• Provide employees with proper assist devices and equipment to reduce excessive lifting hazards.
  
  
  • Proper equipment selection depends on the specific needs of the facility, patients/residents, staff, and management.

• Devices such as shower chairs that fit over the toilet, using this device can eliminate multiple transfers, saving health care workers multiple lifts. A patient/residents can be moved to the shower chair, toileted, showered, and transferred back to the wheelchair.

• Shower stalls that allow for shower chairs to be pushed in and out on level floor surfaces. This is a standard shower without the front lip to allow for easy access.

• Other bathing systems include: Bath Cabinets and Adjustable Tubs.

• Toilet seat risers: Use toilet seat risers on toilets to equalize the height of wheelchair and toilet seat, making it a lateral transfer rather than a lift up and back into wheelchair.

• Mechanical lift equipment to help lift patients/residents who cannot support their own weight. Choose a lift that does not require manual pumping to avoid possible repetitive motion disorders to workers' arms or shoulders. Lift equipment can be categorized into 2 main categories:
  
  
  • Lean-Stand Assist Lift
    
    
  • Sling-Type Full Lift

• Overhead track mounted patient lifters: A tract system built into the ceiling that sling lifts attach to. This system provides patient/residents mobility from room to room without manual lifting.

• Lateral transfer devices: Devices used to laterally transfer a patient/residents for example from bed to gurney. They usually involve multiple staff members to help do the lifting. This is often done with the help of a draw sheet, or similar device. Some new lateral transfer systems do not require any lifting by staff, and are totally mechanical. This type of device helps prevent staff back injuries.

• Sliding boards: A slick board used under patients/residents to help reduce the need for lifting during transfer of patient/residents from bed to chair, or chair to car. Patients/residents are slid rather than lifted.

• Slip sheets/Roller sheets: Help to reduce friction while laterally transferring patients/residents or repositioning patients/residents in bed and reduce the force workers need to exert to move the patient/residents.

• Repositioning Devices: Mechanically pulls patient/residents up in bed eliminating manual maneuvering by staff.

• Height adjustable electric beds that have height controls to allow for easy transfers from bed height to wheelchair height. These beds can be kept low to the ground for patient/residents safety and then raised up for interaction with staff. Avoid hand cranked beds, which can lead to wrist/shoulder musculoskeletal disorders such as strain or repetitive motion injuries.

• Trapeze lifts: A bar device suspended above the bed which allows patients/residents with upper muscle strength to help reposition themselves. This device is particularly useful with adjustable beds and armless wheelchairs.

• Walking belts or gait belts (with handles) that provide stabilization for ambulatory patients/residents by allowing workers to hold onto the belt and support patients/residents when walking. Not designed for lifting patients/residents.

• Wheelchairs with removable arms to allow for easier lateral transfers. Especially useful with height adjustable beds.
  
  
  • Sitting-standing Wheelchairs: Wheelchairs that provide sitting to standing options for patients/residents and health care workers.

• Descent Control System (DCS): Emergency evacuation or retrieval from older or disabled structures may require using stairs or negotiating rough terrain when moving patients. These devices allow ambulance technicians or emergency evacuation personnel to safely move a loaded hospital cot or gurney down stairs or any steep decline. The Device easily attaches to any ambulance cot currently in the pre-hospital care market. When not in use, the DCS simply folds up and out of the way.
   

  Descent Control System
  Descent Control System attached to cot	Demonstration of Descent Control System on stairs

• Patient care plans: A written care plan that describes specific patient/residents needs, degree of assistance required, special treatments etc. Possible scenarios include:

• color coding of patient/residents lift requirements for posting at bedside. By simply looking at displayed color coding system an employee can know what kind of assistance the patient/residents will need with moving or transfers.

• segregation of patients/residents based on need so equipment and trained staff are appropriately assigned.

• staggered staffing to provide additional manpower for peak periods.

• Roll on weight scale: Patients/residents who cannot stand can be weighed in their wheelchairs.

• Pivot transfer disk devices: Used for standing pivot transfers and seated pivot transfers for patients/residents that have weight bearing capacity and are cooperative.

• A more complete list of resident handling devices can be found in Guidelines for Nursing Homes.

• Back belts: The effectiveness of back belts in reducing the risk of back injury among healthy workers remains unproven.

• If workers falsely believe that they are protected when wearing belts they may attempt to lift more weight than they would have without a belt, risking potential injury (See Backbelts: Do They Prevent Injury? (DHHS) (NIOSH) Publication No. 94-127).

• The Nursing Home eTool - Whirlpool/Shower Module
• Back Disorders and Injuries. OSHA Technical Manual Section VII Chapter 1.TED 1-0.15A.
• Back Facts: An OSHA funded SEIU training workbook to prevent back injuries in nursing homes.

• Environmental hazards such as:

• Slippery or wet floors.

• Uneven floor surfaces.

• Lifting in confined spaces.

• Cluttered or obstructed work areas/passageways.

• Poorly maintained walkway or broken equipment.

• Inadequate staffing levels to deal with the workload, leading to single person lifts and greater chances of falls.

• Inadequate lighting, especially during evening shifts.

• Eliminate uneven floor surfaces.

• Create non slip surfaces in toilet/shower areas.

• Immediate clean-up of fluids spilled on floor.

• Safely working in cramped working spaces-avoiding awkward positions, using equipment that makes lifts less awkward.

• Eliminate cluttered or obstructed work areas.

• Provide adequate staffing levels to deal with the workload.

• Twisting while lifting.

• Bending over to lift, see Back Flexion figure.

• Lateral or side bending.

• Back hyperextension or flexion.

• Forces on the spine increase when lifting, lowering or handling objects with the back bent or twisted. This occurs because the muscles must handle your body weight in addition to the weight of the patient/residents being lifted.

• More muscular force is required when awkward postures are used because muscles cannot perform efficiently.

• Fixed awkward postures (i.e., holding the arm out straight for several minutes) contribute to muscle and tendon fatigue, and joint soreness.

• To be considered a risk factor, awkward postures need to last more than 1 hour continuously or for several hours in the work shift.

• Reaching forward or twisting to support a patient/residents from behind to assist them in walking.

• Educate and train employees about safer lifting techniques.
  
  
• Use assist devices or other equipment whenever possible.
  
  
• Team lifting based on assessment.

• Place equipment on a rolling device if possible to allow for easier transport, or have wheels attached to the equipment.
  
  
• Push rather than pull equipment when possible. Keep arms close to your body and push with your whole body not just your arms.
  
  
• Assure that passageways are unobstructed.
  
  
• Attach handles to equipment to help with the transfer process.
  
  
• Get help moving heavy or bulky equipment or equipment that you can't see over.
  
  
• Don't transport multiple items alone for example if moving a patient/residents in a wheelchair as well as an iv pole and/or other equipment get help, don't overexert yourself.

• Placing an object such as a plastic basin in the bottom of the sink to raise the surface up while washing items in the sink or
  
  
• Remove objects to be washed into a smaller container on the counter for scrubbing or soaking and then replace back in the sink for final rinse.

• Using handling bags for laundry, garbage, and housekeeping when possible that have side openings to allow for easy disposal without reaching into and pulling bags up and out. The bags should be able to slide off the cart without lifting.
  
  
  • Limiting the size and weight of these bags and provide handles to further decrease lifting hazards.
  
  
• Using garbage cans that have a frame vs. a solid can to prevent plastic bags from sticking to the inside of the can or use products that stick to the inside of the garbage can that prevent the bag from sticking.
  
  
  • Limit the size of the container to limit the weight of the load employee must lift and dump.
    
    
  • Place receptacles in unobstructed and easy to reach places.

• Installing chutes and dumpsters at or below grade level.
  
  
• Using spring-loaded platforms to help lift items such as laundry keeping work at a comfortable uniform level.

• Keeping carts, hampers, gurneys, or other carts well maintained to minimize the amount of force exerted while using these items.
  
  
• Using carts with large, low rolling resistance wheels. These can usually roll easily over mixed flooring as well as gaps between elevators and hallways.
  
  
• Keeping handles of devices to be pushed at waist to chest height.
  
  
  • Using handles to move carts rather than the side of the cart to prevent the accidental smashing of hands and fingers.
  
  
• Keeping floors clean and well maintained.
  
  
• Pushing rather than pulling whenever possible.
  
  
• Removing from use all malfunctioning carts.
  
  
• Getting help with heavy or bulky loads.

• Be properly designed, and fit to the user.
  
  
• Have padded non-slip handles.
  
  
• Allow the wrist to remain straight while doing finger intensive tasks. Select ergonomic tools such as ergonomic knives or bent-handled pliers.
  
  
• Have minimal tool weight.
  
  
• Have minimal vibration or use vibration dampening devices and vibration-dampening gloves.

• Use trigger bars rather than single finger triggers.
  
  
• Not be used when performing highly repetitive manual motions by hand, use power tools (e.g., use power screwdrivers instead of manual screwdrivers).

• Alternate leading hand.
  
  
• Avoid tight and static grip and use padded non-slip handles.
  
  
• Clean objects at waist level if possible, rather than bending over them (e.g., push wheelchairs up a ramped platform to perform cleaning work, or raise beds to waist level before cleaning).
  
  
• Use knee pads when kneeling.

• Use tools with extended handles, or use step stools or ladders to avoid or limit overhead reaching.
  
  
• When sweeping or dusting use flat head dusters and push with the leading edge; sweep all areas into one pile and pick up with a vacuum.
  
  
• Use chemical cleaners and soaks to minimize force needed for scrubbing.
  
  
• Frequently change mopping styles when mopping (e.g., push/pull, figure 8, and rocking side to side) to alternate stress on muscles.
  
  
• Be sure buckets, vacuums, and other cleaning tools, have wheels or are on wheeled containers with functional brakes.
  
  
• Alternate tasks or rotate employees through stressful tasks.
  
  
• Avoid awkward postures while cleaning (e.g. twisting and bending).
  
  
• Use carts to transport supplies rather than carrying.
  
  
• Use buffers and vacuums that have lightweight construction and adjustable handle heights.
  
  
• Use spray bottles and equipment that have trigger bars rather than single finger triggers.