Individual and organizational factors associated with injury history and patient handling behaviors: Results from a nationwide survey of healthcare workers

With proper compliance, safe patient handling and mobility (SPHM) programs reduce musculoskeletal disorders (MSDs). To better understand individual, environmental, and organizational factors associated with both the adoption of SPHM and prevalence of MSDs, a nationwide online survey was administered. 973 healthcare workers (HCWs) completed the survey, for which 59.6% reported past work-related MSDs or pain. Among those with pain or injury, 33.3% changed roles, 79.7% worked while injured, and only 30.9% reported workers' compensation claims. Less than half of HCWs agreed that SPHM equipment is readily available, and most considered manually handling patients weighing over 91 kg acceptable. Equipment availability, ceiling lift availability, supervisor encouragement, and annual training were associated with increased use of SPHM equipment. Availability of SPHM equipment reduced the likelihood of injured nurses changing roles. Despite overall agreement that SPHM programs are beneficial, common clinical practice remains insufficient to adequately protect HCWs from risk of injury.

Investigating the Risk of Patient Manual Handling Using the Movement and Assistance of Hospital Patients Method among Hospital Nurses in Botswana

BACKGROUND

Evidence on the prevalence of lower back pain (LBP) among nurses is widespread in the literature, with several risk factors being reported. These include manual handling of patients, repetitive bending and twisting movements, and long working hours. It is reported that LBP has negative health outcomes and causes poor work performance among healthcare workers (HCWs). The magnitude of ergonomic risks associated with these healthcare activities has not been adequately investigated in Botswana. Thus, this study aimed to investigate the ergonomic risk levels associated with the manual handling of patients and its association with the prevalence of LBP among nurses in Botswana.

METHODS

This was an observational cross-sectional hospital-based study conducted in a Botswana public tertiary hospital from March to April 2023. The Movement and Assistance of Hospital Patients (MAPO) tool was used to collect data on ergonomic risk levels. Data on the demographic characteristics of participants were collected using a tool adapted from the Nordic Musculoskeletal Questionnaire (NMQ). Odds ratios and 95% confidence intervals were estimated to determine the association between ergonomic risk levels and the prevalence of LBP.

RESULTS

A total of 256 nurses participated and completed the study. The self-reported prevalence of LBP in this study was 76.6%. The risk of acquiring LBP was high (90.5%) based on the MAPO index. Although the frequencies of self-reported LBP were high among nurses, these did not show any significant association with the MAPO index data. This could be partly due to the small sample size.

CONCLUSIONS

There was a high prevalence of LBP in this study, which was corroborated by the MAPO index data. This has demonstrated the value of the MAPO index in forecasting the risk of patient manual handling. The findings might help Botswana formulate policies intended to address ergonomic preventive measures, directed towards reducing the MAPO index score by addressing the single risk determinants.

The effects of hospital bed features on physical stresses on caregivers when repositioning patients in bed

Repositioning patients in bed is the most common patient handling activity and is associated with musculoskeletal disorders in caregivers. Hospital bed features may mitigate the risk of injury. The current study investigated the effect of bed features on the physical stress on caregivers. Ten nurses were recruited to perform three repositioning activities. Hand forces were recorded, and spine loading was estimated using a dynamic biomechanical model. Results demonstrated that except for the peak L5/S1 compressive load in the turning task, the use of assistive features significantly reduced the physical stresses for all repositioning activities. However, recommended thresholds for injury were still exceeded in many conditions. Compared with spinal load, hand force was much higher relative to the injury thresholds, suggesting a greater risk of shoulder and upper extremity injuries than low back injury. Mechanical lift equipment remains the safest and most robust way to reposition a patient.

An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers

Patient lateral transfers between two adjacent surfaces pose high musculoskeletal disorder risks for nurses and patient handlers. The purpose of this research was to examine the ergonomic benefits of utilizing the laterally-tilting function of operating room (OR) tables during such transfers - along with different friction-reducing devices (FRD). This method allows the patient to slide down to the adjacent surface as one nurse guides the transfer and another controls the OR table angle with a remote control. Sixteen nursing students and sixteen college students were recruited to act as nurses and patients, respectively. Two OR table angles were examined: flat and tilted. Three FRD conditions were considered: a standard blanket sheet, a plastic bag, and a slide board. Electromyography (EMG) activities were measured bilaterally from the posterior deltoids, upper trapezii, latissimus dorsi, and lumbar erector spinae muscles. The Borg-CR10 scale was used for participants to rate their perceived physical exertions. The efficiency of each method was measured using a stopwatch. Results showed that the tilted table technique completely replaced the physical efforts that would have been exerted by the pushing-nurse, in that muscle activation did not increase in the pulling-nurse. On the contrary, EMG activities of the pulling-nurse for most of the muscles significantly decreased (p < 0.05). The subjective Borg-ratings also favored the tilted table with significantly lower ratings. However, the tilted table required on average 7.22 s more than the flat table to complete the transfer (p < 0.05). The slide board and plastic bag were associated with significantly lower Borg-ratings and EMG activities for most muscles than blanket sheet, but they both were not significantly different from each other. However, they each required approximately 5 s more than the blanket sheet method to complete the patient transfer (p < 0.05). By switching from flat + blanket sheet to tilted + slide board, EMG activities in all muscles decreased in the range of 18.4-72.3%, and Borg-ratings decreased from about 4 (somewhat difficult) to 1 (very light). The findings of this study propose simple, readily available ergonomic interventions for performing patient lateral transfers that can have significant implications for nurses' wellbeing and efficiency.

Intervertebral Disc Disease of the Lumbar Spine in Health Personnel with Occupational Exposure to Patient Handling-A Systematic Literature Review and Meta-Analysis

Lifting or carrying loads or working while the trunk is in a bent position are well established risk factors for the development of disc disease of the lumbar spine (LDD). Patient handling is associated with certain hazardous activities, which can result in exposure to heavy loads and high pressure for the discs of the lumbar spine of the nurses performing these tasks. The purpose of this review was to examine the occurrence of work-related LDD among health personnel (HP) with occupational exposure to patient handling activities in comparison to un-exposed workers. A systematic literature search was conducted using the following databases: PubMed, CINAHL, Scopus, and Web of Science. A meta-analysis of odds ratios (OR) was conducted by stratifying for various factors. Five studies reported a higher prevalence for LDD among nurses and geriatric nurses (11.3–96.3%) compared to all controls (3.78–76.47%). Results of the meta-analysis showed a significantly increased OR for LDD among HP compared to all controls (OR 2.45; 95% confidence interval (CI) 1.41, 4.26). In particular, the results of this review suggest that nurses have a higher probability of developing disc herniation than office workers.

Collaborating with radiographers to address their work-related musculoskeletal discomfort

The prevalence of musculoskeletal (MSK) symptoms in radiographers is high, similar to other healthcare occupations that involve high levels of physical exertion (e.g. patient handling; grasping and moving equipment). Reports of interventions to reduce MSK discomfort in radiographers are limited. A participatory approach was used to investigate daily challenges, needs, and opportunities for developing interventions to address exposures to many of the risk factors that contribute to MSK symptoms in radiographers. In this paper, we present the expressed needs of experienced radiographers (including assistance with patient handling, security, supportive design of equipment and work spaces), along with their evaluations of several intervention concepts intended to address some of those needs. We also report results from tests of three prototype interventions stemming from this participatory process that demonstrate the potential for new engineering control concepts to reduce the physical effort associated with some of the most common tasks radiographers perform.

Manual handling: the challenges of different care environments

Work-related musculoskeletal disorders (WRMSDs) continue to be a problem in the health and social care setting, despite staff receiving mandatory manual handling training for many decades. The author discusses WRMSDs, with a focus on various nursing roles. The principle of manual handling as solely 'person moving' or 'transferring' is challenged because a range of activities can cause musculoskeletal problems. The legislation and regulations are explored in relation to practice. The benefits of introducing a specific risk-assessment tool designed for nurses working in neonatal wards is discussed.

Can the Use of Turn-Assist Surfaces Reduce the Physical Burden on Caregivers When Performing Patient Turning?

OBJECTIVE

To quantify differences in physical workload afforded by turn-assist surfaces relative to manual patient turns, and between nursing caregivers (turn-away vs. turn-toward) while performing partnered patient turning.

BACKGROUND

Nurse caregivers experience an increased risk of musculoskeletal injuries at the back or shoulders when performing patient-handling activities. Use of turn-assist surfaces can reduce the physical burden and risk on caregivers.

METHOD

Whole-body motion capture and hand force measures were collected from 25 caregivers (17 female) while performing partnered manual and technology-facilitated turns. Shoulder and low back angles and L4/L5 joint contact forces were calculated at the instant of peak hand force application for both caregivers.

RESULTS

Hand force requirements for the turn-away caregiver were 93% of the estimated maximum acceptable force when performing a manual turn. Use of a turn-assist surface eliminated hand forces required to initiate the patient turn for the turn-away caregiver, where their role was reduced to inserting appropriate wedging behind the patient once the facilitated turn was complete. This reduced shoulder moments by 21.3 Nm for the turn-away caregiver, a reduction in exposure from 70% of maximum shoulder strength capacity to 15%. Spine compression exposures were reduced by 302.1 N for the turn-toward caregiver when using a turn-assist surface.

CONCLUSION

Use of a turn-assist surface reduced peak hand force and shoulder-related exposures for turning away and reduced spine-related exposures for turning toward.

APPLICATION

Turn-assist devices should be recommended to decrease the risk of musculoskeletal disorder hazards for both caregivers when performing a partnered patient turn.

Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study

BACKGROUND

Falls remain an important problem for older people in hospital, particularly those with high falls risk. This mixed methods study investigated the association between multiple bed moves and falls during hospitalisation of older patients identified as a fall risk, as well as safety of ward environments, and staff person-centredness and level of inter-professional collaboration.

METHODS

Patients aged ≥70 years, admitted through the Emergency Department (ED) and identified at high fall risk, who were admitted to four target medical wards, were followed until discharge or transfer to a non-study ward. Hospital administrative data (falls, length of stay [LoS], and bed moves) were collected. Ward environmental safety audits were conducted on the four wards, and staff completed person-centredness of care, and interprofessional collaboration surveys. Staff focus groups and patient interviews provided additional qualitative data about bed moves.

RESULTS

From 486 ED tracked admissions, 397 patient records were included in comparisons between those who fell and those who did not [27 fallers/370 non-fallers (mean 84.8 years, SD 7.2; 57.4% female)]. During hospitalisation, patients experienced one to eight bed moves (mean 2.0, SD 1.2). After adjusting for LoS, the number of bed moves after the move to the initial admitting ward was significantly associated with experiencing a fall (OR 1.56, 95% CI 1.11-2.18). Ward environments had relatively few falls hazards identified, and staff surveys indicated components of person-centredness of care and interprofessional collaboration were rated as good overall, and comparable to other reported hospital data. Staff focus groups identified poor communication between discharging and admitting wards, and staff time pressures around bed moves as factors potentially increasing falls risk for involved patients. Patients reported bed moves increased their stress during an already challenging time.

CONCLUSION

Patients who are at high risk for falls admitted to hospital have an increased risk of falling associated with every additional bed move. Strategies are needed to minimise bed moves for patients who are at high risk for falls.

Impact of a Safe Resident Handling Program in Nursing Homes on Return-to-Work and Re-injury Outcomes Following Work Injury

Purpose This study examined the impact of a Safe Resident Handling Program (SRHP) on length of disability and re-injury, following work-related injuries of nursing home workers. Resident handling-related injuries and back injuries were of particular interest. Methods A large national nursing home corporation introduced a SRHP followed by three years of training for 136 centers. Lost-time workers' compensation claims (3 years pre-SRHP and 6 years post-SRHP) were evaluated. For each claim, length of first episode of disability and recurrence of disabling injury were evaluated over time. Differences were assessed using Chi square analyses and a generalized linear model, and "avoided" costs were projected. Results The SRHP had no impact on length of disability, but did appear to significantly reduce the rate of recurrence among resident handling-related injuries. As indemnity and medical costs were three times higher for claimants with recurrent disabling injuries, the SRHP resulted in significant "avoided" costs due to "avoided" recurrence. Conclusions In addition to reducing overall injury rates, SRHPs appear to improve long-term return-to-work success by reducing the rate of recurrent disabling injuries resulting in work disability. In this study, the impact was sustained over years, even after a formal training and implementation program ended. Since back pain is inherently a recurrent condition, results suggest that SRHPs help workers remain at work and return-to-work.

Overall risk index for patient transfers in total assistance mode executed by emergency medical technician-paramedics in real work situations

Few studies have quantified the risk of musculoskeletal disorders during patient transfers in total assistance mode in real-life prehospital emergency care situations. An index to assess the overall risk of patient transfers was created; it makes it possible to quantify risk based on the patient's position and the height of the patient's location. An analysis of 71 transfers executed by paramedics in actual work situations showed that moving a patient from the ground was characterized by acute sagittal flexions and axial rotations, respectively, 42% and 12% of the time. When the patient was lying on a raised surface, the lifting index and perceived exertion were the lowest (2.55; easy). According to the overall risk index, patient transfers from the ground are the riskiest. Paramedics execute many risky lifts even in favorable patient handling contexts.

Paramedics' working strategies while loading a stretcher into an ambulance

For paramedics, loading a stretcher into an ambulance is an activity with a high risk of back injury and accidents. The objective of this study was to document strategies paramedics use at work while loading a powered stretcher into an ambulance. A total of 249 stretcher loading operations performed by 58 paramedics, and 51 semistructured post-intervention interviews were analyzed. Almost three quarters of loading operations required additional actions (e.g., raising the shoulders and additional lifting) to insert the stretcher into the cot fastener system in the ambulance. Some strategies that were necessary to complete the stretcher loading operation seemed to have negative impacts on the workers' health, such as repositioning the stretcher. This action wastes time and requires significant physical efforts, as it is usually done alone. This study suggests some potential solutions, related to equipment, training, workers and work organization, to reduce the risk of injury while loading stretchers.

The nurse who could lift

This month, we celebrate nurses for their dedication to patient well-being and safety. The American Nurses Association has declared National Nurses Week 2017, May 6-12, the "Year of the Healthy Nurse." This special Nurses Week tribute reminds us that although patient health and safety is the goal of every nurse, it's important to remember our own health as well.

A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff: A controlled before-after study

This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive attitudes and behaviours for safe patient-handling and less physically aggressive episodes. However, this did not translate into improved health of the staff during the 12-month study period.

Spinal load in nurses during emergency lifting of obese patients: preliminary results

BACKGROUND

Nurses are exposed to the risk of injury while handling patients. This is particularly true for obese patients.

OBJECTIVE

The goal of this paper is to estimate the spinal loads and the related risk of injury to nurses while lifting obese patients from the floor with a bariatric sheet during a hospital emergency.

METHODS

Six male nurses participated in this study. The biomechanical analysis focused on the lifting strategy. Thirty obese in-patients were enrolled to take part in the experimental study and divided into three groups according to their Body Mass Index (BMI). Three-dimensional motion analysis was conducted using an optoelectronic system. The trunk kinematics and the loading on the spines of the operating nurses were computed.

RESULTS

Our data showed that when the nurse was operating from the central handle, his trunk was more flexed at the end of the lift with a reduced range of motion. The values were higher when the nurse lifted patients with higher BMIs. All kinetic parameters and tension in the lumbar muscles at the end of the movement were characterised by lower values for the nurse placed beside the patient's head or feet if compared to the operator positioned beside the central handle in all patient groups.

CONCLUSIONS

Our preliminary data suggest that only the reaction load on the spine of the nurse holding the central handle, closest to the patient's centre of mass, seems to exceed the recommended safety limits.

Description of a Simple Method of Stoma Protection During Prone Positioning

Surgeries conducted with the patient in the prone position are frequent and can be lengthy. Abdominal stomas and su- prapubic catheters require protection for the complete duration of the procedure to avoid complications such as stomal ischemia, bleeding, or mucocutaneous separation. Standard protection strategies such as pillows and wedges can eas- ily fail. In the course of managing several patients who had sustained ostomy complications following surgery in a prone position, a simple method of stoma protection was devised. Instead of discarding the foam headrest typically used dur- ing induction by anesthesia staff, this device is placed with its central recess over the stoma and secured to the patient's abdominal wall with gentle tape just before turning the patient into a prone position. This method, used in more than 80 patients, has been found to effectively relieve pressure, and no complications have been observed. The foam shape also enables unobstructed drainage of fluids, facilitating collection and preventing leakage and contamination of the surgical field. Because the device is widely used by anesthesia, it is readily available and does not add any extra cost.

Occupational Therapy Practitioners with Occupational Musculoskeletal Injuries: Prevalence and Risk Factors

PURPOSE

The purpose of this study was to examine the prevalence and risk factors of occupational musculoskeletal injuries (OMIs) among occupational therapy practitioners over a 12-month period.

METHOD

A self-administered questionnaire mailed to 500 randomly selected practicing occupational therapists (OTs) and occupational therapy assistants (OTAs) living in the state of Texas.

RESULTS

A response rate of 38 % was attained with 192 questionnaires returned. In a 12-months working period, 23 % of occupational therapy practitioners experienced musculoskeletal injuries. Muscle strain (52 %) was most reported injury and lower back (32 %) was most injured body part. Years of practicing experience (t = 2.83, p = 0.01), and age x(2)(2, N = 192) = 8.28, p = 0.02 were found as significant factors associated with injuries among OTAs. No factors were significantly associated with injuries among OTs.

CONCLUSION

Patient handling was the primary factor associated with injuries. Also, minimal experience and older age were concluded as risk factors that might contribute to OMIs.

Fentanyl as pre-emptive treatment of pain associated with turning mechanically ventilated patients: a randomized controlled feasibility study

PURPOSE

To compare pain incidence and changes in pain scores with fentanyl versus placebo as pre-emptive treatment during turning and 30 min post-turning in mechanically ventilated critically ill patients.

METHODS

We performed a randomized, double-blind, parallel-group, placebo-controlled clinical trial in the intensive care unit of a university hospital. Seventy-five mechanically ventilated patients were randomized to an intervention group (fentanyl) or a control group (placebo). Patients in the intervention group received 1 µg/kg (medical patients) or 1.5 µg/kg (surgical patients) of fentanyl 10 min before turning. Pain indicators were assessed using the behavioral pain scale. Safety was assessed by determining the frequency and severity of pre-defined adverse events. Pain was evaluated at rest (T0), at turn start and end (T1 and T2) and at 5, 15 and 30 min post-turning (T3, T4 and T5).

RESULTS

The two groups had similar baseline characteristics. The area under the curve for BPS values was significantly smaller in the fentanyl group than in the control group [median and interquartile range (IQR): 132 (108-150) vs. 147 (125-180); p = 0.016, respectively]. Nineteen non-serious adverse events were recorded in 14 patients, with no significant between-group differences (23 % fentanyl group vs. 14 % control group; p = 0.381).

CONCLUSIONS

These results suggest an intravenous bolus of fentanyl of 1 µg/kg for medical patients or 1.5 µg/kg for surgical patients reduces the incidence of turning-associated pain in critically ill patients on mechanical ventilation. ClinicalTrials.gov: NCT 01950000.

Moments of speaking and silencing: Nurses share their experiences of manual handling in healthcare

Nursing care involves complex patient handling tasks, resulting in high musculoskeletal injury rates. Epidemiological studies from the 1980s estimated a lifetime prevalence of lower back injuries for nurses between 35 and 80%. National and international studies continue to mirror these findings. Despite the development of programs intended to reduce manual handling injuries, sustainable solutions remain elusive. This paper reports on a study of nurses speaking about their perspectives on current manual handling practices. Qualitative research conducted in 2012 investigated nurses' perceptions and experiences relating to manual handling in the healthcare context and their participation in injury prevention programs. There were two research methods: semi-structured interviews and researcher reflective journaling. The research was framed in critical emancipatory methodology. Thirteen nurses from two Australian states participated in the study. Thematic analysis revealed an overarching theme of 'power relations' with a subcategory of '(mis)power' that comprised two subthemes, these being 'how to practice' and 'voicing practice issues'. Specifically, this paper explores nurses verbalising their views in the workplace and responses which left them feeling silenced, punished and disillusioned. The findings suggest that the sociopolitical context within which nurses practice impacts upon their ability to voice concerns or ideas related to manual handling. Inclusion of nurses in the manual handling dialogue may generate an expanded understanding of, and the potential to transform, manual handling practices in healthcare environments.

Reducing your risk of back injury at work

Many patient-care activities performed by healthcare assistants involve lifting, turning and moving patients. These activities can cause back strain and even contribute to chronic back injuries.

1. Avoiding back injury

This article looks at healthcare professionals, in particular midwives, and considers how to maintain back health and prevent injury through principles of good practice. Knowledge of back pain, mindfulness in working conditions and modifications of current practice will reduce the risk of repetitive injury, and present management options in the short- and long term. Considerations on improving the 'working lifestyle' rather than quick fixes are ultimately the long-term goal.

Prevalent Causes of Low Back Pain and its Impact among Nurses Working in Sahid Gangalal National Heart Centre

BACKGROUND

Nursing is considered as caring profession and nurse is a person who provides holistic care to the individual or community. Nurse's jobs vary from simple task to more complex one and are at risk of various occupational health problems. Among those, musculoskeletal problem including low back pain (LBP) is commonest one. Thus this study examines the prevalence and perceived causes of low back pain and its impact among the nurses working in national heart centre.

METHODS

A descriptive cross-sectional study design was used. After informed verbal consent, 50 nurses were selected purposively. Semi structured self administered questionnaires with single and multiple response items were distributed to them and were collected next day. Response rate was 100%. Data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 16 for windows. Descriptive statistics i.e., percentage, mean and chi square was used to interpret the data. For multiple responses, percentage was calculated in terms of total responses therefore exceeds 100%.

RESULTS

Among 50 nurses, 78% of nurses were suffering from LBP. Study found that LBP was predominant among married nurses (88%) compared to unmarried (69%). Prolonged standing (82%), heavy physical workload and frequent bending & twisting (51% each) were some perceived causes of low back pain. Due to LBP, 44% were not able to perform their job properly, 33% became less productive, 28% had restriction in work and 26% could not provide quality care to the patient.

CONCLUSIONS

Three fourth of nurses working at national heart centre were suffering from low back pain which indicates high prevalence. Therefore it is recommended to maintain proper body mechanics and use supportive devices like back belts, knee cap, and chair with back rest during patient care.

Paramedics on the job: dynamic trunk motion assessment at the workplace

Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼ 10s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.

Risks associated with obese patient handling in emergency prehospital care

The number of ambulance crewmembers may affect the quality of cardiopulmonary resuscitation in particular situations. However, few studies have investigated how the number of emergency care providers affects the quality of CPR. Nonetheless, problems in the initial handling of patients due to small ambulance crew sizes may have significant consequences. These difficulties may be more frequent in an obese population than in a non-obese population. Hence such problems may be frequently encountered because obesity is epidemic in developed countries. In this report, we illustrate the fatal consequences of initial problems in patient handling due to a small ambulance crew size in an obese patient who suffered an out-of-hospital cardiac arrest. Following successful resuscitation, this patient presented humeral fractures that may have promoted a disorder of hemostasis. The patient eventually died. This case highlights the requirement for specific instructions for paramedics to manage obese patients in these emergency conditions. This case also highlights the need to take into account body mass index when deciding on appropriate pre-hospital care, especially regarding the number of ambulance crewmembers.

Results of a pilot intervention to improve health and safety for health care workers

OBJECTIVE

To test the feasibility of a multicomponent pilot intervention to improve worker safety and wellness in two Boston hospitals.

METHODS

A 3-month intervention was conducted on seven hospital units. Pre- (374 workers) and postsurveys (303 workers) assessed changes in safety/ergonomic behaviors and practices, and social support. Wellness outcomes included self-reported pain/aching in specific body areas (musculoskeletal disorders or MSDs) and physical activity (PA).

RESULTS

Pain was reported frequently (81%), and PA averaged 4 hours per week. There was a postintervention increase in safe patient handling (P < 0.0001), safety practices (P = 0.0004), ergonomics (P = 0.009), and supervisor support (P = 0.01), but no changes in MSDs or PA.

CONCLUSIONS

Safe patient handling, ergonomics, and safety practices are good targets for worker safety and wellness interventions; longer intervention periods may reduce the risk of MSDs.

TROPHI: development of a tool to measure complex, multi-factorial patient handling interventions

Patient handling interventions are complex and multi-factorial. It has been difficult to make comparisons across different strategies due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes and comparing performance across interventions. Focus groups were held with expert patient handling practitioners (n = 36) in four European countries (Finland, Italy, Portugal and the UK) to identify preferred outcomes to be measured for interventions. A systematic literature review identified 598 outcome measures; these were critically appraised and the most appropriate measurement tool was selected for each outcome. TROPHI was evaluated in the four EU countries (eight sites) and by an expert panel (n = 16) from the European Panel of Patient Handling Ergonomics for usability and practical application. This final stage added external validity to the research by exploring transferability potential and presenting the data and analysis to allow respondent (participant) validation.

PRACTITIONER SUMMARY

Patient handling interventions are complex and multi-factorial and it has been difficult to make comparisons due to the lack of a comprehensive outcome measurement method. The Tool for Risk Outstanding in Patient Handling Interventions (TROPHI) was developed to address this gap by measuring outcomes to compare performance across interventions.

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.

Patient handling and musculoskeletal disorders among hospital workers: analysis of 7 years of institutional workers' compensation claims data

OBJECTIVES

Musculoskeletal disorders (MSDs) are the most common occupational injuries and illnesses among hospital workers in the United States. To date, there is little in the literature examining the principal effect of patient handling on MSDs. The primary objective of this study was to investigate and confirm the principal effect of patient handling on hospital worker MSDs.

METHODS

Workers' Compensation (WC) claims related to MSDs filed during 2003-2009 by employees in a large US healthcare system were classified using ICD-9. Patient handling, demographic, work, and injury characteristics were obtained. Two multivariable Poisson regression models were compared to evaluate association between risk factors and MSDs. One model contained all risk factors, excluding patient handling; the other model included patient handling.

RESULTS

Among 3,452 claims from 24,824 FTEs, 76% were MSDs. About half of the MSDs involved patient handling. In the regression model without patient handling, EMS workers, women, 50-59 years of age, union members, evening shift workers, and fulltime workers showed associations with MSDs. However, all the observed associations disappeared when patient handling was included in the second regression model; patient handling was the only factor showing an association with MSDs, although the effect was not strong (RR = 1.2, 95% CI = 1.2-1.3).

CONCLUSIONS

All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers.

Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants

AIMS

This paper is a report of a study of association between workplace injuries experienced by nursing assistants in nursing homes in the United States and four factors that may affect injury rates: initial nursing assistant training, training at the current facility, lifting devices, and time to execute daily duties.

BACKGROUND

High injury rates among nursing personnel have been reported in multiple settings across countries. The existing literature is divided on the effectiveness of training and assistive devices in reducing injury rates among nursing assistants.

METHODS

We examined associations between whether or not the nursing assistant has experienced an injury and four key factors: quality of initial injury prevention training, injury prevention training at current facility, lift availability and whether or not the nursing assistant has sufficient time to complete resident activities of daily living. We estimated a survey-weighted logit model using 2004 National Nursing Assistant Survey data.

RESULTS/FINDINGS

The odds of an injury in the past year were lower among nursing assistants who reported always having a lift available when needed (41% lower odds), available facility training to reduce workplace injuries (39%), and sufficient time to complete resident activities of daily living (35%). Quality of initial training to prevent work injuries was not significantly associated with injury status.

CONCLUSION

Regions without widespread access to lifting devices may be able to reduce injury rates by increasing the availability of lifting devices. The potential for reductions in injury rates in the United States is greatest from improving training and ensuring adequate time for resident care, as most facilities currently have lifts available.

Safe patient handling curriculum in occupational therapy and occupational therapy assistant programs: A descriptive study of school curriculum within the United States of America

The purpose of this study was to identify safe patient handling (SPH) curricular content in accredited occupational therapy and occupational therapy assistant programs in the United States of America. A survey was emailed to 155 accredited occupational therapy and 137 accredited occupational therapy assistant programs. With a 39% response rate, most programs addressed SPH curricula by including lectures and lab-based experiences with gait belts, slide boards, and manual transfers while stressing ‘safe’ body mechanics. There were limited responses regarding curricular-based hands-on experience, evaluation of sit-to-stand lifts, how to safely transfer bariatric persons, and information on “no-lift” policies. While occupational therapists have a central role in teaching SPH to caregivers, it is important to enhance SPH curricula to reduce exposure to musculoskeletal risk, thereby, increasing the health and safety of the occupational therapy workforce as well those whom the profession serves.

Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers

Musculoskeletal injuries are frequently reported among Emergency Medical Services (EMS) professionals. The objective of this study was to evaluate occupational injuries in an urban EMS system before and after implementation of hydraulic stretchers. Data for this analysis were obtained from Austin Travis County EMS (A/TCEMS). In December 2006, A/TCEMS placed into service electrically powered patient stretchers. The pre-intervention period was between 01/01/1999 and 12/31/2006, and the post-intervention period was between 01/01/2007 and 4/30/2008. Incidence rate calculations were performed for four injury sub-groups and rate ratios (RRs) and corresponding 95% confidence interval (CI) were presented. There were 2087 and 706 person-years of observation pre- and post-intervention, respectively. The incidence rates for overall injury pre-intervention and post-intervention were 61.1 and 28.8 per 100 FTE, with a corresponding RR of 0.47 (95% CI 0.41-0.55) indicating a significant decrease in the rate of injury. The subcategory of stretcher-related injuries had the lowest RR (0.30; 95% CI 0.17-0.52) when comparing pre- and post-intervention time periods.

Evaluation of the implementation fidelity of an ergonomic training program designed to prevent back pain

The aim of this study was to evaluate the implementation fidelity of a multidimensional ergonomic program designed to prevent back pain injuries among healthcare personnel. The program, provided by peer trainers included training intended to modify patient handling and transfer behaviour, trainee follow-up, prevention activities aimed at work environment improvements and follow-up monitors training. Two hundred twenty-one peer trainers at 139 Quebec healthcare institutions participated in our study. Only 61.5% were involved in training; most of them taught safe patient handling, positioning, transfer, and preparation techniques, which are the cornerstones of the program; 72.7% were involved in prevention activities, 46.1% in follow-up activities, and 10.7% in follow-up monitors training. The study results should help organizations anticipate and prevent potential discrepancies between prescribed and implemented programs.

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.

[Reduction of injuries related to manual handling of patients: two preventive methods used in five Ferrara district hospitals]

AIMS

To evaluate the effectiveness of two training programs on the reduction of injuries from manual handling of patients in five hospitals under the district of Ferrara.

MATERIALS AND METHODS

We analyzed injuries that occurred between 2002 and 2010. In 2004/2005 and 2008/2010 the health-care workers underwent to two different training programs. In 2007, the hospitals purchased assistive devices.

RESULTS

In 2006 there were 82 accidents. After the acquisition of the assistive devices (2007) and the new training program (2008/2010), the accidents dropped to 32.

CONCLUSIONS

The results highlight the effectiveness of the combined training programs and assistive devices in reducing the number of accidents.

Evaluating repeated patient handling injuries following the implementation of a multi-factor ergonomic intervention program among health care workers

OBJECTIVE

The objective of this study was to evaluate repeated patient handling injuries following a multi-factor ergonomic intervention program among health care workers.

METHODS

This was a quasi-experimental study which had an intervention group and a non-randomized control group. Data were collected from six hospitals in Saskatchewan, Canada from September 1, 2001 to December 1, 2006.

RESULTS

A total of 1,480 individuals who had a previous injury were eligible for the study. Medium and small size hospitals in the intervention group had significantly fewer repeated injuries than in the control group. Multivariate analysis showed that the intervention group had 38.1% lower odds of having repeated injury compared to the control group, after adjusting for hospital size.

CONCLUSIONS

The work-related repeated injury after a multi-factor intervention program was reduced. The synergistic relationships between components of multi-factor intervention and applicability of injury prevention programs to different settings need to be further explored.

IMPACT ON INDUSTRY

Implementing a multi-factor program with the right equipment and training can lower the risk of injury among health care workers.

Effect of patient handling education on radiation therapy students

OBJECTIVE

To assess the influence of an educational intervention on the knowledge, attitude, behavior and intention to use safe patient handling and movement (SPHM) of radiation therapy students during their initial clinical education experience.

METHOD

Seventeen first-year students in a 2-year radiation therapy baccalaureate program received education on traditional manual patient handling and SPHM through 2 1-hour lectures and a 2-hour skills laboratory. Questionnaires and a group discussion were used to collect data on the students' knowledge, attitude, behavior and intention to use SPHM in clinical practice.

RESULTS

Although students' patient handling knowledge improved following the educational intervention, their overall knowledge, attitude and intention to use SPHM did not change. However, fewer students perceived patient handling injuries to be a problem in radiation therapy after their initial clinical education.

CONCLUSION

A gap exists between students' SPHM knowledge and their performance of the techniques. Educators should incorporate SPHM into their curriculum because the information helped students achieve high levels of perceived behavioral control, increased patient handling knowledge and positive attitudes regarding SPHM.