Washington State Department of Labor and Industries program is working to reduce back and shoulder injuries among nursing home workers. WISHA, as the Washington State program is commonly known, for the Washington Industrial Safety and Health Act, launched the Hazard Impact Partnership program in 1998 to address workplace safety over a broad range of industries, focusing first on nursing homes.

The innovative program supports the use of resident-lifting equipment, caregiver training, and job modifications for workers with ergonomic injuries.

Participating nursing homes received up-front reductions in workers' compensation premiums so they could afford to invest in several types of mechanical lifts that do the bulk of the lifting. "Total lifts" are used for residents who are completely dependent on others, and "sit-to-stand" lifts are for residents who have some partial or momentary capacity to bear weight.

Both types of equipment minimize the physical stress placed on caregivers as they move residents, for example, between a bed, chair, toilet, and bath. "The goal is to minimize the number of times the human body is required to function as a derrick in moving another person," said Ken Mettler, ergonomics program manager. "Because even if it is done correctly, each lift puts additional strain on the spine that could lead to discomfort and injury. That's what we want to avoid."

Participants in the program report impressive early reductions in lost workdays and improved resident comfort during transfers. During Fiscal Year 2000, they reduced back injuries by 43 percent and shoulder injuries by 61 percent. WISHA officials continue to track injury rates and trends.

The staff was quick to point out, however, that equipment alone does not create a "zero-lift" environment. They emphasized that residents must be carefully evaluated with the possible use of equipment kept in mind, and re-evaluated as changes in their conditions occur. Officials also stressed the need for periodic training on the equipment use, written policies and procedures that support the zero-lift environment, and ongoing communication and cooperation between management and employees.

For nurses and nursing assistants with open workers' compensation claims due to ergonomic injuries, jobs may be modified so employees can continue to work yet avoid additional injury. The modification may be as simple as a job rotation or may involve buying a lifting device or other tool to allow an injured nurse or nursing assistant to continue resident-care duties.

Outreach and education continues to be a major contributor toward the program's success. During the project startup, the Washington State Department of Labor and Industries produced two new publications, "Frequently Asked Questions about Portable Total Body Patient/Resident Lifts" and "Frequently Asked Questions about Sit-to-Stand Patient/Resident Devices" to encourage use of zero-lift technology in resident and patient care facilities. Both publications, as well as additional information about the program, are posted on WISHA's website at www.lni.wa.gov/wisha.

The department also documents best practices currently used in skilled nursing facilities and shares the information throughout the industry. In addition, the staff provides technical expertise in risk management and occupational health.

"We're continuing in our efforts to reduce ergonomic injuries among caregivers in nursing homes," said Mettler. "Working directly with facilities through the Hazard Impact Partnership, we're making steady progress." JSHQ