Preventing Back Injuries in Health Care Settings

127 comments on “Preventing Back Injuries in Health Care Settings”

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I borke my back ,over 30 years ago. Over the years I have learned many things about people like me. In general, we are not told we will NEVER BE THE SAME ! We are NOT told much of anything. Until M.D._s are REQUIRED to tell people like me the complete 9 yards,Training is a waist of time & money. All that is done is try to prevent lawers from getting involved. The commen head cold is the #1 reason for E.R. visits—#2 is related to BACK PAIN. People like me have no-one to talk to. We don’t know who the BAD DOC_s are, etc. I’d love to hear your reasons for that.

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Work-related back injuries are a serious problem and account for nearly 20 percent of all injuries and illnesses in the workplace. All healthcare professionals need to be informed of the risks and prevention of workplace-related back injuries. NIOSH recently worked with its partners to ensure that nursing school training materials contain the latest evidence-based research on safe patient lifting and back injury information. Research studies have shown that a large fraction of work-related back pain can be prevented by ergonomic design of the workplace and use of assistive equipment.

NIOSH was created by the Occupational Safety and Health Act to examine ways to prevent injuries in the first place recognizing that once an injury has occurred there can be permanent damage. As such, NIOSH research in this area focuses on the use of ergonomic workplace design to prevent injury and/or re-injury. The Agency for Healthcare Research and Quality (AHRQ) funds studies on the effectiveness of injury treatment methods.

I work in Employee Health and handle our Worker’s Comp claims, consequently I have seen a few musculoskeletal injuries over the years. I have been instructing our staff on how to use the battery operated patient lifts and lateral transfer air mattress devices the hospital purchased.

The staff is extremely enthused about the equipment during the demonstrations and then never use it on the units. The equipment is kept buried in a closet with commodes, scales, electronic blood pressure cuffs ect. Unfortunately our facility has a policy that hallways must be kept clear.They feel that the time they take to get the equipment they could have had the patient manually moved. Equipment must be easily accessible and visable or staff will not use it! We need to start worrying less about how a hallway looks. Use of patient moving devices is a safety issue,not only will their use reduce employee injuries but can prevent potential patient injuries.

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Despite the fact that mechanical lifts and lateral transfer devices can make a huge impact on improving the safety of both health care staff and patients, a broader program is required to overcome the barriers and cultural resistance to using mechanical patient lifts.

Many healthcare organizations have dedicated resources on back injury prevention with little resulting improvement. Research has shown that in order for safe patient/resident lifting programs to be successful they must not only incorporate mechanical lifting equipment and repositioning devices and training in the use of these devices, but it requires a change in the workplace culture that can be facilitated with a written safe patient lifting policy, top management support, nursing management support on each unit, and patient lifting algorithms that identify how patients with different conditions and weight bearing ability should be lifted.

Details on establishing a comprehensive safe patient handling and movement program can be found at:

http://www.visn8.med.va.gov/patientsafetycenter/resguide/ErgoGuidePtOne.pdf
(94 pages, 2.78 MB)
http://www.visn8.med.va.gov/patientsafetycenter/resguide/ErgoGuidePtTwo.pdf
(95 pages, 3.49 MB)

I understand the reasoning for implementing safe lifting practices in healthcare; however, due to the increase in obesity and the older adults who need assistance, it is hard to perform these tasks with minimal assistance and poorly maintained or out of date equipment. How can we get healthcare institutions to open their eyes to the fact that employees are getting injured and they could probably purchase new and improved equipment with the Workman’s comp funds they have paid out?

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NIOSH conducted an intervention trial in six nursing homes that included a business case and cost-benefit analyses (cost to implement the program was balanced with the workers’ comp savings) that are described in the DHHS (NIOSH) Publication Number 2006-117, Safe Lifting and Movement of Nursing Home Residents, and the peer-reviewed publication, An evaluation of a “best practices” musculoskeletal prevention program in nursing homes, in Injury Prevention, August 2004.

The NIOSH numbered publication (on page 6) also cites Tiesman et al., 2003, Nelson et al., 2003, and Garg 1999 as other intervention trials on safe patient lifting that have included cost-benefit analyses.

Thank you for pushing this important issue forward. I am an Occupational Health Nurse in Maryland. At my last place of employment I was unable to convince my hospital management to commit any financial resources to safe patient lifting, even though I could show direct costs for back injuries related to moving patients. I brought in quality equipment for demonstrations, I gave presentations to senior management, I circulated articles regarding best practices, all to no avail.Our State Legislature passed a safe patient lifting bill last year that required all hospitals to form a safe patient lifting committee, and develope policies, but the bill fell short of requiring actual mechanical devices (in the case of this hospital, they passed out gait belts). There is also no oversight to see that it will be implemented, and no penalty for not complying. Because OSHA has not promulgated a standard, there is no fear of federal regulation. Joint Commission does not look at employee injuries as part of it’s environment of care inspection process. Even “Magnet” status will only start to look at some types of employee injuries as part of it’s application process in the coming year (but not back injuries). If we are to improve the working environment for healthcare workers, it seems NIOSH may need to lead the way by pushing OSHA to promulgate standards to protect us. Best practice recommendations will not be enough.

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NIOSH is considering research that will evaluate the impact of the nine safe patient handling state laws to evaluate the effectiveness of each of the state laws to better inform pending Federal legislation. Links to each state law are provided below.

Three states have passed legislation supportive of, but not requiring, safe patient and/or resident handling:

1.Ohio HB 67. Scroll to Sec. 4121.48.
2.New York A 07836 and S 5116.
3.Hawaii HCR 16.

Six states have passed legislation requiring safe patient and/or resident handling policies, and/or programs, and/or patient lifting equipment:

1.Texas SB 1525.
2.Washington HB 1672. March 22, 2006.
3.Rhode Island H 7386 and RI S 2760.
4.Maryland HB 1137 and SB 879.
5.Minnesota HF 712 and SF 828 passed within HF 122.
Language in three areas: 1. Grant funding Art 1, Sec 6, Sub 3, pp 25-26; 2. main body of wording Art 2, Sec 23. 182.6551 to Sec 25. 182.6553, pp 48-51; and 3. study ways for workers’ comp insurers to recognize compliance in premiums and for on-going funding Art 2, Sec 36, and work groups on safe patient handling and equipment Sec 37, pp 58-59.
6.New Jersey SB 1758 and AB 3028.

Additionally, the national bill HR 378 “Nurse and Patient Safety and Protection Act of 2007” was introduced into the House of Representatives in January 2007. The bill remains in committee. For links to the status, complete history, and text of HR 378, go to http://thomas.loc.gov.

This was a very interesting article and great information, but is it in the actual job description for nurses or health care providers to physically try to lift or move patients? I know that it is something that we learn in nursing school (body mechanics) but if a nurse were to say to administration “I can not physically move this patient”, do you think that she/he would be terminated?

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NIOSH is a research agency and we do not have the expertise or information to answer your specific question. We are aware that workers are expected to perform essential job tasks and in certain cases patient lifting may be an important or essential part of a nurse’s duties. When selecting a place of employment, nurses and other healthcare professionals should evaluate whether facilities have a safe patient handling and movement program (SPH&M) with proper lifting equipment as a determining factor for where they want to work. Since there is a shortage of nurses, it is in the best interests of the facility to provide a safe patient handling environment with the proper equipment and resources to protect the workforce.

A factsheet on health care workers from the U.S. Equal Employment Opportunity Commission (EEOC) website may provide additional information.

One thing I would like to add about back injury and nurses: As caretakers, we need to learn to take care of ourselves. If we are in poor physical condition because we have not taken “care” of ourselves, the likelihood of back injury increases.

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Injuries to the back are one of the most prevalent and costly work-related musculoskeletal disorders in the United States. Low-back pain adversely affects 1,000,000 workers in the United States every year and is responsible for more lost work days than any other musculoskeletal disorder.

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I am graduate student currently enrolled in a Risk Assessment course. I as wondering if home healthcare workers were considered in the assessment of back injuries among healthcare staff and nurses because I would think that not all patients that have to be moved by healthcare workers are just in hospitals and long term facilities. The article appears to be only focusing on healthcare facilities and not other forms of long term care.

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NIOSH says:
Although home healthcare workers have been studied less extensively than workers in institutional settings, empirical evidence has been obtained which indicates that patient handling is a significant risk factor for back pain and other muscuoloskeletal symptoms in home settings. Home care aides typically provide a variety of services which include housekeeping, and may include personal care (bathing, dressing) and assistance with moving and transferring (patient handling). All of these tasks are characterized by risk factors for musculoskeletal symptoms, including forceful exertions and awkward postures (Baron and Habes, 2004; Galinsky et al., 2001). Results of a survey of home care workers conducted by NIOSH indicate that patient handling is associated with musculoskeletal symptoms, after adjusting for several other factors, including worker age, weight, non-work-related physical activities, smoking, medical conditions, work durations, and non-work-related caretaking of children and disabled family members (Waters et al., 2006). Ergonomic strategies for improving patient handling safety in home care settings are described in Parsons et al. (2006 a and b).

Additionally, NIOSH is conducting a community-based participatory intervention study to develop educational materials to assist home care workers to work more safely. These materials include information on how to avoid unsafe lifting.

References:

Baron, S. & Habes, D. (2004). NIOSH Hazard Evaluation and Technical Assistance Report # 2001-0139-2930. Alameda County Public Authority for In Home Supportive Services. Alameda County, California. Cincinnati, OH: Centers for Disease Control and Prevention (National Institute for Occupational Safety and Health).

Galinsky, T.L., Waters, T., and Malit, B. (2001). Overexertion injuries in home health care workers and the need for Ergonomics. Home Health Care Services Quarterly, 20, 57-73.

Parsons, K., Galinsky, T.L., and Waters, T. (2006a). Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: Lift and transfer assistance for partially weight-bearing home care patients. Home Healthcare Nurse, 24, 158-166.

Parsons, K., Galinsky, T.L., and Waters, T. (2006b). Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 2: Lift and transfer assistance for non weight-bearing home care patients. Home Healthcare Nurse, 24, 227-234.

Waters, T., Collins, J., Galinsky, T.L., Caruso, C. (2006). NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry. Orthopaedic Nursing, 25, 380-389.

We have often heard advice on how to bend at the knee, use proper body mechanics, and strenthen our backs. Unfortunately, none of this advice will ever make the manual lifting of a 250 pound person safe, and in fact, it perpetuates the myth that we are somehow partly to blame when we become injured. Employers are responsible to provide a safe working environment for their employees. This includes the structure, policies, administrative support, staffing, and equipment necessary to perform a job safely.

American hospitals will eventually have to deal with this issue, but the question remains, how long will it take, and how many will be injured before that happens.

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I want to know if there is a correlation between MSD-injuries and stress? Is there evidence about it? I did a risk assessment with 70 nurses (homecare): how do they perceive their job (interesses, tired, risks, autonomy, …? wellbeing – MSD injuries.

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There is a lot of research on this topic. You may want to contact the Netherlands Organisation for Applied Scientific Research – TNO, specifically Pauline Bongers.

Some studies have shown that psychosocial work factors, such as lack of control over work planning, are risk factors for musculoskeletal symptoms in home health care workers, especially when combined with physical risk factors such as strenuous postures (e.g., Brulin et al., 1998, Johansson, 1995).

References:

Brulin, C., Gerdle, B., Granlund, B., Hoog, J., Knutson, A., and Sundelin, G. (1998). Physical and psychosocial work-related risk factors associated with musculoskeletal symptoms among home care personnel. Scandinavian Journal of Caring Sciences, 12, pp 104-110.

Johansson, J. (1995). Psychosocial work factors, physical work load and associated musculoskeletal symptoms among home care workers. Scandinavian Journal of Psychology, 36, 113-129.

I am an occupational therapist working in a large health care organization 15,000 associates (multiple hospitals and outpatient centers). I would like to know what other organizations are documenting in their job descriptions regarding the expected lifting demands for nurses and patient care assistants. I am working to lower our RN/PSA lifting requirements and require utilization of lift/transfer equipment for safe patient handling.

Feedback please.

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Have you identified the hopitals for your 2009 bariatric study? I’m currently in the process of implementing a safe patient handling/movement program in a major teaching healthcare setting in Atlanta, one of which is a bariatric center for excellence. Are you interested in dialoging with me about Emory Hospitals being part of your research initiative?

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Thank you for your interest. We will contact you directly to discuss a potential collaboration.

IMPACC WorkSmart Injury Prevention Analysis of MSD Variances/ Claims at St Luke’s Regional Medical Center in Sioux City, IA across all nursing areas has been significantly reduced since 2005.

–From 2005 through end of 3rd Qtr 2008

We have seen a reduction in MSD claims across all nursing areas at St Luke’s by 64%. (Low back and Shoulder most common variance/ claims reported).

We have seen a significant reduction in the severity of claims across all nursing areas such as;

1) We have seen a 91% reduction of MSD claims reported that required Restricted duty in nursing areas at St Luke’s

2) Days on restricted duty have been reduced by 98% since 2005, with only 27 days of nurses on restricted duty thus far in 2008 through 3 quarters. That is Working Smart!!

3) The best is saved for last as we have seen a 100% reduction in lost time claims and days away from work across all nursing areas in 2008!! The only lost time claims we have had at St Luke’s in 2008 was from 2 slip/ falls claims of workers not involved in patient care.

These outstanding IMPACC WorkSmart “Industrial Athlete” program outcomes at St Luke’s were possible by many factors such as;

1) Purchase of new Safe Patient Handling Equipment by the Employee Grants Committee which is headed by employees of St Luke’s to improve workers safety and the health/ safety and well being of our patients we serve at St Luke’s!!

2) Since 2006 St Luke’s has offered a year round Health Challenge (through the Employee Health and WELLness Dept which I am a part of) to improve the health, wellness and injury prevention of the workers at St Luke’s. This has made a HUGE improvement in our numbers since 2006 as workers are getting healthier in their lifestyle choices!!

3) Since 2001 I have led a 30 minute WorkSmart section at St Luke’s every other week at new employee orientation discussing; WorkSmart posture and body mechanics principles, worksmart stetching, principles of workplace ergonomics, self care techniques to treat and prevent headaches, lower back pain, tendonitis, etc… EHW Dept also has a 30 minute section where we discuss our Health Challenge, importance of early reporting, and many others.

4) We have worked with Admin, Mgt and Sup of St Luke’s and the nursing floors, along with employees to improve the ergonomics, choose SPHE and improve the safety at St Luke’s.

5) Since Jan 2007 I have instructed approx 270+ nursing, radiology, respiratory therapy, and rehab staff with the Safe patient handling equipment and WorkSmart posture and body mechanics, and WorkSmart stetching at St Luke’s.

6) Each week of Orientation (every other week) I lead a Safe patient handling equipment training class for all nursing, rehab, radiology employees at St Luke’s.

7) We attend Dept staff meetings throughout the year to review SPHE, worksmart stretching and self cares, posture/ body mechancis and ergo principles specific to their work areas.

8 ) We have had gait belts in all patient rooms that are wipe down for infection control purposes too since early 2007 after I trained all employees again in the IMPACC WorkSmart injury prevention program in 2006.

9) We are now training WorkSmart Champions/ Coaches for each nursing floor to lead in this WorkSmart effort at St Luke’s

10) I am training all nursing, and radiology students at our St Luke’s College of Nursing and Radiology on the safe patient handling equipment, stretching and posture/ body mechanics. This was started in the last two months.

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At the heart of most muscular skeletal disease problems, affecting health care workers in a number of positions from hospital to long term care, is that safety for the health care worker is considered the workers active responsibility and not a built in or passive factor.

Educational programs focus on the correct way to lift a patient, however most injuries are not part of a planned lift but are related to a reflex to protect the patient from further injury once a fall is already in progress. Gait Belts have been handed out with little or no training as a (cure all) for reducing staff injuries at a minimal cost and mechanical devices have been removed from the hallways for safety and the door are locked to avoid tampering with medical supplies also a safety measure.

Unfortunately for the health care staff, these factors compound and become a “set up for failure”. When safety is not a passive built in factor, and healthcare workers are blamed as being, the cause and reason they are injured, people become afraid to report injuries on the job and that is an oppressive frame of mind.

There are a great number of health care workers who have had their fingers and wrists dislocated by Gait Belts as well as other muscular skeletal injuries associated with the use of them. Health Care workers may be injured a little less often but this still should not be acceptable. Safety should never be an active responsibility where you have to impose on others to help keep yourself safe.

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The article notes that

Additionally, nursing aides and orderlies suffer the highest prevalence (18.8%) and report the most annual cases (269,000) of work-related back pain among female workers in the United States. In 2000, 10,983 registered nurses (RNs) suffered lost-time work injuries due to lifting patients. Twelve percent of nurses report that they left the nursing profession because of back pain.

Surveys in dental journals have reported back pain rates as high as 70% for dentists, with 33% retiring early due to back disability. An as-yet unpublished survey of Registered Dental Hygienists in the state of Wisconsin found 92% of respondants reporting pain severe enough to miss work, with 42% reporting regular pain severe enough to interrupt sleep habits. 25% reported job changes as a result of pain. Similar statistics have been consistently reported for over 60 years, since the advent of sit-down dentistry.

Are there other specialty areas within health care that have similar exposures?

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Data from the Bureau of Labor Statistics (note: the NAICS code for Healthcare and Social Assistance is 62) show that in the healthcare industry, those working in ambulance services, other ambulatory healthcare services, nursing care facilities, nursing and residential care facilities, community care facilities for the elderly, general medical and surgical hospitals, and hospitals had the highest rates of overexertion injuries in both 2007 and 2006. The category “Offices of Dentists” does not contain data due to a small sample size. However, injuries and symptoms may be prevalent in the dental industry, as suggested by Mr. Books’ mention of surveys reported in dental journals. Posting the references on the blog will allow others to locate the data.

NIOSH research has focused on patient handling because it is associated with the highest injury rates (nursing aides, orderlies, and attendants had a MSD rate of 252 cases per 10,000 workers—a rate more than seven times the national MSD average for all occupations). In addition to lifting, pushing, pulling, carrying and work in awkward or extreme bent postures can also contribute to back pain and injury. More information on preventing back injury can be found on the NIOSH Ergonomics and Musculoskeletal Disorders topic page.

The above text quotes that the training and equipment changes implemented at eight facilities over 51 months, “Overall, the eight facilities experienced decreases of 32% in all injuries,” This is remarkable.

However 68% of the prior injuries still occurred. This in the light of active participation, in training to reduce injuries, can this imply that once the spotlight shifts away from this intense project, that the numbers will return to prior levels, because these rates of injury are acceptable to the institutions where these people are employed.

These injuries “musculoskeletal disorders (MSDs) at a rate exceeding that of workers in construction, mining, and manufacturing” described are often life altering, accumulative, and end in career changes, debilitation, or both also this often includes life long pain. All these insults to the body and still this will be compounded by many factors, at the top of the list is legal cost to attempt to recover whatever losses have occurred both past and future. Add to this, medical bills denied by workman’s comp carriers that because “100% medical care” is not covered before or after injury, future employers must consider this additional cost, with any experienced personnel as well as how much damage can this potential employee still endure. The same is true with professional athletes but we consider their compensation is written into their contract.

We need to find an alternative that does not require active thinking and pulling coworkers away from their patients to create a “safer environment”. If the Auto industry or any other major manufacturer were to request a 2-4 year degree, often called a journeymen or engineer, to perform a high-risk job like this, what would their pay and compensation be?

Why is there a shortage of new nurses?

References

Garg, A. (1999). Long-term effectiveness of “Zero-Lift Programs” in seven nursing homes and one hospital. U.S. Department of Health and Human Services, National Institute for Occupational Safety and Health, Contract Report No. U60/CCU512089-02.

State of Washington [2006]. An act relating to reducing injuries among patients and healthcare workers. Retrieved January 14,2008, from http://www.leg.wa.gov/pub/billinfo/2005-06/Pdf/Bill Reports/House/1672.HBR.pdf

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The equipment/devices for the healthcare industry to avoid MSDs to workers is out there. Evidence based studies have proven that in spades!!! – how many more studies do you need to convince the industry that injuries can be reduced to insignificant levels? Even if there were hundreds more (studies that is) the impact would be little. It’ll have to be legislated into effect?

The real problem is the nature of Risk Management—it is insurance oriented and not prevention and education oriented. Why is that? Well, partly because it is simply the accepted paradigm – people have made lifelong careers out of it and there is a whole micro-economy built around it. Think about it… healthcare work related MSDs make up a huge part of your local State’s Worker’s Comp Claims. It involves local/state/federal governments (part one of the micro-economy). That means budgets have to be allocated for administrative purposes/programs/information/assistance—Like NIOSH for example. Taxes have to be collected (part two of the micro-economy). Then there are the insurance companies. They make money off these injuries—what, you say? Sure, they offer a needed service and they make a profit from it (part three of the micro-economy). The hospitals and healthcare systems gladly pay the insurance companies because by law they are required to provide worker’s compensation insurance (part four of the micro economy—y’all know there’s an Executive with a staff to handle what’s called Risk Management, right? Well he’s the one that buys the insurance)

The only thing that is going to break the Paradigm is this thing called indirect costs. The insurance companies just raise the rates over time and absorb the rising costs. But there are costs to the healthcare provider that are just now really coming into focus i.e. retention/recruitment—in year 2000 it cost around $100,000 to hire a nurse to replace someone who was injured—it was close to $150,000 to hire a specialty nurse—and this was for just one employee. Meanwhile the executives look at purchasing newer Safe Patient Handling Equipment as a balance sheet liability! (Safe Patient Handling is not billable) Granted the manufacturers of such equipment in the past may have poorly juxtaposed the cost of equipment capital vs. human capital – but to be honest the people crunching the numbers have a hard time seeing the causal relationship. And anyways ask any accountant and they’ll quickly point out that such equipment goes in the liability column.

Here’s the punchline… There are studies out there that point out the tremendous cost savings enjoyed by healthcare providers who implement Safe Patient Handling!!! Maybe this approach will have more effect on forcing a change. But in the meantime changes will be slow and then ever increase at rapid pace as we shift into a new thought paradigm on how to think about Risk Management for the Healthcare Provider.

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Can you please provide references to how recommendations apply to emergency medical technicians (EMTs). As an occupation, they are frequently required to: -Carry more than 50 lbs of unbalanced equipment up stairs; -Move patients weighing more than 150 lbs with only 2 providers from ground-to-stretcher (or chair) and bed-to-stretcher without assistance devices which seems to violate both the weight and angle guidelines that I have seen; -Carry more than 200 lbs down multiple flights of stairs (equipment + patient).

While other professions have a reasonable expectation of calling for help in a timely manner; the current prevalent model of 2 EMTs does not readily allow for waiting for assistance.

Any guidance would be appreciated!

Scot Phelps
Associate Professor of Emergency Management School of Health & Human Services Southern Connecticut State University

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NIOSH has not examined the unique situations faced by EMTs. Laurel Kincl in Oregon and Steve Lavender at The Ohio State University have both conducted research on manual handling for EMTs. A few references are provided below.

◦Designing ergonomic interventions for EMS workers: concept generation of patient-handling devices. Conrad KM, Reichelt PA, Lavender SA, Gacki-Smith J, Hattle S. Appl Ergon. 2008 Nov;39(6):792-802. Epub 2008 Jan 28.
◦Designing ergonomic interventions for emergency medical services workers–part III: Bed to stairchair transfers. Lavender SA, Conrad KM, Reichelt PA, Kohok AK, Gacki-Smith J. Appl Ergon. 2007 Sep;38(5):581-9. Epub 2006 Oct 27.
◦Designing ergonomic interventions for EMS workers – part II: lateral transfers. Lavender SA, Conrad KM, Reichelt PA, Kohok AK, Gacki-Smith J. Appl Ergon. 2007 Mar;38(2):227-36. Epub 2006 Jun 5.
◦Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs. Lavender SA, Conrad KM, Reichelt PA, Gacki-Smith J, Kohok AK. Appl Ergon. 2007 Jan;38(1):71-81. Epub 2006 Mar 13.

what do you recommend for a weight capacity of ceiling mounted patient lifting tracks for tertiary teaching hospitals—people at the hospital I am working for are unsure what the maximum capacity of patient they expect to be admitted.

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Thank you for your comment. Equipment vendors should be contacted for specifications on equipment design and capacity.

The highest patient weight we have seen mentioned in the literature is 1100 pounds, though such patients are rare. Data on rates of obesity and morbid obesity in the general U.S. population can be found in the following article:

Ogden, C., Carroll, M., and Curtin, L. (2006). Prevalence of overweight and obesity in the United States, 1999-2004. Journal of the American Medical Association, 295, 1549-1555.

Manual Lifts are great but they are bulky and like Carole said there are rules about keeping halls clean… That’s why the hospitals need to invest more in ceiling lifts and tracks….. They are great!

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There is a place for both floor-based and ceiling-mounted lifting devices. Floor-based lifts can be used where there are no overhead tracking systems. Ceiling-mounted lifts are easier to use, require less physical effort to use, and are always available, but can only be used where the tracks have been installed.

In your response to post #4, you stated that NIOSH is considering research to look at the effectiveness of safe patient handling legislation that has been enacted in 9 states. Have you decided to go forward with this research, and how, and from whom, will you solicit input?

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The potential research mentioned above would likely come from the NIOSH extramural research program. Currently, there are no projects funded on this topic but we encourage interested parties to apply for funding by mechanisms available and described under “Funding Opportunities.” Proposals are funded annually based on availability of funds, relevance of the proposed work to the NIOSH mission, and the quality of the science proposed.

Comment 4 states “Additionally, the national bill HR 378 “Nurse and Patient Safety and Protection Act of 2007” was introduced into the House of Representatives in January 2007. The bill remains in committee. For links to the status, complete history, and text of HR 378, go to http://thomas.loc.gov

Is this bill still being worked on? I tried the link and searched for both the bill # HR 378 and well as the name you’ve listed in parentheses. I am unable to find any information regarding this proposed bill. I am interested in more information regarding this new proposed Act.

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On May 13, 2009, House Resolution (H.R.) 2381 “Nurse and Health Care Worker Protection Act of 2009” was introduced into the U.S. House of Representatives of the 111th Congress by U.S. Representative John Conyers, Jr., Democrat, Michigan District 14, and co-sponsored by Representative Lynn C. Woolsey, Democrat, California District 6. More information can be found by searching Bill Number H.R. 2381 at http://thomas.loc.gov.

There is a lot of discussion here about electical lifting devices, what about electical bed movers for patient transfer? How common is this equipment in US hospitals?

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Does anyone have link to information on state laws passed and state laws enacted regarding Safe Patient Handling
thank you

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For more information on injured Nurses, the Work Injured Nurses Group (WING) can be found at [http://www.wingusa.org]. The site lists important links regarding H.R.2381 as well.

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I left nursing in 2004 due to back problems. I had already had a lumbar laminectomy and had began having difficulties with cervical vertebra. In Nursing it was my feeling that a nurse should have the appearance of health and stamina. I know that if you didn’t, you were looked upon by management as a workers comp case ready to happen. We were in the begining phases of implementing lift equipment and evaluating injury related to lifting and moving patients. We were monitoring this through our Quality / Risk Dept. and had chosen indicators to measure improvement and compliance. This being a new concept we had some difficulty with in education and buy in from the staff. Remembering the days of the old hoyer lifts, it was much easier and faster to use manual lifting maneuvers. There were usually one hoyer per floor and finding it was as difficult as getting a second person to assist you in using it. The issue after getting the new equipment was remembering how to use it and still finding someone to assist you in the use of the product. It was about saving time and manpower. I was already injured from years of physical abuse in nursing. Now I find myself unemployed with years of experience as a skilled nurse from everything to bedside nursing to risk management and infection control, educaton as a preseptor and in teaching new technology to the staff nurses from computerized nursing documention and e-mar to any and all new equipment including lift equipment and monitoring for compliance to an abundance of wound management and developing and revising nursing standards. I am the average age of a retired nurse, but I loved it. I never collected workers comp. I just figured it was part of the job.

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I appreciate the comments from those individuals about the equipment being tucked away and not utilized in their facilities. Our acute care hospital and acute rehab have implemented a Safe Patient Handling and Movement program over the past 18 months. This was a huge undertaking, but we are starting to see the benefits. We have learned some important lessons as we have rolled this out in our facility. We had to have administration backing and a policy that prohibited the manual lifting of dependent patients in all but life threatening circumstances. We have worked very closely with Employee Health and all patient care staff get 2.5 hours of hands on training on the equipment, techniques, back safety and policy.

This has really helped. We still have to make rounds and post updates in our hospital newsletter frequently to remind staff of the equipment and policy. It is definitely a 2-3 year process for buy-in, education and ongoing transition to a “Culture of Safety”. Don’t give up, just like anything new it takes time and persistance!

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I am curious as to why there are so many nurses getting injured on the job. There are other professions such as EMT’s Physical and Occupational therapists that lift, transfer and reposition patients all day long. I don’t quite understand the “zero lift policy” if a resident is in a nursing home, as part of providing quality care one should try to maintain the residents abilities, not decrease it by putting everyone in a mechanical lift where they don’t use their muscles. Another concern is that short-term rehab residents are there to get stronger. If nurses aides are using a mechanical lift for all transfers mean while therapists are trying to teach the patient to be independent, the length of stay will be much longer costing the resident perhaps their house.

If body mechanics/ergonomic training are effective in many professions then one should look into why it’s not effective in the nursing profession. I strongly feel a combination of ergonomic training along with mechanical lifts and having the staff follow the facilities policies and procedures on patient handling will reduce the number of injuries.

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All healthcare personnel, including physical therapists and rehabilitation nurses, are at high risk of musculoskeletal injuries from patient handling. EMTs and physical and occupational therapists likely have high rates of back injuries because they lift, transfer, and reposition patients all day long. For that reason, it is important to incorporate lifting technology into the work they do. Body mechanics/ergonomic training have not been shown to be effective in other professions when not incorporated into a comprehensive ergonomics program that includes use of technology when available. A safe-lifting policy (also referred to as “no-lift,” “zero-lift,” “no manual lift,” or “safe patient lifting policy”) is one part of a comprehensive approach to preventing musculoskeletal injuries to healthcare workers (Collins, 2006). The purpose of a safe-lifting policy is to provide a clear understanding of the elements of a safe patient handling and movement program, to define the roles and responsibilities for all affected staff (healthcare administrators, supervisors, frontline caregivers, therapy staff, maintenance personnel, and housekeeping staff) and to provide a reference for review when questions arise. A sample of a safe lifting policy is available in the appendix of the book “Safe Patient Handling and Movement – A Practical Guide for Health Care Professionals.”

Physical therapy tasks tend to be of longer duration than typical transfer tasks, which increases exposure to excessive spinal loads during therapy tasks. A discussion of injury risk in rehabilitation personnel is provided in a recent article by Nelson et al. (2008b). They also cited research in which a significant percentage of injured therapists stopped performing or altered treatments that aggravated their own symptoms, raising concerns about the impact of patient handling injuries on the quality of rehabilitative treatment (Cromie et al., 2000).

There has been reluctance to use mechanized equipment in physical therapy/rehabilitation, due to concerns that it might impede therapeutic progress and thereby reduce patients’ functional status and independence (Nelson et al., 2008b). Nelson et al. point out that there is a lack of evidence on which to base such concerns. Use of patient handling equipment has been shown to be effective in improving rehabilitation outcomes (i.e., it speeds recovery and is adaptable to patient needs). Use of equipment or technology likely improves the quality of care afforded to patients (Nelson et al., 2008a).

Nelson et al. encourage further development of mechanized methods for simultaneously administering physical therapy while reducing exertion and injury risk for therapy/rehabilitation personnel. Examples of such methods and ongoing research to evaluate their effectiveness are described by Baptiste et al. (2008) and Rockefeller (2008).

References

Baptiste, A., McCleerey, M., Matz, M., and Evitt, C. (2008). Proper sling selection and application while using patient lifts. Rehabilitation Nursing, 33, 22-32.

Collins, James W. (2006). Safe Lifting Policies. Chapter 10 in “Safe Patient Handling and Movement – A Practical Guide for Health Care Professionals.” Audrey Nelson, Editor, Springer Publishing Company.

Cromie, J., Robertson, V., and Best, M. (2000). Work-related musculoskeletal disorders in physical therapists: Prevalence, severity, risks, and responses. Physical Therapy, 80, 336-351.

Nelson A., Collins J., Siddharthan K., Matz M., and Waters T.(2008a) Link between safe patient handling and patient outcomes in long term care. Rehabilitation Nursing 33(1).

Nelson, A., Harwood, K., Tracey, C., and Dunn, K. (2008 b ). Myths and facts about safe patient handling in rehabilitation. Rehabilitation Nursing, 33, 10-17.

Rockefeller, K. (2008). Using technology to promote safe patient handling and rehabilitation. Rehabilitation Nursing, 33, 3-9.

Do you have any numbers on the use of lifting devices (in hospitals, factories, etc.?

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There are no concrete data available for this topic. Many Nursing homes have 1 or 2 lifts but few have best practices programs. I am only aware of a handful of acute care hospitals with best practices programs. Many have a lift or two but only a few with hundreds of lifts. The VA recently received 300 million dollars to put a lift over every VA bed in the country. We are on the front end of a huge paradigm shift where lift implementation is dramatically increasing. The more important issue is the implementation of comprehensive programs that include lifting equipment, management support, written policies, and management support.

Where do gait belts fall as part of a safe patient handling program?

Minnesota has enacted a statute (MN Statute 182.6553 and 182.6554) with the goal of minimizing manual lifting of patients. The question of are facilities still going to be able to use gait belts keeps coming up.

Several prominent facilities have made the determination that gait belts are not considered safe patient moving equipment and have 35lb. lifting limits to back this. Research indicates that gait belts do not prevent injuries but many lifting algorithms still include them as an assistive device for moving patients. What does NIOSH say?

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Gait belts are wide, fabric belts worn around the patient’s waist, with sewn-in fabric handles that are grasped by the caretaker. They are helpful assistive devices for some patient handling tasks, but they are not designed for lifting patients. Gait belts, as their name suggests, were designed to help stabilize weight-bearing patients during ambulation. In addition, patient handling algorithms developed by the Veterans’ Administration Patient Safety Center include the use of gait belts to assist with transfers in some circumstances. For example, they can be used to assist partially weight-bearing patients to stand and pivot or to assist a non weight-bearing patient who has upper extremity strength while s/he is initially learning to do a seated transfer with a seated transfer aid, such as a transfer board. The algorithms can be found in the document “Assessment Form and Algorithms” under “Algorithms for Safe Patient Handling and Movement” at the following website:
http://www1.va.gov/visn8/patientsafetycenter/safePtHandling/default.asp

Many emergency dental care providers suffer from back pain and injury due to sloughing over all day.

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When implementing Safe Patient Handling Programs the challenge is to keep the ratio of equipment to patients at a reasonable level to keep the equipment accessible. The NIOSH publication “Safe Lifting and Movement of Nursing Home Residents” gives an equipment ratio. However, the next challenge is to purchase enough slings to keep the equipment accessible and not to over purchase slings which is quite costly.

Is there any documentation on an appropriate ratio of slings to patients or residents?

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There are a couple of options to consider regarding slings that should be discussed carefully with your lifting equipment vendor. Where infection control is a concern, disposable slings have proven to be an effective solution and in some cases these slings can be billed to the patient. An alternative choice is washable non-disposable slings. You should have at least two of each size sling per piece of equipment to handle a range of different sized patients and to have a back up sling when soiled slings are being laundered. As noted, slings are expensive so care should be taken to carefully track and maintain your inventory of washable slings. At one nursing home serving as a study site in our research, slings were being laundered offsite at a commercial laundry and were frequently lost. The nursing home solved the problem by buying a washer and dryer to put in the nursing home that was dedicated to laundering only slings.

I find it unsettling that there are no articles on helping the nursing staff that work in the home with lifting issues. I can not find anything that regulates safety for the indidual who works in the home with total care patients who for some reason or another are not in nursing homes, convelascence centers, or other controlled environments where there is one person doing all the care and no one to call upon for help should the need arise. I work as a certified nursing assistant with total care patients. I do know how to use a lift and but I find that it is often hard to get a patient set in the sling with no help especially if they are obese or lack any mobiltiy at all to help off set their own weight. I am currently dealing with constant back pain due to work related stress on my back, hips, shoulders and arms. Quiting work is not an option for me. I would like to see articles written that address the in home patient and their special nursing requirements. OSHA needs to set lifting guidelines for home health workers as the population continues to age and people cannot afford nursing home care you are going to see a need for more skilled workers in the private sectors. I fear that you will find a shortage of people who will continue to train and work in this area. I have been working in this field 5 years and hope to leave it when my training to become a medical assistant is over due issues such as this.

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At this time there are no laws or even OSHA guidelines specifically for the home healthcare worker related to lifting tasks. NIOSH published suggestions on equipment that is suitable for home use (see references below), but those publications don’t include patient lifting algorithms that identify how patients with different conditions and weight bearing ability should be lifted. I would suggest that the VA algorithms (see Assessment Form and Algorithms below) should apply in home settings. These algorithms for many transfer situations require more than one caretaker, even when equipment is used. I suggest it would be advisable to request a conference with the home care agency and the patient/family, using the algorithms to determine and arrange proper methods for patient handling in the home, including more than one caretaker when appropriate.

Parsons, K., Galinsky, T., Waters, T. (2006). Suggestions for Preventing Musculoskeletal Disorders in Home Healthcare Workers, Part 1: Lift and Transfer Assistance for Partially Weight-Bearing Home Care Patients. Home Healthcare Nurse. 24 (3), 158-164.

Parsons, K., Galinsky, T., Waters, T. (2006). Suggestions for Preventing Musculoskeletal Disorders in Home Healthcare Workers, Part 2: Lift and Transfer Assistance for Non–Weight-Bearing Home Care Patients. Home Healthcare Nurse. 24 (4), 227-234.

“Assessment Form and Algorithms” under “Algorithms for Safe Patient Handling and Movement” at the following website: http://www1.va.gov/visn8/patientsafetycenter/safePtHandling/default.asp

In response to post #33: The safe patient handling legislation that is currently being proposed (HR 2381 and SB 1788) do include provisions that would cover home care. If this legislation passes intact, OSHA would be directed to create a standard that also covers the Home Care environment.

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I am currently researching my situation and what the general lifting requirements are for an ER RN. My job description says that I am required to frequently lift over 75 lbs. I had back surgery 2yrs ago and was completely fixed!! The surgeon was FANTASTIC!!

The issue is now I have re-injured my back. My doctor said that with my previous back surgery and Modic I changes with my current injury, I should never lift over 50 lbs.

I am in a bind because I can do every aspect of my job except for lifting on patients. I don’t want to be forced out of my job because I am unable to lift greater than 75 lbs AND I also don’t want to have to get around in a w/c the rest of my life because of my back.

If you have any idea where I could find information regarding lifting requirements and RN’s that work in ER’s I would truly appreciate it.

I am not a person that can be labeled as “disabled” when I can fully function in my job and delegate the task of patient lifting.

Searching for an answer.

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Research indicates that during any patient transfering task, if any caregiver is required to lift more than 35 pounds of a patient’s weight, then the patient should be considered to be fully dependent and assistive devices should be used for the transfer (Waters, T. [2007] When is it safe to manually lift a patient? American Journal of Nursing, 107[8]53-59). The Safe Patient Handling and Movement page on the VA website provides a variety of resources including Algorithms for Safe Patient Handling and Movement (Assessment Form and Algorithms (Word–rev. 3/12/09)).

Additionally, NIOSH recently released two documents Safe Patient Handling Training for Schools of Nursing and NIOSH Hazard Review: Occupational Hazards in Home Healthcare. These documents may be of interest to others reading the blog.

I am a physical therapist working in an acute care setting. The information that I have read is certainly interesting and promising toward improving work-related musculoskeletal injuries. Of all the information presented, the one aspect I feel is missing from the literature is the viewpoint and participation of the patient. I often see or hear of nurses trying to passively lift patients, including those who are obese, rather than simply engaging the patient to complete a task. Of course, this involves active conversation with the patient and the time to do so which can certainly be a limiting factor to this approach. This behavior (e.g. passively moving a patient) frequently results in injury and/or dissatisfaction of the nurse and indignity and/or dissatisfaction of the patient. Addressing patient activity in a passive manner fosters a less self-efficacious stance on behalf of the patient, which is exactly the opposite of who the patient should and could be.

All in all, I am excited to see the efforts being made toward safe patient handling. I am not opposed to using the equipment, if and when it becomes available. I do however, believe, that these efforts would best serve the patient if they were framed either from the patient’s perspective and/or a patient-nursing or patient-health care provider perspective. Safe patient handling, as I see it, is a joint experience where each participating member should be valued equally.

On a side note, I feel like interprofessional training courses would really maximize the delivery of these courses and may have greater impact in environments where professionals from a variety of background must work together to optimize patient relationships and care.

Thank you for your time.

Sincerely,
Cori Zook-Arquines PT

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Serious subject. I am a public health specialist (occupational health) and I think most hospitals in this part of the world (Botswana) have not been sensitized on the benefits of proper ergonomics. As Botswana looks for ways to attract and retain healthcare workers, one would expect all government hospitals to formulate and implement the Zero lifting policy without further ado. I am therefore in the process of writing a project proposal tittled “Making Patient Lifting Safer”. The idea is to use the information generated by the NIOSH and others with a view to injecting a local dimension to the evidence already available. I will need to collaborate with any organization which can supply patient lifting devices and/or any other research body for whatever part they can play e,g, funding. My previous research activities includes an inquiry into the effectiveness of retractable syringes under the PEPFAR funded “Making Medical Injections Safer project” which I successfully carried out between 2003 and 2008 under the watchful eye of the Centres for Disease Control, Atlanta. I am also a member of the Worker’s Compensation medical Board and hence a witness to the high number of back pain related compensation claims. Anybody interested can reach me at kiamamwaniki@yahoo.com.

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Recently, when working with a nursing home client, a inquiry came up regarding a new OSHA regulation that may prohibit nursing assistants from using powered patient lifts, or even assisting with the use in moving patients.

Is this true?

It seems counterproductive when the patient lifts are available to provide safe movement for patients and safe transfer situations for staff.

Thank you for clarification.

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On May 20, the Department of Labor announced final child labor rules that went into effect on July 19, 2010. DOL is describing these new rules as the “…most ambitious and far-reaching revisions to the child labor regulations in the last thirty years.”

The new rules include numerous recommendations made by NIOSH, including a change that now prohibits 16- and 17-year-olds from operating or assisting in the operation of powered hoists of less than one ton capacity. NIOSH made this recommendation based on the potential for hoisted loads less than one ton to cause injury as a result of the load falling or being improperly rigged or handled, and reports of young worker fatalities associated with hoists, including a fatality of a youth using a half-ton electric hoist in an industrial setting. At the time NIOSH made this recommendation to the Department of Labor, NIOSH did not consider the potential application of this recommendation to patient lifting devices which have since been proven to be very effective in reducing worker injuries associated with patient handling when used as a part of a comprehensive program including worker training and employer policies.

The Department Of Labor is aware of stakeholder concerns about this aspect of the new child labor laws, and is currently examining the issue. NIOSH will provide technical assistance to the Department of Labor to help them in their consideration of risks to 16- and 17-year-olds associated with power-driven patient hoist/lifts, and the most appropriate means of providing meaningful opportunities for youth work in health care settings, while ensuring such work is safe.

For more information on the new child labor rules see the federal register notice and Department of Labor fact sheet. NIOSH recommendations to the Department of Labor for changes to child labor laws are available at http://www.cdc.gov/niosh/docs/NIOSHRecsDOLHaz/default.html

A new study of about 3,000 sonographers and vascular technologists shows that nearly 90% are scanning in pain (see [http://www.sdms.org/pdf/preventinginjury.pdf]).

This is ongoing, and endemic to the industry and profession.

As found in “Ultrasound Ergonomics – Designed With the Sonographer in Mind”, [http://www.imagingeconomics.com/issues/articles/MI_2004-12_08.asp] performing countless ultrasound scans, each taking 15-45 minutes, sonographers are among the highest risk groups in the medical profession for work-related musculoskeletal disorders (WRMSD) and career-ending injuries.

I’m a sonographer, and know of many who’ve needed surgery. I believe something must be done.

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I’ve been a bedside nurse since 1980. I work primarily in ICUs. I’m called on frequently to assist with lifting and positioning of patients.

Now at age sixty four I’ve been diagnosed with severe degenerative disc disease at the level of L4-L5. It was the turning of a 345lb. patient that brought about the sudden onset of pain. I was initially diagnosed with a back sprain and given medications and some physical therapy. Relief was temporary. After an MRI disclosed the degenerative process the hospital was quick to let me that while they would pay for some physical therapy and the initial examination they could not be responsible for any subsequent surgery if it became necessary. As I work through the hospital’s Flexpool, I have no benefits. I’m told I would have to be out of work for a year before I could qualify for disability here in SC. If I choose to retire now at this age I’ll have to accept a reduced social security benefit. Unfortunately I have some habits I must support, like eating and having a place to live. I’ve cut my work back to one – two days per week. Fortunately I have health insurance paid for through my wife’s plan. She works at the same hospital full time and qualifies for benefits.

So we are lucky. I personally know nurses who have injured their backs or shoulders received a similar “ongoing process” type diagnosis and were eventually dismissed when they could not return to non-restricted work status. With nursing being staffed mainly by women I have to wonder what happens in a male dominated work force with a similar high incidence of disabling injuries. Are male workers so easily dismissed and discarded?

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As a physical therapist I treat many nurses and health care workers that have injured their backs. I myself had a bout of back pain after doing an internship at a hospital where I had to transfer patients. I my opinion a standard prerequisite for any health care job where one has to transfer patients is a thorough education in body mechanics and core strengthening.

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Most experts believe that reliance on body mechanics or strength training is not an effective approach to prevention of injuries due to patient transfers. Rather, implementation of a safe patient handling program using ergonomic equipment and methods has been shown to be effective.

hi,i work in a facility where everything is said ask for help but in reality that doesnt work.there is not enough staff to help u with a constant lift or repositioning.90% of the patients are not able to help and range up to over 100 pounds.its crazy but once you talk with the higher ups everything is according to plan .ugh they dont work the floor and only go by their theoratical thought.i take care of 7 residents and only 1 of the beds can adjust to my height which really strains my back.oh yeah and if inspectors do show you just wont believe how much help we have out of the blue which is not available any other time.i think more direct guidlines and equipment needs to be recommended.like 2 caregivers working together at all times.

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Nice read here. People in the field of dentistry are never exempted from these back pains. In fact, they’re as susceptible to such health issues since they would usually bend over to assist their patients.

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Thank you for your comment. You may be interested the related discussion in comment 15 and the response above.

I understand the need for lift equipment as part of a SPH program for it to be effective. However, I have heard horror stories of patients being dropped from lifts and caregivers being injured by human error or mechanical failure. Additionally, I have heard complaints from patients that the transfer in a hoyer lift takes too long, is at times uncomfortable, can cause skin tears and is generally degrading. Are these the best options for transfer equipment today?

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The large reduction in potentially disabling worker injuries obtained by using lifts far outweighs the potential for injury caused by the equipment to the worker. Unpublished data from a previous NIOSH study* shows only one worker’s compensation claim due to lifts (the employee bumped up against a lift). We are not aware of data indicating patients being dropped from lifts. New modern lifting equipment is generally safe and reduces risk of injury to the patient.

* Collins JW, Wolf L, Bell J, Evanoff B. 2004. An Evaluation of a “Best Practices” Back Injury Prevention Program in Nursing Homes. Injury Prevention 10:206-211.

I have recently been diagnosed with degenerative disc. I have it all up and down the spine…..I had surgery on my neck to releave the pain in my neck and migrane head aches…I have been in direct care for 11 years…..Yes we have lifts and yes we are trainned how ever when you work with people who dont help or fight against the roll you are gonna get hurt….My injury is proven to be something that happened over time and that being said they dont prove it happened at work but it is the only way i can see it happened. I asked on several occassions for the company (i was working for and they fired me because of a doctors note that states i have a long term weight restriction/ no pushing or pulling.) To get me another staff and do 2 person help on one particular resident as he fought if you turned him one way he wanted to go the opposite and he had to be changed or gotten up or you were neglecting him. They never got the help for me…..Now its been 3 months and they have 2 more staff out with back injuries that we cannot prove happened at work. Why do companies get away with killing peoples backs?

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When you get a back injury or suspect a back injury you should report it right away to your employer. This is so that when you feel the effects the following day it can be linked to the incident.

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I appreciate all the work being done to implement safe lifting. It is a great cause for all the new nurses, but what about the already injured nurse. We care for the sick day in and day out yet, when it comes to an injured nurse, you are tossed to the curb. Sure there is worker’s comp but with all the new laws, one basically gets nothing. The pay isn’t even close to a regular salary and to top it off, the employer can not be held responsible for their negligence (ie) No lifting equipment!

It is well documented nurses are at the top of the injury list, and you would think since they save lives, they would be cared for. HA! As a nurse for 30 years, I am now injured and VERY fearful of losing everything I have worked so hard to attain. The system is not fair. OSHA needs to get on the ball and make them (employers) RESPONSIBLE for the safety of the staff. One can certainly tell the WC laws are made strictly for the employers and insurance companies and do NOT have the best interest of the employee at heart. Nurses CARE for people, NO ONE cares for injured nurses!

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I’m trying to find statistics on whether back injuries are more or less common amongst people who habitually avoid heavy lifting.

I am a geriatric nursing assistant, but I worked for over a year as a professional furniture mover. The two industry’s approach to back safety are like night and day.

Specifically, movers never think about or talk about or try to avoid back injuries. We did everything you’re not supposed to do. In the moving industry, you don’t refuse to lift anything unless you are physically incapable of doing so. In the moving industry, you often have no choice about body mechanics. When you’re negotiating a long 3-hundred pound dresser through hallways and doors you sometimes *have* to twist and you sometimes *have* to hold the object away from you and you sometimes *have* to do both at the same time.

By conventional wisdom, there were about a thousand times when I should have gotten a back injury, yet I never did. None of us ever did. I’ve worked with over a hundred professional movers, many of them over sixty years old, and the only mover I had ever met who’d had back problems had gotten them years after retiring.

I’ve worked as a stocker as well, with the same results. People lifted heavy objects and did not get hurt.

Now I work in nursing, where there is this huge, constant, awareness about back injuries, where I’m constantly being told, “don’t hurt yourself”. Yet this is the industry with the highest incidence of back injuries.

In the 1950s it was common for doctors to advise men over the age of 40 to not exercise or do anything that might put strain on the heart — because this is how you get heart attacks. Now we know better: if you don’t want to overstrain your heart then you do want to strain it enough to keep it strong.

It seems to me that nurses’ avoidance of back strain is the very thing that causes back injuries in the long run.

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While we appreciate your comment, the data do not support your observations. We are not aware of research on your specific question regarding the avoidance of lifting but, the converse is certainly true. Several studies of back injuries, such as the National Research Council and NIOSH reviews of the literature, show that lifting heavy loads is associated with increased risk of back disorders. According to the 2009 Bureau of Labor Statistics data, movers have one of the very highest lost workday injury rates of all industries. They have a lost-workday total overexertion rate of 134.8 per 10,000, which is above that of nursing care facilities at 102 per 10,000. Furthermore, warehouse workers have very high back injury rates (grocery selectors who work grocery distribution centers have around a 50% recordable back injury rate). Unfortunately, back injury continues to be a debilitating and costly problem in the workplace. Awareness and “being told not to hurt yourself” do not reduce the risk of injury. In nursing homes, using mechanical lifting equipment, training in the use of the lifting equipment, and the implementation of a safe lifting policy have succeeded in reducing injury.

Bernard, B.P., ed. 1997b Musculoskeletal Disorders and Workplace Factors: A Criticial Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Publication No. 97-141. National Institute for Occupational Safety and Health. Cincinnati, OH: U.S. Department of Health and Human Services.

National Research Council, Institute of Medicine. [2001]. Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremitites. National Research Council and Institute of Medicine – Panel on Musculoskeletal Disorders and the Workplace. Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

Bureau of Labor Statistics (BLS). 2010. Table R8. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by industry and selected events or exposures leading to injury or illness, 2009. Bureau of Labor Statistics, U.S. Department of Labor, Washington, DC., Survey of Occupational Injuries and Illnesses in cooperation with participating State agencies.

I am a Licensed Massage Therapist in New York. I’ve worked in one of the leading hospitals. My employment at the hospital was to offer therapeutic post-surgical massage to patients.

I saw for myself how physically demanding the work of dedicated nurses can be. For this reason, whenever there was a lack of patients, I offered my services to the nursing staff. They really needed to be kneaded!

I also offered advise on strengthening one’s core muscles and reducing abdominal size which put the overweight nurses at additional risk of back injury. As you noted in your post, the average age of nursing staff will rise, which adds another layer of injury potential to factor in.

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I am the manager of little massage studio in Colorado and am well aware of this problem in the health care profession. I always remind my therapists to adjust their tables to the proper height and work ergonomically. The times that I’ve had therapists complain is when their table is too low and they are slumped over. I believe that managers of health care workers need to educate their staff regularly on this subject before it is too late. I know it is already too late for me because I have 2 compressed discs in my lower back, so lucky I can get massage therapy to help, but not much works to actually fix it.

Thanks for the blog post.

-Julie Friedman
manager, Sol Impressions Massage Studio, Breckenridge CO

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Thank you for your helpful comment. Awkward work postures such as forward bending increase the risk of musculoskeletal strain and injury. We agree that adjusting the height of the work surface should be used as a strategy to prevent bending forward or reaching upward, and this strategy can be used in many different occupations. In healthcare settings, patient care providers as well as housekeeping staff should adjust the height of the bed so that they are standing comfortably, without bending down or reaching up, while performing patient care tasks, changing linens, etc.

I encounter a lot of patients with back injuries due to lifting since I am a physical therapist and physical therapy marketing speciallist. These injuries should really be taken seriously.

When lifting heavy objects, make sure that you are in the proper lifting position to avoid any injuries.

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While maintaining good body posture is important in manual lifting, it is important to remember that some lifts are just too stressful for workers to perform without assistance no matter how well they maintain their posture. Moreover, there is no single posture that is considered a “proper lifting position.” Optimal body mechanics is not sufficient for preventing injury when lifting heavy objects. Therefore it is important to determine when lift assist technology should be used to help perform the lift. In occupations requiring manual materials handling, mechanical lifting devices should be used for objects exceeding the NIOSH recommended weight limit (Waters et al., 1993; Waters et al., 1994). In healthcare settings, lift devices should be used when lifting a patient or a part of a patient’s body (e.g., a leg or an arm) that weighs over 35 pounds (Waters, 2007). Download the NIOSH lifting equation from our website.

Waters T., Putz-Anderson V., Garg A., and Fine L. J., Revised NIOSH equation for the design and evaluation of manual lifting tasks. Ergonomics. 36(7):749-776, 1993.

Waters T., Garg A., and Putz-Anderson V. Applications manual for the revised NIOSH lifting equation [DHHS(NIOSH) Pub. No. 94-110]. Cincinnati, Ohio: Department of Health and Human Services, National Institute for Occupational Safety and Health, Division of Biomedical and Behavioral Science, 1994.

I am managing the care of my 380 lb 34 yr old daughter at home. She has progressive MS that affected her spinal cord and can move very little below the neck. My insurance company is providing good equipment, Medicaid is providing health care aides for most of the day. I am the one responsible for keeping [name removed] and her caregivers (including myself) safe, meeting their needs, connecting with various agencies, arranging [name removed] special and regular medical care, etc. I know why the health care facilities find this job (that I do) so difficult, the reasons are endless. But I don’t see why they aren’t doing better at it than I am.

Reading this Blog confirms what I have seen, [name removed] would not be as safe in a public facility, as she is here. But I am 63 and she is 34. I hope they get their act together soon.

Meanwhile I have many specific questions and don’t know where to find answers. Today’s questions are:

◦Where can I find a lift sling adequately padded or designed to prevent the sores under her thighs caused by the slings EDGES when she is lifted? This must be happening to every patient of any normal or + size who is being lifted in any sling but I don’t see any maunfacturer or medical references. I don’t know how to find out.
◦Who is the professional that knows if the increasing curve of her back to her right is a spinal problem or a support problem, and can or should it be corrected with wheel chair straps and attachments or whatever. The PT who doesn’t know, refers me to the OT who isn’t sure.
◦Is there any agency to help bariatric patients find major equipment facilities that fit such as MRI and Muga scan?
If you even know where I can look for these answers I would be grateful Thank you

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at last an innovative technique for those who are in need for a effective rehabilitation great article very informative

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I asked on several occasions for the company i was working for and they fired me because of a doctors note that states i have a long term weight restriction/ no pushing or pulling.

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Just sharing my experience on the individual impact brought about by back injuries: About 80 percent of back injuries are brief in duration, and workers are able get back to standard wellness. Within the short-term, they may possibly encounter discomfort and decreased functioning. For some, the pain and suffering is long-term. And for a modest percentage of people, it truly is lifelong. For personnel with long-term, disabling musculoskeletal injuries, lifetime earnings could drop drastically. These staff could also suffer a loss of independence as well as a diminished top quality of life.

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Back injuries can always be problematic and can cause long term suffering with constant pain and in seek of relief . I encounter a lot of patients with back injuries due to lifting. Many employers dont look at this seriously too.

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I am a certified nurse aide and I work at a assisted living facility. These residents as you know care for themselves accept for a little assisted from the nurses. Well I was working one a day and they had a resident in the facility that wasn’t suppose to be there for she couldn’t care for herself. (Immobitilty) She was suppose to be in nursing home or at a rehab. So I had to lift her up and put her in the wheelchair. She was deadweight for she couldn’t move herself at all. I injuried my back transferring her from the bed to the wheelchair. Eventhough I used the proper way of lifting a patient I still injuried my back and now my job is on the line because one they know they aren’t suppose to have any resident that can’t care for themselves there. And also worker’s comp won’t pay my bills or the time I was out of work. Light duty is restricted at my job. I am afraid that they will set me up and fire me because I am a hazard to their company. Because of my injury that happen at the job.

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I broke my back 3 years ago. I have in the past always done heavy, physical work. Now I have to be content with others (my wife) helping me to do most things. All I was told at my release from hospital was if it had not healed within 2 years, live with it!

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What are safe lifitng limits (unassisted) for health care workers – without any type of mechanical devices?

Are there any resources for this – specific to male/female and age?

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In general, the revised NIOSH Lifting Equation yields a recommended 35-lb. maximum weight limit for use in patient-handling tasks. When weight to be lifted exceeds this limit, assistive devices should be used. For more information consult the article “When is it Safe to Manually Lift a Patient?” by Thomas Waters in the American Journal of Nursing (Aug. 2007. vol. 107, No. 8). The article can be found at: http://journals.lww.com/pages/login.aspx?ReturnUrl=%2fajnonline%2fFulltext%2f2007%2f08000%2fWhen_Is_It_Safe_To_Manually_Lift_A_Patient_.30.aspx.

Regarding your question of gender, Appendix A in the Applications Manual for the Revised NIOSH Lifting Equation contains a reprint of an article from the Journal Ergonomics. The article states that the revised lifting equation “yields recommended weight limits that are lower than weights acceptable to at least 90% of females.” (Section 5.4, p. 760; and, Table 5, p. 761). This means that more than 75% of females and 99% of males should be able to safely lift weights defined by the recommended weight limits. We did not discuss age in the article.

I am glad you pointed this out, and bringing more awareness to this issue. People, patients that it, rely on doctors and nurses to help them but often think just about themselves, but sometimes the caregivers are those that need a proper care.

Igor

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Injuries can mostly be avoided by simple strength training and a basic exercise regimen. If something is too heavy ask for help. Don’t try to push your limits, exercise regularly and eat healthy. I am a Laguna Hills Physical Therapist and I see numerous injuries that could have been avoid by doing simple stretching and exercising.

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Thank you for your comment. We agree that regular exercise and a nutritious diet are necessary for maintaining good health. However, most of the research evidence on patient handling indicates that strength training and exercise are not, by themselves, sufficient for preventing overexertion injuries. As previously noted in this blog, recent research using the NIOSH lifting equation indicates that under ideal conditions, 35 pounds is the maximum weight a health care worker can manually lift during patient handling without increasing the risk of a musculoskeletal injury. We agree with the comments, “If something is too heavy ask for help,” and “Don’t try to push your limits.” We suggest that using 35 pounds as a manual lifting limit can be helpful in determining the need for assistance during patient handling situations.

Dear PT Laguna

You said, “Injuries can mostly be avoided by simple strength training and a basic exercise regimen.” Please share with us a scientific study (that meets the requirements for validity, reliability of data and transfer-ability of conclusions) demonstrating that simple strength training and basic exercise have decreased the incident frequency and severity of back disorders.

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I am a physical therapist currently off work due to a serious back injury. I work in an acute care hospital and have for 5 years. I consider myself in good health. I am outraged at the comment made by PT Laguna. You can be in the best condition, use the best body mechanics in the world and still get injured. The repeated demands of lifting ill, overweight patients without good staffing, with productivity demands and without proper equipment is a recipe for disaster. The PT staff is used as human hoyer lifts. Patients are left in bed far too long before any attempt to get them up is made. There are countless reasons for the making of this perfect storm.
In an ideal world you can set lifting limits, as stated 35 pounds. This would meen that you would be unable to assist anyone. When you factor in a patients body weight and just bending and reaching to roll them from a supine to a side lying position to even initiate bed mobility, the lever arm becomes so long any weight would be too much. Until management weights the cost of worker injury to staff safety, you will continue to have injuries. Health care workers are nurturers by nature and will typically do what it takes to get there job done, no matter what the cost. Something has to be done. I plan on pursuing this answer because I do not want anyone to have to suffer what I am going through.

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Everything that was shown to me is very helpful in my everyday work. thank you

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Check Out the ” A Back Injury Prevention Guide for Health Care Providers” Guide For More Information: http://www.dir.ca.gov/dosh/dosh_publications/backinj.pdf

The guide discusses how to:
Understand the scope of the back injury problem
Analyze the workplace to find work activities, equipment and related factors
which may contribute to the development of back injuries
Identify and implement improvement options
Evaluate the results Etc

Dr. Akash Lapsi

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Back injuries in the work and especially in the healthcare industry are a big concern. I believe this guide “A Back Injury Prevention Guide for Health Care Providers” can also be very useful to those who work in other industries. Back injuries happen anywhere and every little bit that can be prevented helps. Dental facilities are part of the health system. Though there is not a whole lot of lifting going on in dental facilities, yet back injuries can happen in them. If it is just one and this guide can help prevent that, it is well worth it.

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A great post. Back injuries can always be problematic and can cause long term suffering with constant pain and in constant seek of relief . Thanks a lot for your informative post.

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Lifting accidents resulting from faulty lifting equipment can cause serious injury. In the UK lifting equipment is regulated by LOLER 1998 inspections.

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great piece of article. never knew health workers were at such risk. back injuries can be truely reduced when concerted efforts are taken. thanks for this information

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Thanks for sharing the informative post. Back injuries can always be problematic and can cause long term suffering with constant pain and in constant seek of relief. it is just one and this guide can help prevent from them.

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Dental facilities are part of the health system. Though there is not a whole lot of lifting going on in dental facilities, yet back injuries can happen in them. If it is just one and this guide can help prevent that, it is well worth it.still love your website,
Julia

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I think the pressures that healthcare workers go through are quite difficult. I didn’t realise how difficult it can be. These type of issues need to be looked into more.

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We have the same issues here in australia and I am suprised that your legislation is not the same as ours we have staff at the clinic that need to be loking in this direction and bring themselves up to date wewill pass this on to them

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Greetings! Very useful advice within this article! It is the
little changes that make the most significant changes.

Thanks a lot for sharing!

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In an in home situation, is it safe for a Hoyer lift to be operated with one person?

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NIOSH has not evaluated the performance of the Hoyer brand or other specific commercial brands of lifts. In regard to the use of a lift with one caregiver, each case should be assessed individually by the patient’s healthcare provider(s). Personnel from the discharging hospital or home health care agency should be able to determine if more than one caregiver is needed to transfer a patient in a lift, based on factors such as the patient’s condition and weight, the lift’s features, the amount of space available for transfers, etc. The caregiver(s) should be thoroughly trained to properly use the lift by the consulting healthcare personnel and/or the appropriate representative of the company from which the lift was purchased. It is also important to ensure that the sling(s) used are appropriate for the lift, and that the conditions of the lift and slings are regularly inspected and maintained. Further information regarding patient handling in home settings can be found at http://blogs.cdc.gov/niosh-science-blog/2010/04/16/homehealthcare/.

Thanks for an informative article – We are small UK dental practice and quality content like this is always a good read

Regards

Lee

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Work-related back injury is definitely inevitable to nursing personnel and something should really be done about it. It’s great that the health industry has taken steps on how to avoid MSDs on these workers. Hopely, MSDs would be eradicated in the near future. Great info!

back pain moscow, pa

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This article has some vast and valuable information about this subject.

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I see no hope in sight. When 1 nurse and 2 cna’s are assigned to care for 30+ residents, it doesn’t matter if mechanical lifts are available. There simply is not enough time to go get the lift to “pull” a resident up in bed. If this was done every time a resident was repositioned, there would be no time to attend to everthing required to care for the residents, i.e. med pass, feeding, chasing wanderers, controlling combative behaviors. I could go on. Also, many LTC facilities still have old, manually cranked beds. Cranking a bed with a 250 lb+ resident is just as injurious as lifting them with a draw sheet. As healthcare workers, we are expected to be super-human! I understand good body mechanics and have instructed others in properly lifting and positioning. Staff partners are reluctant to report any back pain because typically they are blamed for not following protocol. I am a 60 year old RN and experiencing severe lower back pain but must hobble through until retirement. The nursing home does not want to acknowledge that lack of adequate staffing is harming the staff that is there. I’m tired of pencil pushers telling healthcare workers that we are ignorant when it comes to safety. Having said all of this, my back still hurts and I will be going in to work overtime because there is nobody else available.

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Thank you for your comments. We are very sorry to hear of your back pain. Understaffing and inadequate equipment are factors working against an effective safe patient handling (SPH) program. As noted in the blog text, methods focused solely on body mechanics are not sufficient for reducing injury risk. SPH interventions using ergonomic equipment and methods to lift and move patients do significantly reduce injuries. Similar to the studies described in the blog text, other research has also shown that SPH programs are cost-effective: savings from reduced injury costs exceed the SPH program costs within 3 to 4 years on average (e.g., Nelson et al., 2006). Unfortunately, SPH programs are still sorely lacking in U.S. Healthcare settings. However, progress toward more widespread use of SPH programs is being encouraged by safety researchers, practitioners, and advocates, with an upsurge in attention by the public and the press (e.g., National Public Radio, Public Citizen). Progress is also being motivated by SPH laws in increasing numbers of states, continued federal legislative efforts, and new enforcement policies recently implemented by OSHA (2015). We hope that healthcare facility owners and managers respond to these developments by starting and maintaining effective SPH programs. Further information and links to other resources can be found on the NIOSH Safe Patient Handling topic page .

Reference
Nelson, A., Matz, M., Chen, F., Siddharthan, K., Lloyd, J., and Fragala, G. (2006). Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks. International Journal of Nursing Studies, 43, 717-733.”

Great article and much appreciated. As a nurse, I understand and sympathize with Kathy (Aug. comment) and others. I have experienced a number of injuries throughout my career from boosting, re-positioning and transferring patients (and catching fainting patients) in hospital environments that were often short-staffed and in home environments where you are on your own (although 1 nurse and 2 CNAs for 30 patients is completely unacceptable). The adage “nurses are the “worst patients” is probably true as I (along with a number of my colleagues) only reported 1 of my injuries since we never wanted to leave our colleagues or patients in the lurch. So in addition to not having the proper amount of staff or SPHM devices, we were much more prone to additional injuries and eventually many of us left direct care.

Healthcare workers should be aware that in addition to mechanical lifts, there is a fairly new solution called the [name removed] which can safely boost a patient in bed with the touch of a button or transfer them (typically with one person) to a docked wheelchair — no lifting involved. The wheelchair also converts to a commode.

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Safety seminars or practices should be reviewed periodically so workers in construction will not forget about it. As they say it, prevention is better than cure.

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Great article with a great point, so really how about those who are doing the job on assisting patients and residents. They should have good facilities to help them especially in moving or transporting patients.

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nice information thanks for sharing

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Nice Theories for Curing Back Injuries..
Thanks for Posting..

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This post have such a nice and so much valuable information people can get Musculoskeletal disorders is now days so many people are suffering for that , the reason behind it is only at a rate exceeding that of workers in construction, mining, and manufacturing. The workers who work on that field they should take more care for himself and also they should do some kind of workout and yoga and also for they should go also for regular checkup.

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very nice post and people can get lots of information

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GOOD INFO

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As an allied care worker in the forensic field I often find myself moving and/or maneuvering dead bodies without the assistance of equipment. My employer provided ergonomic practices that are applicable to live patients. Are there any training materials regarding best lifting practices for the autopsy technician?

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To our knowledge there are currently no widely-published training materials regarding best lifting practices for autopsy technicians. Equipment designed and marketed specifically for lifting/moving cadavers is available, however research is still needed to develop and validate best practices in this area. Lifting a cadaver is essentially comparable to lifting a living patient who is completely dependent (e.g., paralyzed, comatose), although the lifting dynamics may differ greatly depending on the presence or absence of rigor mortis. In any case, manual lifting of cadavers should not be attempted. Until evidence-based research specific to cadavers is available, the use of cadaver/patient lifting equipment should be used along with currently available guidance for lifting and moving living patients who are completely dependent.

A great deal of information on safe patient handling and mobility (SPHM) can be found on the NIOSH SPHM Topic Page, including links to the most recently-published guidelines from the Veterans Health Administration (VHA). Their SPHM toolkits include algorithms for lifting patients of all sizes and dependency levels. Easy access to the algorithms and other tools is also available on their free mobile app.

Great site.

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The article has good information though is not current. The site claims the page was last reviewed and updated on August 25, 2017. Could this page be archived and another page published with current statistics, etc.? Thank you.

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Thank you for your comment. The ‘reviewed and updated’ date is automatically created when any change is made to the blog and does not mean that the data and references have been reviewed and updated. We are sorry for any confusion this created. We will be updating the content of the blog in the near future. In the meantime, you can find a great deal of more up-to-date information related to health care overexertion injuries and safety interventions at the NIOSH Topic Page on Safe Patient Handling and Mobility.

lot to take care of

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I am just starting out in training manual handling in the hospital environment. Even though I have years of experience working in hospitals I am finding there are a number of things I am needing to research. The one I am struggling with at the moment is finding out the weights that can safely be pushed in wheelchairs, specifically as it relates to bariatric patients. At what weight do we need 2 people pushing a wheelchair? And at what weight is a person too heavy to be pushed in a wheelchair, even if it is by 2 people?
I am hoping you might be able to point me in the right direction to find answers for these questions.
Thank you in advance,

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There are many factors to consider when assessing the risk of injury associated with pushing or pulling a patient in a wheelchair. Using one single factor patient’s weight may not be appropriate because the design of a wheelchair, the patient’s weight, the working surface, the incline angle (up or down), and the way of using the wheelchair contribute to the overall safety of the manual handling task. Guidelines on manual material pushing or pulling may be applied to pushing or pulling a wheelchair. You may visit the Ohio’s Bureau of Workers’ Compensation’s website (Ohio BWC – Push/Pull guidelines) for determining the risk level for this particular task.

Very Informative

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