Ergonomics Guidelines Training for Nursing Homes

1
Ergonomics Guidelines for Nursing Homes
2
What this presentation covers

• How to develop an ergonomics process to protect
  workers
• Benefits of implementing an ergonomics process
• Identify and analyze problem jobs innursing
  homes
• Recognize practicalsolutions to address problem
  jobs

• Module 1 addresses problems involved with manual
  lifting and repositioning of residents.
• Module 2 covers other activities.

3
What this presentation covers
Note The recommended solutions presented in
these slides are not intended to be an exhaustive
list, nor are they all expected to be used in any
given facility. The information represents a
range of available options that a facility can
consider using.
4
Introduction
Providing care to nursing home residents is
physically demanding work. Nursing home residents
often require assistance to walk, bathe, or
perform other normal daily activities.
Manual lifting and repositioning of residents
account for the majority of lost workday injuries
and illnesses in nursing homes.

• Injury prevention efforts focused on manual
  lifting and repositioning methods may reduce
  work-related injuries and associated workers'
  compensation costs.

5
Introduction
Providing a safer and more comfortable work
environment can also result in additional
benefits to staff as well as residents

• reduced staff turnover and associated training
  and administrative costs
• reduced absenteeism
• increased productivity
• improved employee morale
• increased resident comfort

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What is Ergonomics?
Ergonomics is the science of fitting the job to
the worker. Ergonomics involves designing
equipment and work tasks to conform to the
capability of the worker.

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Ergonomics Process
Develop a process for systematically addressing
ergonomics issues

• Provide management support
• Involve employees
• Submit suggestions or concerns
• Discuss workplace and work methods
• Participate in design of work, equipment,
  procedures, and training
• Evaluate equipment

8
Ergonomics Process
(Continued)

• Identify problems
• Use systematic methods
• Implement solutions
• Workplace modifications that

• Eliminate hazards
• and
• Improve work environment

9
Ergonomics Process
(Continued)

• Address reports of injury
• Limit severity of injuries
• Improve treatment of injuries
• Minimize disability or permanent damage
• Reduce claims and costs

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Ergonomics Process
(Continued)

• Provide training

• recognize potential hazards
• understand measures available to correct them
• cover hazards found in each job
• provide refresher training as needed

• Evaluate ergonomic efforts

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Benefits to Employees
What are the benefits of an effective ergonomics
program to employees?

• Employee injuries reduced
• Employee turnover declined
• Absenteeism reduced
• Productivity and morale increased
• Compensation costs lowered

12
Benefits to Residents
What are the benefits of an effective ergonomics
program to residents?

• Dignity
• Independence
• Security

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Risk Factors in Nursing Homes

• Nursing home residents often require assistance
  to walk, bathe, or perform other normal
  activities.
• Risk factors that workers face when performing
  tasks associated with these activities include

• Force
• Repetition
• Awkward postures

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Risk Factors in Nursing Homes

• Force

Amount of physical effort required to perform a
task or to maintain control of equipment or
tools (e.g., lifting, pushing, pulling, holding)

• Examples of excessive force include
• lifting or transferring heavy residents
• unexpected or abrupt forceful motions
• stopping resident falls or lifting them off the
  floor after a fall

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Risk Factors in Nursing Homes

• Repetition

Performing the same motion or series of motions
continually or frequently

• Examples of repetitive activities include
• repeated repositioning in bed

• numerous transfers to and from beds, chairs, or
  commodes without rest breaks

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Risk Factors in Nursing Homes

• Awkward posture

Assuming positions that place stress on the
body (leaning, bending, twisting the torso while
lifting, reaching above shoulder height,
kneeling, squatting, etc.)

• Examples of awkward posture are
• dressing or undressing residents
• providing in-bed medical care
• repositioning or turning residents in beds

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Exposure to Risk Factors

• Excessive exposure to risk factors result in
  musculoskeletal disorders, which include

• Low back pain
• Sciatica
• Rotator cuff injuries
• Epicondylitis (elbow injuries)
• Carpal tunnel syndrome

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Identifying Problem Jobs

• To obtain information, analyze and review

• Injury and illness logs
• Workers compensation reports
• Accident and near-miss reports
• Insurance company reports
• Employee interviews
• Workplace observations

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Identifying Problems for Resident Lifting and
Repositioning
Resident Assessment

• Level of assistance the resident requires
• Size and weight
• Ability and willingness to understand and
  cooperate
• Rehabilitation plan
• Medical conditions impacting choice of methods
• Other factors

Factors to consider
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Identifying Problems for Resident Lifting and
Repositioning
Resident Assessment Example

• Fred is an 80 year old resident at a nursing
  home.
• He weighs 156 pounds and is 59 tall.
• He has dementia and a history of falls.
• Although some days he is cooperative, on other
  days he is combative and fearful.
• When he is cooperative, he can bear weight.
  Otherwise he resists standing.
• He is to be out of bed every day in a chair.

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Identifying Problems for Resident Lifting and
Repositioning
(Continued)
Resident Assessment Example
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Identifying Problems for Resident Lifting and
Repositioning
(Continued)
Resident Assessment Example

• Selection of equipment and method of transfer

• Use full body sling with two caregivers

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Finding Solutions to Problem Jobs

• Engineering solutions

• Involve a physical change to the way a job or
  task is conducted or physical modifications to
  the workplace.

• Work practice solutions

Involve the way work is done and do not involve a
physical change to the workplace.
24
Factors That May Affect Solutions

• Residents rehabilitation plan
• Need to restore residents functional abilities
• Medical contraindications
• Emergency situations
• Resident dignity and rights

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Resident Lifting and Repositioning Solutions
Sit-to-Stand Lift
Floor-Based Sling Lift
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Resident Lifting and Repositioning Solutions
(Continued)
Lateral Sliding Aid
Transfer Board
Electric Bed
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Resident Lifting and Repositioning Solutions
(Continued)
Ambulation Assist
Weighing Scale with Ramp
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Summary
In this module, you learned about the following

• Ergonomics process

• Provide management support
• Involve employees
• Identify problems
• Implement solutions

• Address reports of injuries
• Provide training
• Evaluate ergonomic efforts

• Identifying and analyzing problem jobs in nursing
  homes
• Recognizing practical solutions to address
  problem jobs

29
Resources

• Guidelines for Nursing Homes
• developed by the Occupational Safety and Health
  Administration (OSHA)

30
Resources

• NC OSHA
• http//www.osha.gov
• OSHAhttp//www.osha.gov/ergonomics/guidelines/nur
  singhome/index.html
• NIOSH
• http//www.cdc.gov/niosh/topics/ergonomics/

31

• Thank you for taking the time to learn about
  safety and health and how to prevent future
  injuries and illnesses.

?
32
Ergonomics Guidelines for Nursing Homes
33
What this presentation covers

• Identifying some problem tasks in nursing homes
• Resident care (other than manual lifting and
  repositioning)
• Housekeeping, stocking supplies
• Dietary operations
• Laundry operations
• Recognizing practical solutions to address
  problem tasks

See Module 1 for problems addressing manual
lifting and repositioning of residents.
34
What this presentation covers
Note The recommended solutions presented in
these slides are not intended to be an exhaustive
list, nor are they all expected to be used in any
given facility. The information represents a
range of available options that a facility can
consider using.
35
Introduction
There are significant numbers of work-related
musculoskeletal disorders (WMSDs) that occur in
activities other than manual lifting and
repositioning of residents in the nursing home

• Resident care (other than manual lifting and
  repositioning)
• Housekeeping, stocking supplies
• Dietary operations
• Laundry operations

36
Identifying Problem Jobs/Tasks
Job Assessment

• Observe employees perform task
• Discuss with employees about activities and
  conditions that they associate with difficulties
• Check injury records
• Identify problems

• Implement solutions/improvements

37
Resident Care Other Than Lifting and Repositioning
Problems Reaching, Leaning, Bending, Kneeling,
Squatting, etc.)
Caregivers may find themselves working in awkward
postures when assisting residents in activities
of daily living and related activities, such as
Bending and reaching to make bed

• showering and bathing
• toileting
• dressing or undressing
• performing personal hygiene
• feeding a resident
• making a bed

Bending to help with shoes
38
Resident Care Other Than Lifting and Repositioning
Solution Height-adjustable beds, bathtubs, lift
bath carts, shower gurneys
Adjusting equipment/ devices to waist height
eliminates bending and reaching for caregivers
and for those who clean tubs and make beds.
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Resident Care Other Than Lifting and Repositioning
Solution Work Practices

• Use upright, neutral working postures and proper
  body mechanics. Bend your legs, not your back.
• Use long-handled extension tools on hand-held
  shower heads, wash or scrub brushes, and other
  items to eliminate bending, twisting, and long
  reaching when washing residents legs, feet, and
  trunk. 
• Lower rails on beds/gurneys when feeding
  residents or providing other care to eliminate
  extended reaching.
• Work with enough space to avoid awkward postures.

Good posture - straight back, bent knees
Bad posture - Extended reach over rail
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Laundry Operations
Problems Lifting, Bending, Reaching, Twisting
Excessive reaching, bending, and/or lifting
laundry (especially heavy when wet) can cause
work-related MSDs such as strains and sprains to
the back or shoulder area.

• collecting and sorting soiled linens
• placing in washers
• transferring wet linen to dryers
• folding and storing on shelves or placing in
  carts for transport

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Laundry Operations
Solution Side-access hampers, tilted hampers
Tilted laundry bins bring items closer and reduce
awkward reaching.

• Hamper with platform under the laundry bag allows
  easy side access to the bag without having to
  lift the bag up to clear the hamper.

42
Laundry Operations
Solution Spring-loaded carts

• Spring-loaded carts automatically bring linen
  within easy reach and help reduce the amount of
  bending over and pulling on linen that the worker
  has to do.

Carts should have wheel locks. Heavy carts should
have brakes.
Cart floor rises as weight of linens decreases
43
Laundry Operations
Solution Front-Loading Washers and Dryers
Front-loading washers and dryers with bottom of
door opening between hip and elbow height
For deep tubs, use a rake with a long or
extendable handle to pull linen closer to the
door opening.
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Laundry Operations
Solution Work Practices

• Load and unload washers and dryers in small
  amounts.
• Avoid lifting and twisting when handling loads.
  Face the load and keep the items as close to the
  body as possible.
• If you must use top loading washers handle small
  loads of laundry, handle only a few items at a
  time, and brace your body against the front of
  the machine when lifting.
• Use easy-to-move carts on wheels rather than
  picking up baskets of soiled linen or wet
  laundry.
• Avoid lifting/reaching or working aboveshoulder
  height.

45
Dietary Operations
Problems Lifting, Reaching, Bending

• Frequent elevated and extended reaches for
  supplies or heavy containers
• Bending and unpacking cases from the floor
• Lifting heavy food supplies to and from storage
  areas
• Lifting and dispensing large containers of soup,
  food
• Lifting food trays above shoulder level or below
  knee level

46
Dietary Operations
Solution Redesign or reposition

• Redesigning or repositioning tasks eliminates
  extended and elevated reaching, and allows elbows
  to remain close to the body (e.g., turn boxes
  over on side to allow for easier access).

Kitchen worker using elevated reach
Box placed on side allows for less reaching.
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Dietary Operations
Solution Height-adjustable countertops,
work stands

• Work at a height appropriate for the task being
  performed to keep elbows close to the body and
  thus reduce reaching.  

• Height-adjustable countertops
• Step stool or work stand to avoid reaching above
  shoulders

Work station with adjustable feet that
raise/lower work surface to fit worker.
Working at appropriate height
48
Dietary Operations
Solution Kettle, pot, and skillet tilts
Kettle, pot, and skillet tilts allow for easy
dispensing of foods, as well as for cleaning.
This eliminates the need for lifting.

• Anti-fatigue mats or insoles or shock-absorbing
  floors to minimize back and leg strain  

49
Housekeeping
Problems Lifting, Reaching, Pushing/Pulling,
Bending, Kneeling
The housekeeping staff performs many tasks that
may result in forceful exertion, repetition, and
awkward postures

• Mopping floors
• Dusting, sweeping
• Cleaning whirlpools, tubs
• Collecting trash
• Changing light bulbs, other building maintenance
  work

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Housekeeping
Solution Work Practices

• When mopping, alternate mopping styles frequently
  (e.g., push/pull, figure 8, and rocking
  side-to-side). Wear rubber-soled shoes in wet
  areas to prevent slipping.
• Use powered devices over manual equipment (e.g.,
  vacuum instead of broom) for moderate-to-long
  duration use.
• Use chemical cleaners and abrasive sponges to
  minimize scrubbing force (may need to ventilate
  rooms when chemicals are used).
• Use kneepads when kneeling.

51
Housekeeping
(Continued)
Solution Work Practices

• Use extension handles, step stools, or ladders
  for overhead jobs. When dusting overhead, use an
  extender.
• Avoid lifting heavy buckets, e.g., lifting a
  large, full bucket from a sink. Use a hose or
  similar device to fill wheeled buckets with
  water.
• Use carts to transport supplies, or carry only
  small quantities and weights of supplies.

Instead of lifting a large full bucket (left),
fill a wheeled bucket (below).

• For cleaning small objects in a deep sink, place
  a plastic basin or other object in bottom of deep
  sink to raise the work surface.

52
Carts, Other Mobile EquipmentDesign and
Maintenance Issues
Carts

• moving
• food trays
• cleaning supplies
• equipment, tools
• laundry, linens
• dispensing medications

Cart to transport cleaning supplies, tools, etc.
Food tray cart
Other equipment, such as

• beds, gurneys
• wheel chairs
• mobile medical equipment
• large wheeled containers for cleaning

Mobile medical equipment
Medication dispenser
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Carts, Other Mobile EquipmentDesign and
Maintenance Issues

• Problems Holding, pushing, or handling equipment
  can cause forceful exertions or awkward body
  postures. Some of the ways equipment can cause
  problems include

• Jammed or worn wheels, which make it harder to
  move and steer
• Faulty brakes, which cause equipment to shift
• Handles on beds, carts, or other equipment, which
  are either the wrong size or placed at an
  inappropriate height
• High or heavy medical, food, or linen carts,
  which require bending, reaching, or twisting to
  load or unload

Hard to push heavy cart, handles too high, hard
to see over
54
Carts, Other Mobile EquipmentDesign and
Maintenance Issues

• Solution

• Use well maintained carts and equipment with
  large, low rolling, low resistance wheels for
  easier maneuvering, and that can roll easily over
  mixed flooring as well as gaps between elevators
  and hallways. This can decrease the force.
• Carts should have full-bearing wheels of a
  material designed for the floor surface.
• Make sure that cart or equipment is not too high
  or wide to see over or around.
• Make sure handles are at waist height and
  positioned to allow neutral posture. Adjust if
  needed.

55
Carts, Other Mobile EquipmentDesign and
Maintenance Issues
(Continued)

• Solution

• Make sure that storage or retrieval of items does
  not require bending too low or reaching too high
  or far.
• Organize cleaning carts to avoid lifting and
  reaching over the cart. Place commonly used
  supplies in front.
• Have scheduled systematic preventative
  maintenance
• Check brakes for their ability to lock and hold
• Oil and adjust mechanisms to work easily
• Clean or replace casters or wheelsso they roll
  easily and smoothly

Jammed wheel, faulty brake
56
Summary
In this module, you learned about the following

• Identifying some problem tasks in nursing homes
• Resident care (other than manual lifting and
  repositioning)
• Housekeeping, stocking supplies
• Dietary operations
• Laundry operations
• Recognizing practical solutions to address
  problem tasks

57
Resources

• Guidelines for Nursing Homes
• developed by the Occupational Safety and Health
  Administration (OSHA)

58
Resources

• NC OSHA
• http//www.nclabor.com
• OSHAhttp//www.osha.gov/ergonomics/guidelines/nur
  singhome/index.html
• NIOSH
• http//www.cdc.gov/niosh/topics/ergonomics/

59

• Thank you for taking the time to learn about
  safety and health and how to prevent future
  injuries and illnesses.

?