the kitchen, laundry, engineering, and
housekeeping areas of facilities.
Other tasks that may expose employees to ergonomic stressors include the following:
- transporting of 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
Use engineering or work practice techniques to eliminate the hazard or decrease the hazard. We'll discuss each of these solutions in the remaining sections of this module.
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:
- 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
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)
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.
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