Transfer of the horizontal patient: the effect of a friction reducing assistive device on low back mechanics

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.

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.

Ergonomic exposures and control measures associated with mass fatality decedent handling in morgues and body collection points in a New York healthcare system during COVID-19: A case series

INTRODUCTION

In April 2020, novel coronavirus SARS-CoV-2 (COVID-19) produced an ongoing mass fatality event in New York. This overwhelmed hospital morgues necessitating emergent expansion of capacity in the form of refrigerated trucks, trailers, and shipping containers referred to as body collection points (BCPs). The risks for musculoskeletal injury during routine and mass fatality mortuary operations and experiences of decedent handlers throughout the "first wave" of COVID-19 are presented along with mitigation strategies.

METHODS

Awareness of the high rates of musculoskeletal injury among health care workers due to ergonomic exposures from patient handling, including heavy and repetitive manual lifting, prompted safety walkthroughs of mortuary operations at multiple hospitals within a health system in New York State by workforce safety specialists. Site visits sought to identify ergonomic exposures and ameliorate risk for injury associated with decedent handling by implementing engineering, work practice, and administrative controls.

RESULTS

Musculoskeletal exposures included manual lifting of decedents to high and low surfaces, non-neutral postures, maneuvering of heavy equipment, and push/pull forces associated with the transport of decedents.

DISCUSSION

Risk mitigation strategies through participatory ergonomics, education on body mechanics, development of novel handling techniques implementing friction-reducing aides, procurement of specialized equipment, optimizing BCP design, and facilitation of communication between hospital and system-wide departments are presented along with lessons learned. After-action review of health system workers' compensation data found over four thousand lost workdays due to decedent handling related incidents, which illuminates the magnitude of musculoskeletal injury risk to decedent handlers.

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.

Effect of Repositioning Aids and Patient Weight on Biomechanical Stresses When Repositioning Patients in Bed

OBJECTIVE

The aim of the study was to estimate the risk of injury when repositioning patients of different weight with commonly used repositioning aids.

BACKGROUND

Repositioning dependent patients in bed is the most common type of patient handling activity and is associated with high rates of musculoskeletal disorders in healthcare workers. Several studies have evaluated repositioning aids, but typically for a single patient weight and often without estimating risk of injury based on biomechanical analysis.

METHOD

Ten nurses performed four repositioning activities on three participants (50, 77, 141 kg) using three repositioning aids (pair of friction-reducing sheets [FRS], turn and position glide sheet, air-assisted transfer device) and a draw sheet. Motion capture, hand forces, and ground reaction forces were recorded. Spine loading was estimated using a dynamic biomechanical model.

RESULTS

Hand forces and spine compression exceeded recommended limits for most patient weights and repositioning tasks with the draw sheet. FRS and glide sheet reduced these loads but still exceeded recommended limits for all but the 50-kg patient. Only the air-assisted transfer device reduced forces to accepted levels for all patient weights. Physical stresses were relatively low when turning patients.

CONCLUSION

Most repositioning aids are insufficient to properly mitigate risk of musculoskeletal injury in healthcare workers. Only the air-assisted transfer device was sufficient to adequately mitigate the risk of injury when moving patients of average or above-average weight.

APPLICATION

To safely move dependent patients, a robust solution requires mechanical lifts and may utilize air-assisted transfer devices for patient transfers.

Association of musculoskeletal disorders and workload with work schedule and job satisfaction among emergency nurses

BACKGROUND

The emergency department is a highly demanding work environment, considered by high workload and stress. The impact of work-related factors on musculoskeletal disorders (MSDs) in emergency nurses (ENs) are not yet well understood. We investigated the association of MSDs and workload with work schedule (permanent day and night work) and job satisfaction in ENs.

METHOD

Data were collected through a questionnaire including individual and work-related factors, workload (National Aeronautics and Space Administration-Task Load Index [NASA-TLX]) and MSDs (Standardized Nordic Questionnaire) from 380 ENs in five hospitals.

RESULTS

The findings revealed that work schedule and job satisfaction levels were significantly associated with the MSDs in different body regions. Work schedule was significantly related to physical demand, performance, frustration, and overall workload, whereas it was not to the mental and temporal demands and effort. Job satisfaction level was negatively associated with mental demand and frustration. A high prevalence of musculoskeletal problems, particularly in knees, upper back, lower back, neck and shoulders were found.

CONCLUSION

MSDs are highly prevalent among ENs involved in night work and with low job satisfaction levels. The results are discussed in terms of their implications for emergency hospital nurses. The findings can help to better understand the working conditions and emphasize the need for ergonomic interventions in order to reduce MSDs and workload. Also, the study findings highlight the importance of mental aspects of workload in this occupational group.

Use of Assistive Devices to Lift, Transfer, and Reposition Hospital Patients

BACKGROUND

Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized.

OBJECTIVE

The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used.

METHODS

Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics.

RESULTS

Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was "always/almost always" provided from coworkers (83.3%) and often perceived as "very helpful" (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% "always/almost always") yet perceived as "very helpful" by 66.3%. One fifth always used friction-reducing devices.

DISCUSSION

Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.

Forces involved when sliding a patient up in bed

BACKGROUND

This study investigated the effects of 3 different types of slide sheets upon hand forces while sliding a patient up in bed.

METHODS

The sheets used included the reusable Arjo Maxislide, the McAuley disposable sheet, and a standard cotton sheet. Hand forces were measured from 38 male and female participants as they slid a 'patient' up in bed. A repeated measures ANOVA with 5 levels to the repeated factor (number of sheets and sheet type) was used, along with post-hoc repeated measures contrasts to compare differences between each condition.

RESULTS

A significant reduction in required force occurred when using the friction reducing sheets as compared to the cotton sheets when used according to manufacturer recommendations, as well as a reduction in one of the single friction reducing sheet categories compared to the cotton. However, it is important to note that there was still substantial force being placed on the participants.

CONCLUSIONS

This study illustrates the importance of using friction reducing slide sheets while engaging in manual patient handling. Future research should investigate the forces involved with other friction reducing materials and methods as well as the possibility of combining said materials and methods.

Biomechanical Evaluations of Bed-to-Wheelchair Transfer: Gait Belt Versus Walking Belt

Nursing personnel, particularly caregivers who frequently perform manual patient transfer tasks, are at risk for work-related musculoskeletal disorders (WMSDs). The purpose of this study was to perform biomechanical evaluations of bed-to-wheelchair transfer using two low-cost assistive devices: walking belt and gait belt. Twenty-eight college students, serving as caregivers, transferred 14 students, serving as patients. "Caregiver" spinal loading and strength requirements at major joints were measured using a 3D Static Strength Prediction Model. "Caregiver"-perceived stresses were assessed using the Borg CR-10 Scale. "Patient" safety and comfort ratings were determined using Likert-type scales. The findings indicated that transferring "patients" using walking belts with a pulling technique produced significantly lower biomechanical stress than using gait belts. "Patients" also felt more comfortable and safer during walking belt transfers. It is recommended that health care facilities should consider use of walking belts in place of gait belts to transfer partially weight-bearing patients.

Repositioning a passive patient in bed: Choosing an ergonomically advantageous assistive device

Repositioning of passive patients in bed creates health risks to the nursing personnel. Therefore, appropriate assistive devices should be used. Our aim was to find the optimal assistive device for reducing musculoskeletal load while moving a passive patient in bed. Torso kinematic inputs evaluated by the Lumbar Motion Monitor (LMM) and perceived load (Borg scale) were measured in female nurses performing 27 patient transfers [represented by a mannequin weighing 55 (12 nurses), 65 (24 nurses) and 75 kg (12 nurses) in bed] using a regular sheet, a sliding sheet and a carrier. The lowest rates of perceived exertion were found when the sliding sheet and/or carrier were used, for all tasks (p ≤ 0.009). According to the predicted risk for Low Back Disorder (LBD) based on the LMM inputs, negligible differences between assistive devices were found. In a 75 kg mannequin, the participants were able to perform all tasks only by using a sliding sheet. Utilizing sliding sheets is an advantageous technique in comparison to traditional cotton sheets and even carriers.

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.

Saving your back: How do horizontal patient transfer devices stack up?

The authors evaluated the use of a new transfer device (roller tray) and compared it with three commonly used devices (slide board, nylon tube, and roller board). Caregivers experienced the greatest low back stress moving patients weighing 70 to 90 kg (approximately 150 to 200 lb). Qualitative data overwhelmingly favored the new roller tray with disposable absorbent underpads over the other devices. Caregivers experienced the greatest L4-5 torque not when transferring the heaviest patients (over 90 kg or approximately 200 lb), but rather when transferring those weighing 70 to 90 kg. These "middle-weight" patients are often moved using only two instead of three caregivers or a lift team, as are used for heavier patients. Caregivers should use three caregivers (two pullers and one pusher) even when patients are medium weight. The researchers' nursing faculty members are enthusiastic about using the new transfer device in their teaching stations.

Prevention of Nurses’ Work-Related Musculoskeletal Disorders Resulting From Repositioning Patients in Bed

Repositioning patients in bed to promote comfort and prevent impairments caused by continuously lying in a prone position is a task frequently performed by nurses and nursing assistants. Repositioning is a high-risk activity, frequently causing occupational injuries. These occupational injuries are attributed to excessive physical demands on nurses due to patients’ weight and awkward nurse postures. During repositioning, risk of injury can be lowered by reducing friction between the patient and the bed. Hence, certain friction-reducing devices have been developed to reduce the manual force required to move patients. Nevertheless, further research is needed to evaluate the potential effectiveness of these devices. Therefore, the aim of this review was to present current research about the risk factors, prevention strategies, and assistive devices that could reduce work-related musculoskeletal disorders caused by repositioning patients in bed.

Modelling the spine as a deformable body: Feasibility of reconstruction using an optoelectronic system

The aims of this study were to develop a kinematic model of the spine, seen as a continuous deformable body and to identify the smallest set of surface markers allowing adequate measurements of spine motion. The spine is widely considered as a rigid body or as a kinematic chain made up of a smaller number of segments, thereby introducing an approximation. It would be useful to have at our disposal a technique ensuring accurate and repeatable measurement of the shape of the whole spine. Ten healthy subjects underwent a whole-spine radiographic assessment and, simultaneously, an optoelectronic recording. Polynomial interpolations of the vertebral centroids, of the whole set of markers were performed. The similarity of the resulting curves was assessed. Our findings indicate that spine shape can be reproduced by 5th order polynomial interpolation. The best approximating curves are obtained from either 10- or 9-marker sets. Sagittal angles are systematically underestimated.

Lumbar-load analysis of manual patient-handling activities for biomechanical overload prevention among healthcare workers

Manual patient handling commonly induces high mechanical load on the lower back of healthcare workers. A long-term research project, the 'Third Dortmund Lumbar Load Study' (DOLLY 3), was conducted to investigate the lumbar load of caregivers during handling activities that are considered 'definitely endangering' in the context of worker's compensation procedures. Nine types of handling activities in or at a bed or chair were analysed. Measurement of action forces via specifically developed devices and posture recording by means of optoelectronic marker capturing and video recordings in order to quantify several lumbar-load indicators was previously described in detail. This paper provides the results of laboratory examinations and subsequent biomechanical model calculations focused on lumbar load and the potentials of load reduction by applying biomechanically 'optimized' transfer modes instead of a 'conventional' technique and, for a subgroup of tasks, the supplementary usage of small aids such as a sliding mat or a glide board. Lumbosacral-disc compressive force may vary considerably with respect to the performed task, the mode of execution, and individual performance. For any activity type, highest values were found for conventional performance, lower ones for the improved transfer mode, and the lowest compressive-force values were gathered when small aids were applied. Statistical significance was verified for 13 of these 17 comparisons. Analysing indicators for asymmetric loading shows that lateral-bending and torsional moments of force at the lumbosacral disc may reach high values, which can be reduced considerably by implementing an improved handling mode. When evaluating biomechanical loads with respect to age- and gender-specific work-design limits, none of the analysed tasks, despite execution mode, resulted in an acceptable load range. Therefore, applying a biomechanically adequate handling mode combined with small aids to lower the friction between patient and surfaces is highly recommended, especially to prevent overload in older caregivers.

It’s not about the hoist: A narrative literature review of manual handling in healthcare

The manual handling of people and objects is integral to the provision of nursing care to patients globally. Despite over 30 years of research intended to guide improvements for nurses’ safety, substantial rates of manual handling injuries persist internationally within the nursing profession. This paper reviews the contemporary international literature regarding manual handling interventions noting the unique context for injury prevention strategies within healthcare. The review includes the recognition of underlying assumptions inherent in the conceptualisation of manual handling and its management, and the preponderance of the post-positivist paradigm in this field.

The complexity of manual handling in healthcare has resulted in a theoretical shift from single factor interventions based on technique training towards an emerging multidimensional approach. However the key elements for sustainable solutions to reduce nurses’ manual handling injuries have not yet been identified and consensus is lacking regarding the implementation and appropriate evaluation of injury prevention programmes. Furthermore, whilst the literature is replete with data derived from surveys or insurance industry records of compensation claims, there is a dearth of literature exploring nurses’ manual handling experiences. The in-depth investigation of nurses’ perspectives on manual handling may uncover new knowledge critical to improvement of the manual handling issues.

Individual and organisational determinants of use of ergonomic devices in healthcare

OBJECTIVE

This study aims to identify individual and organisational determinants associated with the use of ergonomic devices during patient handling activities.

METHODS

This cross-sectional study was carried out in 19 nursing homes and 19 hospitals. The use of ergonomic devices was assessed through real-time observations in the workplace. Individual barriers to ergonomic device use were identified by structured interviews with nurses and organisational barriers were identified using questionnaires completed by supervisors and managers. Multivariate logistic analysis with generalised estimating equations for repeated measurement was used to estimate determinants of ergonomic device use.

RESULTS

247 nurses performed 670 patient handling activities that required the use of an ergonomic device. Ergonomic devices were used 68% of the times they were deemed necessary in nursing homes and 59% in hospitals. Determinants of lifting device use were nurses' motivation (OR 1.96), the presence of back complaints in the past 12months (OR 1.77) and the inclusion in care protocols of strict guidance on the required use of ergonomic devices (OR 2.49). The organisational factors convenience and easily accessible, management support and supportive management climate were associated with these determinants. No associations were found with other ergonomic devices.

CONCLUSIONS

The use of lifting devices was higher in nursing homes than in hospitals. Individual and organisational factors seem to play a substantial role in the successful implementation of lifting devices in healthcare.

Lumbar spine forces during manoeuvring of ceiling-based and floor-based patient transfer devices

Patient handling continues to represent a high risk task for low back pain (LBP) among health caregivers. Previous studies indicated that manual transfers of patients impose unacceptable loads on the spine even when two caregivers perform the transfer. Patient lift devices are considered a potential intervention; however, few biomechanical analyses have investigated the spine loads and LBP risk associated with these transfer devices. This study analysed the 3-D spine forces imposed upon the lumbar spine when 10 subjects manipulated ceiling-based and floor-based patient lifts through various patient handling conditions and manoeuvres. The results indicated that ceiling-mounted patient lift systems imposed spine forces upon the lumbar spine that would be considered safe, whereas floor-based patient handling systems had the potential to increase anterior/posterior shear forces to unacceptable levels during patient handling manoeuvres. Given these findings, ceiling-based lifts are preferable to floor-based patient transfer systems.

Applications of biomechanics for prevention of work-related musculoskeletal disorders

This paper summarises applications of biomechanical principles and models in industry to control musculoskeletal disorders of the low back and upper extremity. Applications of 2-D and 3-D biomechanical models to estimate compressive force on the low back, the strength requirements of jobs, application of guidelines for overhead work and application of strain index and threshold limit value to address distal upper extremity musculoskeletal disorders are presented. Several case studies applied in the railroad industry, manufacturing, healthcare and warehousing are presented. Finally, future developments needed for improved biomechanical applications in industry are discussed. The information presented will be of value to practising ergonomists to recognise how biomechanics has played a significant role in identifying causes of musculoskeletal disorders and controlling them in the workplace. In particular, the information presented will help practising ergonomists with how physical stresses can be objectively quantified.

Evolving ergonomics?

The theme developed in this position paper follows the current evolution of injury prevention in the backs of workers. Job change or 'fitting the task to the person' has come far, but will probably not result in zero injury rates. This is because the cause of injury is heavily influenced by the way that a worker moves. A review of injury mechanisms reveals the need for the biomechanist/ergonomist to incorporate features in biomechanical models that recognise these injury mechanisms. The implication of one such model is that the next leap toward a zero injury rate may be approached with 'fitting the person to the task' or at least retraining the way that workers move. A few examples of movement-based back injury prevention strategies are provided. Finally, some thoughts on implementing such an approach are expressed. This is a review and position paper written in honour of Professor Don Chaffin's career.

Designing ergonomic interventions for EMS workers: concept generation of patient-handling devices

Fire service personnel and private ambulance paramedics suffer musculoskeletal injuries as they lift and carry patients while performing emergency medical services (EMS). Engineering changes, such as the design of new EMS patient-handling devices, offer a potential intervention opportunity for combating this problem. The purpose of this qualitative descriptive study was to generate beginning ideas for the design of new EMS patient-handling devices that were framed within the contextual reality of the end user firefighter/paramedics. Guided by an ecological model of musculoskeletal injuries in the fire service, focus groups were conducted with 25 firefighter/paramedics from 13 suburban fire departments. Based on their availability, participants were assigned to one of three groups with each group focusing on a different EMS patient-handling scenario. Each group participated in two focus group sessions: one session to brainstorm ideas for devices and a second session to validate sketches of their design ideas. The sketches were professionally drawn by an industrial designer who attended all focus group sessions. Sketches, photos, videotapes, and written transcripts were content analyzed to describe the phenomena of interest. The ideas centered on EMS devices for lateral transfers, bed-to-stairchair transfers, and stair descent transport, and served as the starting point for the development of EMS devices in subsequent phases of a mixed method research study. The outcomes of this study were an improved understanding of the contextual issues that need to be considered in designing EMS patient handling devices and a set of industrial design sketches that served as a starting point for subsequent development of the devices. End user acceptance criteria for the devices included: affordability, portability/compactness, durability, operability including being quickly ready for use, and cleanability.

Measuring low back injury risk factors in challenging work environments: an evaluation of cost and feasibility

BACKGROUND

Measuring low back injury risk factors in field research presents challenges not encountered in laboratory environments.

METHODS

We compared the practical application of five measurement methods (observations, interviews, electromyography (EMG), inclinometry, and vibration monitoring) for 223 worker days in 50 heavy-industry worksites in western Canada. Data collection successes, challenges, costs, and data detail were documented for each method.

RESULTS

Measurement success rates varied from 42.2% (seatpan accelerometer) to 99.6% (post-shift interview) of worker days assessed. Missed days for direct monitoring equipment were primarily due to explosive environments, workplace conditions likely to damage the equipment, and malfunctions. Costs per successful measurement day were lowest for interviews (approximately 23 dollars), about 10-fold higher for observations and inclinometry, and more than 20-fold higher for EMG and vibration monitoring.

CONCLUSIONS

Costs and successful field performance need to be weighed against the added data detail gained from monitoring equipment when making choices about exposure assessment techniques for epidemiological studies.

Technology solutions for high-risk tasks in critical care

There are several high-risk nursing tasks in the critical care environment discussed in this article. These tasks include lateral transfers, repositioning patients up or side to side in bed, bed-to-chair or -wheelchair transfers, pericare of bariatric patients, toileting in bed, sustained limb holding for dressing wounds, and patient transport. Although many, if not all, of these tasks currently are performed manually, there are technological solutions available that undoubtedly can reduce the risks for caregiver and patient injuries. These solutions should be implemented in critical care to promote the safety of all involved in patient care.