Reducing Ergonomic Hazards
The subject of ergonomics has been a hotbed of political controversy for a long time at the federal level, as well as at the state level. The current Labor Department administration introduced a four-pronged approach on April 5, 2002, to reduce ergonomic injuries by providing information to nursing home employers and employees about potential ergonomic hazards and ways to reduce those hazards.
Reduction of MSDs in nursing homes were chosen first because it is physically demanding work and residents often require assistance to walk, bathe or perform other normal daily activities.
OSHA's goal was to provide a safer and more comfortable work environment, which has shown other benefits for some facilities, including reduced staff turnover, associated training and administrative costs, reduced absenteeism, increased productivity, improve employee morals and increased resident comfort.
It is OSHA's recommendation that employers implement a systematic process for identifying and resolving ergonomics issues, and incorporate this process into its overall program to recognize and prevent work-related injuries and illnesses. OSHA recognizes that small nursing homes may not need a formal program to accomplish this goal.
1. Transfer from sitting to standing position
Workers can use powered sit-to-stand or standingassist devices. Transferring residents who are partially dependent, have some weight-bearing capacity, are cooperative, can sit up on the edge of the bed with or without assistance, and are able to bend hips, knees and ankles. Transfers from bed to chair (wheelchair, Geri or cardiac chair), or chair to bed, or for bathing and toileting. Can be used for repositioning where space or storage is limited. Look for a device that has a variety of sling sizes, lift-height range, battery portability, hand-held control, emergency shut-off and manual override. Ensure that the device is rated for the resident's weight. Electric/battery powered lifts are preferred to crank or pump type devices to allow smoother movement for the resident, and less physical exertion by the caregiver.
2. Ambulation
The use of an ambulation assist device is for residents who are weight bearing and cooperative and who need extra security and assistance when ambulating. This increases resident safety during ambulation and reduces the risk of falls. The device supports residents as they and push it along during ambulation. Ensure that height adjustment is correct for resident before ambulation, and ensure that it is in good working order before use and is rated for resident's weight. Apply the brakes before positioning or releasing any resident from the device.
3. Lateral transfer, repositioning
A convertible wheelchair, Geri or cardiac chair to bed is used for lateral transfer of residents who are partial- or non-weight bearing. Use of this eliminates the need to perform a lift transfer in and out of wheelchairs. Can also be used to assist residents who are partially weight bearing from a sit-to-stand position. More than one caregiver is needed to perform a lateral transfer. Additional assistance may be needed depending upon the resident's status, such as a heavier or non-cooperative resident. Additional friction-reducing devices may be required to reposition a resident. Heavy duty beds are available for bariatric residents. The device should have an easy-to-use control system located within easy reach of the caregiver, sufficient foot clearance, and a wide range of adjustment. Motorized height adjustable devices are preferred to those adjusted by crank mechanisms to minimize physical exertion, and always ensure the device is in good working order before use.
4. Repositioning in chair
Use of a variable position Geri and cardiac chairs are best used in repositioning partial- or non-weight-bearing residents who are cooperative. More than one caregiver will be necessary and use of a friction-reducing device is needed if a resident cannot assist to reposition themselves in the chair. Ensure use of good body mechanics by caregivers. Wheels on the chair add versatility. Lock wheels on the chair before repositioning, and remove trays, footrests and seat belts where appropriate. Ensure the device is rated for the resident's weight.
5. Transfer from sitting to standing position
Stand-assist devices can be fixes to a bed or chair, or can be free-standing. These devices may be used when transferring residents, who are weight-bearing and cooperative, and can pull themselves up from sitting to standing position. The devices can be used for independent residents who need extra support to stand. Ensure that the device is stable before use and is rated for resident's weight to be supported. Ensure that the frame is firmly attached to the bed, or if it relies on the mattress for support, ensure that the mattress is heavy enough to hold the frame.
6. Bathtub, shower and toileting activities
Height adjustable bathtub and easy-entry bathtubs are beneficial for bathing residents who sit directly in the bathtub, or to assist ambulatory residents to be able to climb more easily into a low tub, or easy-access tub. Bathing residents in a portable-powered or ceiling mounted lift device using appropriate bathing sling. Using this type of device will reduce awkward postures for caregivers and those workers who clean the tub afterwards. The tub can be raised to eliminate bending and reaching for the caregiver. Use correct body mechanics, and adjust the tub to the caregiver's waist height when performing hygiene activities. This also will increase the resident's safety and comfort.
7. Storage, transfer of food, supplies and medications
Use of carts will help deflect musculoskeletal injuries by moving food trays, cleaning supplies, equipment, maintenance tools and dispensing medications. This also speeds the process for accessing and storing items. Placement of items on the cart should keep the most frequently used and heavy items within easy reach between hip and shoulder height. Carts should have full-bearing wheels of a material designed for the floor surface in your facility. Cart handles that are vertical, with some horizontal adjustability will allow all employees to push at elbow height and shoulder width. Carts should have wheel locks. Handles that can swing out of the way may be useful for saving space or reducing reach. Heavy carts should have brakes. Be sure to balance loads and keep loads under cart weight restrictions. Ensure the stack height does not block vision. Use of low profile medication carts with easy-open side drawers are recommended to accommodate hand height of shorter nurses.
8. Medical equipment
Review the work methods and tools to transport equipment by using assistive devices and other equipment. In considering oxygen tanks, use small cylinders with handles to reduce weight and allow for easier gripping. Secure the oxygen tanks to transport devices. For medication pumps, use stands on wheels, and for transporting equipment, push the equipment rather than pull, when possible. Keep arms close to the body and push with the entire body, not just the arms. Remove unnecessary objects to minimize weight, and avoid obstacles that could cause abrupt stops. Place the equipment on a rolling device, if possible, and take defective equipment out of service. Perform routine maintenance on all equipment.
9. Working with liquids in housekeeping
Here are some salient points in filling and emptying liquids from containers. In housekeeping areas when filling and emptying buckets with floor drain arrangements, remember to reduce the risk of spills and slips. The faucet and floor drain is sued in housekeeping, so be certain to ensure that the casters don't get stuck in the floor grate. Use a hose to fill the bucket, and use buckets with casters to move mop buckets around. Ensure that casters are maintained and roll easily.
10. Loading, unloading laundry
It is easier to use front-loading washers and dryers when loading and unloading laundry from washer, dryers and other laundry equipment. This speeds the process for retrieving and placing items, and minimizes wear-and-tear on linen. Washers with tumbling cycles separate clothes, making removal easier. For deep tubs, a rake with a long or extendable handle can be used to pull linen closer to the door opening. Raise machines to that the opening is between the hip and elbow height of employees. If using top loading washers, work practices that reduce risk include handling small loads of laundry, handling only a few items at a time, and bracing your body against the front of the machine when lifting. If items are knotted in the machine, brace with one hand while using the other to gently pull the items free. Ensure that items go into a cart rather than picking up baskets of soiled linen or wet laundry.
This article originally appeared in the May 2003 issue of HME Business.