Effectiveness of overhead lifting devices in reducing the risk of injury to care staff in extended care facilities

Near-1: the evaluation of usability and task load demand of a motorized lifter for patient transfer

PURPOSE

Despite the proven benefits of motorized lifting devices in reducing the physical stresses experienced by nurses during patient transfers, the low adoption of these devices remains limited. The study aimed to assess the perceptions of nurses regarding the new motorized lifting device (NEAR-1) in terms of their perceived workload and usability during patient transfers.

MATERIALS AND METHODS

A cross-sectional study was conducted to evaluate the perceptions of nurses (n = 45) and students (n = 6) when performing patient transfers from bed to wheelchair and vice versa using the NEAR-1 compared to an existing floor lift, walking belt, and manual transfer. Participants filled out surveys evaluating the perceived task demands and usability of the NEAR-1, as well as open-ended interviews.

RESULTS

The use of the NEAR-1 significantly reduced the mean of all NASA-TLX constructs (p < 0.001) when compared to manual transfer. When comparing with other existing lifting devices, the NEAR-1 (24.4 ± 3.0) recorded the lowest overall score of NASA-TLX perceived workload, followed by the existing floor lift (26.1 ± 11.6), a robotic-assisted transfer device (28.3 ± 6.8) and mechanical floor lift (31.5 ± 9.3). The participants recorded a usability score of 76.86, indicating positive perceptions of the nurses towards the technology.

CONCLUSIONS

Overall, the NEAR-1 has the potential to reduce the physical stresses on nurses and decrease the likelihood of work-related musculoskeletal disorders (WMSDs). The NEAR-1 may represent a promising new intervention for transferring patients that is capable of minimizing the nurses' perceived workload in clinical and non-clinical settings.

Impaired hospitalized patient mobility is associated with nurse injuries

BACKGROUND

Staff injuries adversely affect the health of staff members as well the ability of health care teams to effectively care for patients. Identifying patients who pose an increased risk of injury may allow for the planning of risk mitigation strategies, but few studies have examined patient factors associated with staff injury risk.

AIMS

Examine the relationship between staff injury and patient mobility, which has been linked to other key hospital outcomes.

METHODS

Linking occupational health and electronic medical record data, we examined documented patient mobility levels, based on the Activity Measure for Post-Acute Care (AM-PAC) and the Johns Hopkins Highest Level of Mobility (JH-HLM) Scale, on the day prior to injury. In addition, we created a matched cohort of control patients not associated with staff injury to examine the influence of patient mobility on the odds of staff injury.

RESULTS

We identified 199 staff injuries associated with 181 patients with 1063 matched controls. Patients had median scores of 11 and 3 on the AM-PAC and JH-HLM, respectively, indicating moderate-severe mobility impairments. In addition, scores in the lowest AM-PAC tertile (6-15) and lowest JH-HLM tertile (1-4) were associated with a 4.46-fold and 2.90-fold increase in the odds of nurse injury, respectively.

CONCLUSIONS

These results indicate that moderate-severe mobility impairments are associated with increased risk of nurse injury. Hospitals and clinical care teams should consider documenting mobility routinely and utilizing these values to identify patients who pose an increased risk of nurse injury.

Effectiveness of Safe Patient Handling Equipment and Techniques: A Review of Biomechanical Studies

OBJECTIVE

This review aimed to evaluate all studies that have evaluated the biomechanical effects when using assistive devices.

INTRODUCTION

The physical demands of patient handling activities are well known. One safety strategy for the reduction of the physical risks is use of assistive devices.

METHOD

The search process identified articles published in English-speaking journals through Google Scholar, Medline, and ISI Web of Science. The included 56 studies contained a biomechanical assessment of a patient handling activity with assistive devices.

RESULTS

The biomechanical effects included four groups: changes in body posture (spinal, other joints), subjective assessment (force, effort, discomfort), measured force (hand force, ground reaction force, spine force, joint torque), and physiological measures. The evidence showed caregivers benefited from using lift hoists, air-assisted devices, and to a lesser extent friction reducing devices for lateral transfers and repositioning, while floor and ceiling lifts were most effective for patient transfers. Some gaps were noted in the evidence and other handling tasks such as sit-to-stand, turning patient in bed, limb lifting, and repositioning and some more high hazard activities like supporting people with limited balance and those that fall need to be investigated with respect to biomechanical outcomes.

CONCLUSION

There is a growing level of biomechanical evidence to support the use of assistive devices for many patient-handling tasks, but the benefits of equipment use in some transfers remain uninvestigated.

PRACTICAL APPLICATION

Evidence indicates the best way to lift patients safely is with floor or ceiling lifts, and air-assisted devices for lateral and repositioning tasks.

Effectiveness of Team and Organisational Level Workplace Interventions Aimed at Improving Sustainable Employability of Aged Care Staff: A Systematic Review

Purpose The sustainable employability of healthcare professionals in aged care is under pressure, but research into the effectiveness of interventions aimed at improving employees' sustainable employability is scarce. This review therefore aimed to investigate the effectiveness of workplace interventions on sustainable employability of healthcare professionals in aged care. Methods A systematic literature search was performed. Studies were included when reporting about the effect of an intervention at work in an aged care setting on outcomes related to one of the three components of sustainable employability (i.e. workability, vitality, employability). The methodological quality of each study was assessed and a rating system was used to determine the level of evidence. Additionally, a sensitivity analysis was performed, accounting for the match between the intervention's focus and the targeted component of sustainable employability. Results Current review includes 32 interventions published between 1996 and 2019. Interventions covered learning and improving skills, changing the workplace, and exercising or resting. The initial analysis showed a strong level of evidence for employability and insufficient evidence for workability and vitality. The sensitivity analysis revealed strong evidence for the effectiveness of interventions addressing either employability or workability, and insufficient evidence for vitality. Conclusions Evidence for workplace interventions on sustainable employability of healthcare professionals in aged care differed. We found strong evidence for effects of workplace interventions on employability and for those directly targeting workability. Evidence for effects of interventions on vitality was insufficient. The alignment of the interventions to the targeted component of sustainable employability is important for effectiveness.

The impact of mechanical devices for lifting and transferring of patients on low back pain and musculoskeletal injuries in health care personnel-A systematic review and meta-analysis

OBJECTIVES

Heavy lifting in nursing is highly associated with low back pain (LBP) and musculoskeletal injuries (MSI). We aimed to evaluate the impact of mechanical devices used for patient lifting and transferring on risk of LBP and MSI of health care personnel.

METHODS

We conducted a systematic review and meta-analysis. The literature search was performed during 1st and 12th September 2021 using 17 electronic databases and handsearching of bibliographies of included studies. Twenty studies were included in the qualitative synthesis and eight studies with in total 2087 participants in the meta-analysis. Dependent on the study design, risk of bias was assessed by Cochrane RoB 2.0, EPOC, and MINORS. We conducted random-effects meta-analyses assessing Hedges's g and 95% CI of MSI rate, perceived LBP, and peak compressive spinal load. We calculated prediction intervals and conducted a cost-benefit analysis (CBA).

RESULTS

All outcomes showed significant, adjusted pooled effect sizes (MSI rate: g = 1.11, 95% CI 0.914-1.299; perceived LBP: g = 1.54, 95% CI -0.016-3.088; peak compressive spinal load: g = 1.04, 95% CI -0.315 to 2.391). True effect sizes in 95% of all comparable populations fell in the following prediction intervals: MSI rate = -1.07-3.28, perceived LBP = -0.522-3.594, and peak compressive spinal load = -15.49 to 17.57. CBA revealed cost-benefit ratios of 1.2 and 3.29 between cumulative total savings and investment costs of intervention.

CONCLUSIONS

Prediction intervals confirmed strong true effect sizes for MSI rate and perceived LBP in 95% of all comparable populations but not for peak compressive spinal load. Mechanical lifting and transferring devices displayed a favorable cost-benefit ratio and should be considered for clinical implementation.

Translation and cross-cultural adaptation of the risk assessment instrument TilThermometer for a Swedish version – patient handling in the healthcare sector

Background

Work-related musculoskeletal disorders are common in the healthcare sector due to exposure of physical demanding work tasks. Risk assessment is necessary to prevent injuries and promote a safety culture. The TilThermometer has proved to be useful in the Netherlands for assessing healthcare workers’ physical exposure to patient handling. The aim of this study was to translate the risk assessment instrument TilThermometer from Dutch to Swedish, perform cross-cultural adaptation, and evaluate its linguistic validity to a Swedish healthcare context.

Methods

Translation and validation process was performed according to following eight steps: 1) Translation (two translators), 2) Synthesis, 3) Back-translation (two back-translators), 4) Synthesis, 5) Linguistic review (one bilingual reviewer), 6) fifteen experts in a panel review according to Delphi-method, 7) Semi-structured interviewing eleven informants, analyzed using qualitative content analysis and step 8) discussion and input from creators of the instrument.

Results

A new Swedish version, the TilThermometer, was provided through the translation process (steps 1–5). The linguistic validity and usefulness were confirmed thru step 6 and 7. Consensus was reached in the expert review after two rounds, comments were analyzed and grouped into five groups. The qualitative content analyses of the interviews emerged in to three categories: 1) “User-friendly and understandable instrument”, 2) “Further development”, and 3) “Important part of the systematic work-environment management”.

Conclusion

In this study, the cross-cultural adaption and translation performed of the Swedish version of TilThermometer assured linguistic validity. This is this first phase before further testing the psychometrics aspects, inter-rater reliability and feasibility of TilThermometer. In the second phase TilThermometer will be implemented and evaluated together with other measures in the Swedish healthcare sector.

Factors associated with high physical exertion during healthcare work: Cross-sectional study among healthcare workers

BACKGROUND: High physical exertion during healthcare work is a documented risk factor for musculoskeletal pain, long term sickness absence and disability pension. Understanding the underlying factors of physical exertion is important to make the necessary preventive efforts in the working environment. OBJECTIVE: This study investigates factors associated with high physical exertion during healthcare work. METHODS: A total of 2047 Danish health care workers replied to a questionnaire about work and health. Associations (odds ratios; OR) of physical exertion (outcome variable) with the number of patients and self-reliant patients, frequency and type of assistive device use, BMI, leisure time activity, smoking, and age were modelled using mutually adjusted binary logistic regression. RESULTS: Factors associated with high physical exertion (OR and 95% CI) were high frequency of daily patient transfers 1.35 (1.23 – 1.48), less self-reliant patients 0.74 (0.62 – 0.89), less frequent use of necessary assistive devices 1.82 (1.50 – 2.21), as well as more frequent use of sliding pieces 1.23 (1.04 – 1.46), wheelchairs 1.23 (1.02 – 1.49), bed adjustments 0.88 (0.77 – 1.00) and intelligent beds 0.83 (0.71 – 0.95) during patient transfer. Age and lifestyle factors (BMI, smoking, and leisure time physical activity) were not associated with high physical exertion. CONCLUSIONS: The character of patient transfer specific healthcare work is associated with increased odds for high physical exertion whereas life-style factors are not. Thus, proper use of specific assistive devices and avoiding uneven distribution of difficult patients through appropriate planning may be protective strategies for lowering physical exertion during healthcare work.

The effects of patient transfer devices on the risk of work-related musculoskeletal disorders (WMSDs): a systematic review

Objectives. This study aimed to evaluate the efficacy of patient transfer assistive devices in reducing the risk of work-related musculoskeletal disorders (WMSDs) among nurses. Methods. PubMed, Scopus, Google Scholar and the Cochrane Database of Systematic Reviews were searched to identify studies with a quantitative assessment of the efficacy of patient transfer assistive devices on the incidence and injury claims of WMSDs as compared to the manual lifting of patients. A health impact analysis of the pre-post intervention of assistive device implementation was performed. The percentage of the reduction of forces, incidence of WMSDs, number of missed workdays and injury compensation claims were calculated, pooled and presented as boxplots. Results. A total of 25 studies met the inclusion criteria. The best post-intervention outcomes of assistive devices deployment in the healthcare setting included a reduction in WMSD incidence by 59.8%, missed workdays by 90.0% and workers' compensation claims by 95.0%. Additionally, hand force declined by 71% (p < 0.05) and 70% (p < 0.05) with the use of air-assisted devices and ceiling lifts respectively. Conclusions. Overall, the evidence suggests that patient transfer assistive devices, notably ceiling lifts and air-assisted devices, are effective in reducing the risk of WMSDs among nurses.

The influence of organizational factors, eldercare worker characteristics and care situation on the use of assistive devices during resident handling in eldercare work

We evaluated the influence of organization, eldercare worker and care situation on the use of assistive devices during resident handling in eldercare work. We conducted a multi-level study among 20 nursing homes, 126 wards within the nursing homes, 549 eldercare workers within the wards, who performed a total of 1306 care episodes including 3695 resident handlings. The influence of organization (i.e. nursing home and ward), eldercare worker and care situation (i.e. care episode and resident handling) on the use of assistive devices was evaluated using variance components analysis and multivariate generalized linear mixed model. Nursing homes, wards, eldercare workers, care episodes and 'within care episode' all contributed to the total variance in use of assistive devices. Organizational factors and care situation factors were significantly associated with use of assistive devices. All levels of the nursing homes, but in particular care situation, influence the use of assistive devices during resident handling.

A systematic review of work interventions to promote safe patient handling and movement in the healthcare sector

PURPUSE

The aim of this systematic review was to describe interventions which promote safe patient handling and movement (PHM) among workers in healthcare by reviewing the literature of their effectiveness for work and health-related outcomes.

METHODS

Data bases were searched for studies published 1997‒2018. Measures was operationalised broadly, capturing outcomes of work and health. Only Randomized controlled trials (RCTs) and cohort studies with control group were included. Quality was assessed using evidence-based checklists by Swedish Agency for Health Technology Assessment and Assessment of Social Services.

RESULTS

The systematic review included 10 RCTs and 19 cohort. Providing work equipment and training workers is effective: it can increase usage. Training workers to be peer coaches is associated with fewer injuries. Other effective strategies are participatory ergonomics and management engagement in collaboration with workers, facilitating safe PHM.

CONCLUSIONS

This systematic review suggests interventions for safe PHM with an impact of health-related outcomes should include access to work equipment, training as well as employer and employee engagement. The additional impact of multifaceted interventions is inconclusive.

PRACTITIONER SUMMARY

In clinical practice, there is a need for employers in healthcare to; 1) provide healthcare workers access to suitable work equipment. 2) provide training on how to use work equipment to prevent work-related injuries. Furthermore, the study also indicates that 3) training and appointing peer coaches can facilitate safe manual handling and movement (PHM) and, 4) It can be beneficial to involve workers in a participatory approach.

Identification of care tasks for the use of wearable transfer support robots - an observational study at nursing facilities using robots on a daily basis

BACKGROUND

To reduce the physical burden of caregivers, wearable transfer support robots are highly desirable. Although these robots are reportedly effective for specific tasks in experimental environments, there is little information about their effectiveness at nursing care facilities. The aim of this study was to identify care tasks and operations suitable for the use of these robots among caregivers in nursing facilities where these robots have been in use on a daily basis.

METHODS

A 1-min observational time-motion analysis was conducted to examine care tasks and operations in two nursing facilities where wearable transfer support robots, namely Muscle Suit or HAL® Lumbar Type for Care Support, have been used routinely on a daily basis for more than 24 months.

RESULTS

Analysis of the care tasks and their time ratio while wearing the equipment revealed that both robots were used conspicuously for direct care in over 70% of transits, especially during transfer assistance and toileting care. Furthermore, these robots were used intensively in the morning along with wake-up calls to care recipients, where pre-assigned wearers used them as part of their "routine work."

CONCLUSIONS

We found that these wearable transfer support robots enabled effective performance of care tasks and operations in nursing facilities where these robots have been used on a daily basis for an extended period of time. These results may lead to the effective implementation and sustained operation of other types of care robots in the future.

TRIAL REGISTRATION

UMIN Clinical Trials Registry no. UMIN000039204 . Trial registration date: January 21, 2020. Interventional study. Parallel, non-randomized, single blinded.

Evaluation of Absenteeism, Pain, and Disability in Nurses With Persistent Low Back Pain Following Cognitive Functional Therapy: A Case Series Pilot Study With 3-Year Follow-Up

OBJECTIVE

Persistent low back pain (PLBP) is a common and costly health problem worldwide. Better strategies to manage it are required. The purpose of this study was to longitudinally evaluate absenteeism, pain, and disability in nurses with PLBP following a cognitive functional therapy (CFT) intervention.

METHODS

In this case series pilot study, 33 eligible nurses with PLBP were recruited. During the baseline phase (phase A; no intervention), outcome measures were collected on 2 occasions 6 months apart (A1 and A2). During phase B, participants received an individualized CFT intervention for 14 weeks. During phase C (no intervention), outcomes were measured immediately after the intervention, as well as 3, 6, 9, 12, and 36 months after the intervention (secondary outcomes only until 12 months). LBP-related work absenteeism, pain intensity (numerical pain rating scale) and disability (Oswestry Disability Index) were the primary outcomes. Health care seeking, a range of psychological and lifestyle variables, and global perceived effect were secondary outcomes.

RESULTS

Days of absenteeism due to LBP were significantly reduced in the first and second calendar years after the CFT intervention but not the third and fourth. Disability was significantly reduced immediately after (-4.4; 95% CI = -6.5 to -2.2) and at 3 months (-4.3; 95% CI = -6.6 to -2.0), 9 months (-6.0; 95% CI = -8.1 to -3.9), and 12 months (-4.9; 95% CI = -7.0 to -2.8) after the intervention. Pain was significantly reduced immediately after (-1.2; 95% CI = -1.7 to -0.8) and at 3 months (-1.5; 95% CI = -2.0 to -0.9), 9 months (-1.1; 95% CI = -1.9 to -0.3), and 12 months (-0.9; 95% CI = -1.5 to -0.2) after the intervention. Total health care seeking (consults and proportion of participants) was significantly reduced after the intervention. All psychosocial variables, except for 1, demonstrated significant improvements at all follow-up assessments.

CONCLUSIONS

This case series pilot study demonstrated significant reductions in LBP-related absenteeism, pain intensity, disability, health care seeking, and several psychological and lifestyle behaviors until the 1-year follow-up among nurses with PLBP following an individualized CFT intervention. Further evaluation of the efficacy of CFT in high-quality randomized clinical trials among nurses is recommended.

Physical exposure during patient transfer and risk of back injury & low-back pain: prospective cohort study

BACKGROUND

Work-related musculoskeletal disorders (MSDs) are common among healthcare workers. Because frequent patient transfer has been associated with increased risk of MSDs, we aim to quantify the physical load associated with commonly-used assistive devices and to investigate associations between accumulated physical exposure and risk of MSDs.

METHODS

By applying an exposure matrix based on objective measurements of electromyography and trunk flexion on a large (n = 1285) prospective cohort, intensity of low-back pain (LBP) and odds of back injury at 1-year follow-up were modelled using linear models and logistic regressions, respectively. The cohort was divided into groups according to physical exposure; i.e. low (1st quartile), moderate (2nd and 3rd quartiles) and high (4th quartile) exposure.

RESULTS

Exposure profiles are provided for 9 groups of assistive devices, with ceiling lifts and intelligent beds eliciting the lowest physical exposure. In the fully-adjusted model, we report differences in LBP intensity at follow-up between the low and moderate exposure groups (p = 0.0085). No difference was found between the moderate and high exposure groups (p = 0.2967). Likewise, we find no associations between physical exposure and odds of back injury at 1-year follow-up, with a prevalence of 11, 13 and 11% for the three groups, respectively.

CONCLUSIONS

Low physical exposure during patient transfer was prospectively associated with lower intensity of LBP. Consistent use of assistive devices associated with low physical exposure, namely ceiling-lifts and intelligent beds, may play a role in reducing the incidence of MSDs among healthcare workers.

Safety and Health through Integrated, Facilitated Teams (SHIFT): stepped-wedge protocol for prospective, mixed-methods evaluation of the Healthy Workplace Participatory Program

BACKGROUND

Healthcare facilities are notorious for occupational health and safety problems. Multi-level interventions are needed to address interacting exposures and their overlapping origins in work organization features. Worker participation in problem identification and resolution is essential. This study evaluates the CPH-NEW Healthy Workplace Participatory Program (HWPP), a Total Worker Health® protocol to develop effective employee teams for worker safety, health, and wellbeing.

METHODS

Six public sector, unionized healthcare facilities are enrolled, in three pairs, matched by agency. The unit of intervention is a workplace health and safety committee, adapted here to a joint labor-management "Design Team" (DT). The DT conducts root cause analyses, prioritizes problems, identifies feasible interventions in light of the constraints and needs of the specific setting, makes business-case presentations to facility leadership, and assists in evaluation. Following a stepped-wedge (cross-over) design, one site in each pair is randomly assigned to "immediate intervention" status, receiving the full coached intervention at baseline; in the "lagged intervention" site, coaching begins about half-way through the study. Program effectiveness and cost-effectiveness outcomes are assessed at both organizational (e.g., workers' compensation claim and absenteeism rates, perceived management support of safety) and individual levels (e.g., self-rated health, sleep quality, leisure-time exercise). Targeted pre-post analyses will also examine specific outcomes appropriate to the topics selected for intervention. Process evaluation outcomes include fidelity of the HWPP intervention, extent of individual DT member activity, expansion of committee scope to include employee well-being, program obstacles and opportunities in each setting, and sustainability (within the available time frame).

DISCUSSION

This study aims for a quantitative evaluation of the HWPP over a time period long enough to accomplish multiple intervention cycles in each facility. The design seeks to achieve comparable study engagement and data quality between groups. We will also assess whether the HWPP might be further improved to meet the needs of U.S. public sector healthcare institutions. Potential challenges include difficulty in pooling data across study sites if Design Teams select different intervention topics, and follow-up periods too short for change to be observed.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04251429 (retrospectively registered January 29, 2020), protocol version 1.

Biomechanical load during patient transfer with assistive devices: Cross-sectional study

This study utilised a cross-sectional design to perform measurements of muscle activity as well as forward - and lateral trunk inclination angle during a full workday among 52 female healthcare workers from 16 different departments at five Danish hospitals. Using linear mixed models, the 95th percentile ranks of the normalised root mean square (nRMS) values were analysed for the different types of assistive devices. Compared to no assistive device (mean nRMS 27.9%, 95% CI 24.8%-31.0%), the use of intelligent beds (23.9%, CI 20.2%-27.6%) and ceiling-lifts (24.0%, CI 20.3%-27.7%) led to lower erector spinae nRMS values across all types of patient transfers. Conversely, the use of bedsheets (30.6%, CI 27.1%-34.2%), sliding-sheets (30.3%, CI 26.8%-33.9%) and sliding-boards (33.5%, CI 29.5%-37.6%) were associated with higher levels of erector spinae muscle activity.Consistent use of ceiling-lifts and intelligent beds reduces the physical workload and may thereby decrease the risk of musculoskeletal disorders among healthcare workers. Practioner Summary: Frequent patient transfer is associated with an increased risk of back pain and injury among healthcare workers. This analysis compares the level of physical load during patient transfer with commonly used assistive devices. The results show that use of the ceiling-lift and intelligent bed is associated with relatively low physical load during patient transfer. Abbreviations: RMS: root mean square; nRMS: normalized root mean square; EMG: electromyography; MSD: musculoskeletal disorder; LBP: low-back pain; VAS: visual analogue scale; MVC: maximal voluntary contraction.

Comparison of lift use, perceptions, and musculoskeletal symptoms between ceiling lifts and floor-based lifts in patient handling

Lifting equipment can reduce the risk of injury from patient handling, but limited availability and adoption have been a persistent problem. Data from statewide surveys of California nurses (N = 389) in 2013 and 2016 were analyzed to evaluate lift use, perceptions about lifts and injury risk, and musculoskeletal symptoms by type of available lifts. Nurses with ceiling lifts (23%) were significantly more likely to use lifts and had more positive perceptions about lifts, regarding worker safety, patient safety and comfort, ease of use, access, and storing, than nurses with only floor lifts (77%). Nurses with ceiling lifts reported less low back pain and shoulder pain. Our study findings suggest that providing ceiling lifts can result in superior outcomes to floor-based lifts in multiple aspects, including better acceptance and use by nurses for patient handling, as well as being associated with reduced work-related musculoskeletal symptoms in the low back and shoulders.

Economic Evaluation of Occupational Safety and Health Interventions From the Employer Perspective: A Systematic Review

Objectives:

The aim of this systematic review was to evaluate the cost-effectiveness of occupational safety and health interventions from the employer perspective.

Methods:

A comprehensive literature search (2005 to 2016) in five electronic databases was conducted. Pre-2005 studies were identified from the reference lists of previous studies and systematic reviews, which have similar objective to those of this search.

Results:

A total of 19 randomized controlled trials and quasi-experimental studies were included, targeting diverse health problems in a number of settings. Few studies included organizational-level interventions. When viewed in relation to the methodological quality and the sufficiency of economic evidence, five of 11 cost-effective occupational safety and health (OSH) interventions appear to be promising.

Conclusion:

The present systematic review highlights the need for high-quality economic evidence to evaluate the cost-effectiveness of OSH interventions, especially at organizational-level, in all areas of worker health.

Evaluation of the effectiveness of the sliding sheet in repositioning care in terms of working time and subjective fatigue: A comparative study with an experimental design

BACKGROUND

Manual patient handling is a major cause of low back pain among healthcare staff. The sliding sheet is an assistive device designed to aid healthcare staff performing patient repositioning in bed. The use of sliding sheets in healthcare facilities is currently relatively rare because of the perceived additional time required compared with non-assisted handling. However, the details of the time difference between techniques and the barriers to the use of sliding sheets have not been examined in depth.

OBJECTIVES

We sought to evaluate differences in working time and subjective fatigue between the use of sliding sheets and non-assisted handling techniques for patient repositioning, in order to understand the factors preventing the use of sliding sheets among nurses.

DESIGN

We conducted a comparative study with an experimental design.

SETTINGS

The study was conducted in the nursing practice room at a university in Japan.

PARTICIPANTS

We recruited 30 pairs of nurses and care receivers. All nurses were under 60 years old, with experience in lateral turning and repositioning in the process of changing diapers in clinical settings. Those with a previous or current medical history of low back pain were excluded. Care receivers were older adults (65-80 years old). We excluded adults with bedsores, body mass index values >30, or restricted joint motion due to femoral trochanteric fracture or compression fracture. Thus, 27 pairs were included in the final analysis.

METHODS

The care receivers were instructed to behave as if they were bedridden patients with no limb movement, and as if they had contracture and difficulty communicating. Nurses repositioned the patient using three techniques assigned as interventions in random order: repositioning by one person using a sliding sheet (Sheet), repositioning by two people without a sliding sheet (Double), and repositioning by one person without a sliding sheet (Single). Working time was the primary endpoint for comparative analysis among the three technique conditions.

RESULTS

The results revealed that the Sheet technique required significantly more time than the non-assisted techniques. However, when total staff time was taken into consideration, the Sheet technique outperformed the Double technique. Moreover, the Sheet technique was associated with significantly lower levels of subjective fatigue, compared with the Double technique.

CONCLUSIONS

The use of a sliding sheet can substantially reduce caregiver burden when performing patient repositioning, and requires less staff time than manual techniques involving more than one caregiver.

Safer health care environments by design

Health care environments can and are being designed to prevent injury, minimize human error, and actually promote improved health and safety. This article shows risk managers how evidence-based design is reducing medication error, staff injury, infection rates, patient falls, and more. Research knowledge can contribute to effective design solutions by simply clarifying a safety problem so solutions can be sought; it can inform the design process with potential solutions; or it can be part of a structured process where new research knowledge is created. This article shares specific examples of the types of research that can inform designing for a safer physical environment. A case study shows how one project in two phases benefited from engaging initially in a general way and later, in a highly structured process, to integrate the evidence to improve design for safety.

Priority approaches of occupational safety and health activities for preventing low back pain among caregivers

Objectives

The incidence of occupational low back pain (LBP) is high among caregivers. The use of care equipment and training about care methods could prevent LBP among caregivers. However, in care facilities in Japan, these measures are not adequately employed. Moreover, the care facilities have faced issues regarding poor staffing in recent years. The present study investigated the relationship between LBP and occupational safety and health activities (OSHAs) for preventing LBP among caregivers and aimed to validate the priority approaches of OSHA.

Methods

This cross‐sectional study was conducted in care facilities for the elderly in Japan. Questionnaires for administrators and caregivers were distributed to 1,000 facilities and 5,000 caregivers, respectively. Questionnaires completed by 612 facilities and 2,712 caregivers were analyzed.

Results

No direct association was observed between severe LBP and OSHA, but indirect association was done. A significant relationship was noted between severe LBP and the care methods. Direct factors causing severe LBP were lifting a resident using human power and taking an unsuitable posture. These care methods were associated with the following OSHAs: promoting the use of care equipment, training about care methods, and consultation regarding the use of care equipment and employing an appropriate care method with the person in charge.

Conclusions

These OSHAs decreased lifting a resident using human power and taking an unsuitable posture, which are the primary risk factors of LBP. Therefore, these OSHAs should be implemented as priority approaches to prevent LBP among caregivers in care facilities for the elderly.

Outcomes of safe patient handling and mobilization programs: A meta-analysis

BACKGROUND

Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization (SPHM) programs.

OBJECTIVE

We performed a systematic meta-analysis of SPHM program evaluations.

METHODS

Systematic literature review identified published SPHM program evaluations. Injury Rate Ratios (IRR), pre- to post-intervention, were used to estimate intervention effects and to examine the influence of patient care level, program components, and follow-up time using meta-regression.

RESULTS

27 articles reported evaluations from 44 sites. Combined effect estimate for all SPHM programs was 0.44 (95% CI 0.36, 0.54), reflecting substantial injury reductions after program implementation. While specific program components were not associated with greater effectiveness, longer follow-up duration was associated with greater injury rate reduction (p = 0.01) and intervention effects varied by level of care (p = 0.01), with the greatest effect in intensive care unit interventions (IRR 0.14; 95% CI 0.07, 0.30).

CONCLUSIONS

SPHM programs appear to be highly effective in reducing injuries. More research is needed to identify the most effective interventions for different patient care levels.

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE®/PubMed®, EMBASE®, Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL®) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68-0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low.

Incorporating Nurse Input and Evidence Into a Newly Designed Unit to Improve Patient and Nursing Outcomes

OBJECTIVE

The aim of this study was to identify processes, outcomes, and lessons learned from designing a new evidence-based unit. A research study was conducted simultaneously to rigorously measure changes in patient and staff outcomes.

BACKGROUND

Nursing leadership and frontline nursing engagement are critical in evidence-based design to promote positive outcomes and workflow.

METHODS

Quality indicators were tracked premove and postmove. Nursing workflow was tracked, and teamwork was examined.

RESULTS

The incidence of falls and methicillin-resistant Staphylococcus aureus decreased on the new unit. Patient satisfaction improved; the greatest improvement was noise reduction. Teamwork remained stable. Nurses spent significantly more time in the patient rooms on the new unit.

CONCLUSIONS

This hospital found nursing engagement in the unit design process to be imperative to promote positive patient outcomes and stable or improved teamwork. Nursing leaders should be involved at the onset of the design process to facilitate optimal outcomes.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions

BACKGROUND

Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation.

METHODS

Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design.

RESULTS

Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers' needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation.

CONCLUSION

Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Barriers to the Use of Assistive Devices in Patient Handling

Work-related musculoskeletal disorders (WMSD) are a major safety concern in today’s health care environment due to the manual lifting of patients with higher acuity levels and obesity. Nurses move patients multiple times each day, incurring cumulative stress and trauma resulting in chronic pain and potential injury. The purpose of this study was to assess barriers to the use of assistive devices in safe patient handling and mobility (SPHM) that contribute to WMSD in health care workers. Interpersonal, situational, organizational, and environmental influences have both direct and indirect effects on workers’ commitment to use, or their actual likelihood of using, assistive devices. This study confirmed that time constraints contribute to fewer instances of assistive device use. Comprehensive ergonomic programs are needed to promote staff and patient safety. By providing safe environments for health care workers who engage in patient handling and mobility, the risk of injury can be significantly reduced.

Spine loading during the application and removal of lifting slings: the effects of patient weight, bed height and work method

The biomechanical loading on the lumbar spine was assessed as 12 female nurses applied and removed slings under two patients of differing weights (54 and 100 kg), using two work methods, and while working at three bed heights (56, 71, 93 cm). Three-dimensional spine loads at the L2/L3, L3/L4, L4/L5 and L5/S1 disc levels were measured using a validated EMG-assisted biomechanical model. Anterior/posterior (A/P) shear loading at the L5/S1 level consistently exceeded the tolerance threshold limit for disc failure. The peak compression values exceeded the 3400 N tolerance threshold for several participants when placing the sling under the 100-kg patient. In general, working from both sides of the bed generated slightly higher A/P shear loading than the one-sided method. Raising the bed significantly decreased compression and A/P shear forces. Therefore, raising the bed to at least the nurse's knuckle height is recommended when applying and removing patient slings. Practitioners Summary: We investigated the spine loading associated with placing and removing slings used for the mechanised lifting of patients. Peak compression and anterior shear forces exceeded recognised thresholds when placing slings underneath heavier patients. Raising the bed to at least knuckle level helps mitigate these spinal loads.

Injury rates before and after the implementation of a safe resident handling program in the long-term care sector

Manual resident handling (RH) tasks increase risk of musculoskeletal disorders (MSDs) for clinical staff in nursing homes. To reduce the incidence and cost of MSDs, a large healthcare corporation instituted a Safe Resident Handling Program (SRHP) comprising purchase of mechanical lifting equipment, worker training, and detailed usage/maintenance protocols. The program was initially administered by a third-party company; after three years, program responsibility shifted to individual centers. Workers' compensation claim rates were compared before and after SRHP implementation. Claims and FTEs were classified as "pre-SRHP," "first post period" (up to 3 years post-SRHP), or "second post period" (4-6 years post-SRHP), based on claim date relative to implementation date for each center. Complete data were available for 136 nursing homes with average annual employment of 18,571 full-time equivalents. Over the 8-year period, 22,445 claims were recorded. At each time period, the majority of RH claims affected the back (36% low, 15% other) and upper extremity (26%). Workers' compensation claims were reduced by 11% during the first post period and 14% during the second post period. RH-related claims were reduced by 32% and 38%, respectively. After six years, the rate for all claims had decreased in 72% of centers, and RH claim rates decreased in 82%. Relative risk for post-/pre-SRHP injury rates increased for centers with less developed wellness programs, unionized centers, and centers with higher LPN turnover pre-SRHP. Injury reduction among these nursing home workers is plausibly attributable to the introduction of mechanical lifting equipment within the context of this multi-faceted SRHP.

Designing, prototype making and evaluating a mechanical aid device for patient transfer between bed and stretcher

INTRODUCTION

The present study aimed at designing, prototype making and evaluating a new assistive device to improve patient transfer conditions.

METHODS

A new aid device for patient transfer was designed and its prototype was made. Comfort and perceived physical exertion of users and stability and applicability of the device were examined. The test subjects included 37 healthcare workers from a hospital with patient transfer experience. The data collection tools consisted of visual analog scales (VAS) and Borg's rating physical effort scale. The rapid entire body assessment (REBA) method was applied to evaluate working posture.

RESULTS

The results showed that in 70% of the wards, patient transfer was performed manually more than five times per shift. While using the newly designed device, the mean (SD) of the users' comfort, and the clients' comfort and safety, was measured as 8.59 (0.87), 8.46 (0.92) and 8.67 (0.71), respectively, as reported by VAS. The results revealed a significant reduction in the users' rating of perceived exertion (p < 0.001). Additionally, the REBA score was lower in mechanical transfer.

CONCLUSION

The new assistive device increased the users' and the clients' comfort, reduced the users' physical exertion and improved working postures.

Low back pain among workers in care facilities for the elderly after introducing welfare equipment

OBJECTIVE

The purpose of this study was to clarify the causes of low back pain among workers in care facilities for the elderly after the introduction of welfare equipment.

METHODS

We conducted anonymous questionnaire surveys among administrators and care workers in eight elderly care facilities. The questionnaires were designed to investigate the status of both the care workers and facility. In reference to the care facility, the questionnaires were comprised items for investigating basic information, occupational safety, and health activities. For care workers, in addition to basic information, occupational safety, and health activities, the questionnaires also comprised items for investigating resident transfer and bathing methods, low back pain, and occupational stress.

RESULTS

Completed questionnaires were returned by eight care facility administrators (response rate: 100%) and 373 care workers (response rate: 92.3%), among which 367 were used for analyses. Many care workers participated in a variety of occupational safety and health activities that were conducted in the facilities. Various types of welfare equipment were introduced into the care facilities and subsequently used by many care workers during resident transfer and bathing. As a result, 89.9% of the care workers reported having only slight or no low back pain. The remaining 10.1% reported having serious low back pain that interfered with their work. On the basis of logistic regression analysis, low back pain was associated with the following variables: failure to provide the appropriate method of care to each resident, failure of colleagues to discuss methods for improving care, lack of instructions regarding the use of welfare equipment, and inappropriate job rotation. An association was also found between low back pain and poor posture, poor resident-lifting technique, insufficient time to complete work, and a shortage of workers to assist with resident transfer or bathing.

CONCLUSION

Although care workers received instructions on the health and safety activities extracted from the surveys, an association was still found between these activities and low back pain. This was thought to result from some care workers not establishing the appropriate method of care for each resident, not discussing methods for improving care with other colleagues, not using the welfare equipment, and failing to practice appropriate job rotation. These results suggest that low back pain among care workers in the facilities for the elderly that have introduced welfare equipment is caused by a failure to sufficiently conduct appropriate care methods.

Stakeholders' Perspectives About and Priorities for Economic Evaluation of Health and Safety Programs in Healthcare

This study identified and prioritized resources and outcomes that should be considered in more comprehensive and scientifically rigorous health and safety economic evaluations according to healthcare sector stakeholders. A literature review and stakeholder interviews identified candidate resources and outcomes and then a Delphi panel ranked them. According to the panel, the top five resources were (a) health and safety staff time; (b) training workers; (c) program planning, promotion, and evaluation costs; (d) equipment purchases and upgrades; and (e) administration costs. The top five outcomes were (a) number of injuries, illnesses, and general sickness absences; (b) safety climate; (c) days lost due to injuries, illnesses, and general sickness absences; (d) job satisfaction and engagement; and (e) quality of care and patient safety. These findings emphasize stakeholders' stated priorities and are useful as a benchmark for assessing the quality of health and safety economic evaluations and the comprehensiveness of these findings.

A cost-benefit analysis of peer coaching for overhead lift use in the long-term care sector in Canada

OBJECTIVES

To evaluate whether a peer-coaching programme for patient lift use in British Columbia, Canada, was effective and cost-beneficial.

METHODS

We used monthly panel data from 15 long-term care facilities from 2004 to 2011 to estimate the number of patient-handling injuries averted by the peer-coaching programme using a generalised estimating equation model. Facilities that had not yet introduced the programme served as concurrent controls. Accepted lost-time claim counts related to patient handling were the outcome of interest with a denominator of full-time equivalents of nursing staff. A cost-benefit approach was used to estimate the net monetary gains at the system level.

RESULTS

The coaching programme was found to be associated with a reduction in the injury rate of 34% during the programme and 56% after the programme concluded with an estimated 62 lost-time injury claims averted. 2 other factors were associated with changes in injury rates: larger facilities had a lower injury rate, and the more care hours per bed the lower the injury rate. We calculated monetary benefits to the system of $748 431 and costs of $894 000 (both in 2006 Canadian dollars) with a benefit-to-cost ratio of 0.84. The benefit-to-cost ratio was -0.05 in the worst case scenario and 2.31 in the best case scenario. The largest cost item was peer coaches' time. A simulation of the programme continuing for 5 years with the same coaching intensity would result in a benefit-to-cost ratio of 0.63.

CONCLUSIONS

A peer-coaching programme to increase effective use of overhead lifts prevented additional patient-handling injuries but added modest incremental cost to the system.

Design and user evaluation of a wheelchair mounted robotic assisted transfer device

PURPOSE

The aim of this study is to describe the robotic assisted transfer device (RATD) and an initial focus group evaluation by end users. The purpose of the device is to aid in the transfers of people with disabilities to and from their electric powered wheelchair (EPW) onto other surfaces. The device can be used for both stand-pivot transfers and fully dependent transfers, where the person being transferred is in a sling and weight is fully on the robot. The RATD is fixed to an EPW to allow for its use in community settings.

METHOD

A functional prototype of the RATD was designed and fabricated. The prototype was presented to a group of 16 end users and feedback on the device was obtained via a survey and group discussion.

RESULTS

Thirteen out of sixteen (83%) participants agreed that it was important to develop this type of technology. They also indicated that user, caregiver, and robotic controls were important features to be included in the device.

CONCLUSIONS

Participants in this study suggested that they would be accepting the use of robotic technology for transfers and a majority did not feel that they would be embarrassed to use this technology.

Healthy work environments for the ageing nursing workforce

AIM

The aim of this article is to describe the physical challenges that ageing nurses experience and the facility design features that can promote healthy work environments to motivate nurses to continue working.

BACKGROUND

Older nurses are working longer and beyond the usual retirement age. They often experience chronic fatigue and the usual physical and cognitive changes associated with aging. Nursing is a physically demanding profession and many older nurses work in pain while providing direct patient care. The literature is replete with studies focusing on the organisational factors that retain older nurses, but little research addresses design factors that facilitate nurses working longer and more safely in direct patient care.

EVALUATION

Electronic databases in medicine, nursing, psychology, and architecture were searched and evidence-based, non-evidence-based, and review articles and government and organisational newsletters were evaluated.

KEY ISSUES

Hospital design can help address the physical work challenges that older nurses experience.

CONCLUSIONS

Older nurses have a wealth of knowledge and expertise, and the design of nursing units can optimize their work experience.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse Managers must participate in design efforts and advocate designs that support aging nurses.

Improving transfer task practices used with air travelers with mobility impairments: a systematic literature review

Manual lifting in healthcare and air transportation is a high-risk activity and a primary cause of musculoskeletal injuries for workers who are required to provide transfer assistance to people with mobility impairments. In the healthcare industry, safe patient-handling programs and policies are accepted as effective ways to prevent worker injury and to improve patient safety. We reviewed evidence-based studies and several websites for disability groups and the airline industry. Seven studies found significant improvements in musculoskeletal comfort levels and declines in musculoskeletal injuries. One study found significant improvements in every musculoskeletal group surveyed. Our review of websites revealed that there were no published research studies or policies about safe handling practices for air travelers. It is evident that passengers with mobility impairments have different expectations for assistance, not congruent with existing services offered by the airline industry.

An economic analysis of a safe resident handling program in nursing homes

BACKGROUND

Occupational injuries, especially back problems related to resident handling, are common in nursing home employees and their prevention may require substantial up-front investment. This study evaluated the economics of a safe resident handling program (SRHP), in a large chain of skilled nursing facilities, from the corporation's perspective.

METHODS

The company provided data on program costs, compensation claims, and turnover rates (2003-2009). Workers' compensation and turnover costs before and after the intervention were compared against investment costs using the "net-cost model."

RESULTS

Among 110 centers, the overall benefit-to-cost ratio was 1.7-3.09 and the payback period was 1.98-1.06 year (using alternative turnover cost estimates). The average annualized net savings per bed for the 110 centers (using company based turnover cost estimates) was $143, with a 95% confidence interval of $22-$264. This was very similar to the average annualized net savings per full time equivalent (FTE) staff member, which was $165 (95% confidence interval $22-$308). However, at 49 centers costs exceeded benefits.

CONCLUSIONS

Decreased costs of worker injury compensation claims and turnover appear at least partially attributable to the SRHP. Future research should examine center-specific factors that enhance program success, and improve measures of turnover costs and healthcare productivity.

Quantification of patient migration in bed: catalyst to improve hospital bed design to reduce shear and friction forces and nurses' injuries

OBJECTIVE

The study objective was to quantify the movement of hospital bed occupants relative to the bed in typical bed articulations.

BACKGROUND

Movement of a patient in bed results in two common adverse events: (a) increase in shear and friction forces between the patient and bed, which are extrinsic pressure ulcer risk factors, and (b) musculoskeletal injuries to nurses, resulting from repositioning patients who have migrated down in bed.

METHOD

The study involved 12 participants who lay supine in three hospital beds, which were articulated to common positions. Body movement relative to the bed was quantified with the use of motion capture. Cumulative movement, net displacement, and torso compression (shoulder to trochanter distance) were calculated for different bed types and bed movements.

RESULTS

Bed design and bed movement had a significant effect on most of the dependent variables. Bed design (e.g., type) influenced cumulative movement by up to 115%, net displacement by up to 70%, and torso compression by about 20%. Bed movement (e.g., knee elevation) reduced cumulative migration by up to 35%.

CONCLUSION

The quantification of patient migration provides a metric for evaluating the interaction between body and bed surfaces. Overall, the measures were sensitive to design changes in bed frames, bed articulations, and mattress inflation.

APPLICATION

Documentation of the cumulative movement, net displacement, and torso compression provides hospital bed designers quantifiable measures for reducing migration and potentially shear and friction forces when designing bed frames, bed articulations, and mattresses. Optimization of these metrics may ultimately have an impact on patient and caregiver health.

Long-term efficacy of an ergonomics program that includes patient-handling devices on reducing musculoskeletal injuries to nursing personnel

OBJECTIVE

The aim of this study was to evaluate long-term efficacy of an ergonomics program that included patient-handling devices in six long-term care facilities (LTC) and one chronic care hospital (CCH).

BACKGROUND

Patient handling is recognized as a major source of musculoskeletal disorders (MSDs) among nursing personnel, and several studies have demonstrated effectiveness of patient-handling devices in reducing those MSDs. However, most studies have been conducted in a single facility, for a short period, and/or without a comprehensive ergonomics program.

METHOD

Patient-handling devices along with a comprehensive ergonomics program was implemented in six LTC facilities and one CCH. Pre- and postintervention injury data were collected for 38.9 months (range = 29 to 54 months) and 51.2 months (range = 36 to 60 months), respectively.

RESULTS

Postintervention patient-handling injuries decreased by 59.8% (rate ratio [RR] = 0.36, 95% confidence interval [CI] [0.28, 0.49], p < .001), lost workdays by 86.7% (RR = 0.16, 95% CI [0.13, 0.18], p < .001), modified-duty days by 78.8% (RR = 0.25, 95% CI [0.22, 0.28], p < .001), and workers' compensation costs by 90.6% (RR = 0.12, 95% CI [0.09, 0.15], p < .001). Perceived stresses to low back and shoulders among nursing staff were fairly low. A vast majority of patients found the devices comfortable and safe. Longer transfer times with the use of devices was not an issue.

CONCLUSION

Implementation of patient-handling devices along with a comprehensive program can be effective in reducing MSDs among nursing personnel. Strategies to expand usage of patient-handling devices in most health care settings should be explored.

Guidelines for intensive care unit design

OBJECTIVE

To develop a guideline to help guide healthcare professionals participate effectively in the design, construction, and occupancy of a new or renovated intensive care unit.

PARTICIPANTS

A group of multidisciplinary professionals, designers, and architects with expertise in critical care, under the direction of the American College of Critical Care Medicine, met over several years, reviewed the available literature, and collated their expert opinions on recommendations for the optimal design of an intensive care unit.

SCOPE

The design of a new or renovated intensive care unit is frequently a once- or twice-in-a-lifetime occurrence for most critical care professionals. Healthcare architects have experience in this process that most healthcare professionals do not. While there are regulatory documents, such as the Guidelines for the Design and Construction of Health Care Facilities, these represent minimal guidelines. The intent was to develop recommendations for a more optimal approach for a healing environment.

DATA SOURCES AND SYNTHESIS

Relevant literature was accessed and reviewed, and expert opinion was sought from the committee members and outside experts. Evidence-based architecture is just in its beginning, which made the grading of literature difficult, and so it was not attempted. The previous designs of the winners of the American Institute of Architects, American Association of Critical Care Nurses, and Society of Critical Care Medicine Intensive Care Unit Design Award were used as a reference. Collaboratively and meeting repeatedly, both in person and by teleconference, the task force met to construct these recommendations.

CONCLUSIONS

Recommendations for the design of intensive care units, expanding on regulatory guidelines and providing the best possible healing environment, and an efficient and cost-effective workplace.

A biomechanical assessment of floor and overhead lifts using one or two caregivers for patient transfers

This study investigated the differences in peak external hand forces and external moments generated at the L5/S1 joint of the low back due to maneuvering loaded floor-based and overhead-mounted patient lifting devices using one and two caregivers. Hand forces and external moments at the L5/S1 joint were estimated from ground reaction forces and motion capture data. Caregivers gave ratings of perceived exertion as well as their opinions regarding overhead vs. floor lifts. Use of overhead lifts resulted in significantly lower back loads than floor lifts. Two caregivers working together with a floor lift did not reduce loads on the primary caregiver compared to the single-caregiver case. In contrast, two-caregiver operation of an overhead lift did result in reduced loads compared to the single-caregiver case. Therefore, overhead lifts should be used whenever possible to reduce the risk of back injury to caregivers. The use of two caregivers does not compensate for the poorer performance of floor lifts.

Implementation and adoption of mechanical patient lift equipment in the hospital setting: The importance of organizational and cultural factors

BACKGROUND

Work focused on understanding implementation and adoption of interventions designed to prevent patient-handling injuries in the hospital setting is lacking in the injury literature and may be more insightful than more traditional evaluation measures.

METHODS

Data from focus groups with health care workers were used to describe barriers and promoters of the adoption of patient lift equipment and a shift to a "minimal-manual lift environment" at two affiliated hospitals.

RESULTS

Several factors influencing the adoption of the lift equipment and patient-handling policy were noted: time, knowledge/ability, staffing, patient characteristics, and organizational and cultural aspects of work. The adoption process was complex, and considerable variability by hospital and across units was observed.

CONCLUSIONS

The use of qualitative data can enhance the understanding of factors that influence implementation and adoption of interventions designed to prevent patient-handling injuries among health care workers.

Objective measures of adoption of patient lift and transfer devices to reduce nursing staff injuries in the hospital setting

BACKGROUND

Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred.

METHODS

Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability.

RESULTS

Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated.

CONCLUSION

Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption.

Changing the sheets: a new system to reduce strain during patient repositioning

BACKGROUND

Manually repositioning patients puts healthcare providers at risk for injury; this may be reduced by using low-friction bedsheets.

OBJECTIVES

The aim of this study was to evaluate the physical properties and the physiological measures of muscle activity and perceptual participant accounts between a new slider sheet system and traditional hospital bedsheet makeup (soaker pad with a jersey bottom sheet).

METHOD

Surface electromyography was recorded from the arm and shoulder muscles of five healthcare providers executing a patient repositioning (boosting and turning) in a controlled laboratory setting to gain an indication of muscle activity required for two types of bedsheets (slider system and traditional sheet makeup). The Borg Scale was used to establish rating of perceived exertion for these repositioning tasks on the two types of bedsheet makeup. To evaluate the sheets independent of human interaction and contact, the physical resistive characteristics of the sheets were calculated by determining the coefficient of friction.

RESULTS

Patient repositioning on traditional sheets, compared with the slider system, resulted in 16% greater electromyography burst numbers and 11% longer duration for both boosting and turning. Moreover, ratings of perceived exertion for repositioning patients on traditional sheets versus on slider sheets were more than double. The coefficient of friction of the traditional sheets was 65% less in the slider sheet system.

DISCUSSION

This study suggests that manually repositioning patients on a low-friction slider system reduces muscular and perceived effort. Proper usage of this type of bedsheets may reduce the risks associated with musculoskeletal strain and injuries of the healthcare providers.

Peer coaching and mentoring: a new model of educational intervention for safe patient handling in health care

BACKGROUND

To reduce the risk of patient handling-related musculoskeletal injury, overhead ceiling lifts have been installed in health care facilities. To increase ceiling lift usage for a variety of patient handling tasks, a peer coaching and mentoring program was implemented among the direct care staff in the long-term care subsector in British Columbia, Canada. They received a 4-day training program on body mechanics, ergonomics, patient-handling techniques, ceiling lift usage, in addition to coaching skills.

METHODS

A questionnaire was administered among staff before and after the intervention to evaluate the program's effectiveness.

RESULTS

There were 403 and 200 respondents to the pre-intervention and post-intervention questionnaires. In general, staff perceived the peer-coaching program to be effective. The number of staff who reported to be using ceiling lifts "often and always" went higher from 64.5% to 80.5% (<0.001) after coaching program implementation. Furthermore, staff reported that they were using the ceiling lifts for more types of tasks post-intervention. Staff reported that the peer coaching program has increased their safety awareness at work and confidence in using the ceiling lifts.

CONCLUSIONS

The findings suggest that this educational model can increase the uptake of mechanical interventions for occupational health and safety initiatives. It appears that the training led to a greater awareness of the availability of or increased perceptions of the number of ceiling lifts, presumably through coaches advocating their use.