Ergonomics Guidelines for Nursing Homes

Recommendations for preventing and reducing musculoskeletal disorders (MSDs)

Purpose

To enable you to develop an ergonomics process for your nursing home that will help you identify problem job tasks and find practical solutions. The goals are to reduce injuries to your workers and promote resident comfort and safety.

What this presentation covers

How to develop an ergonomics process

Benefits of implementing an ergonomics process

Identifies problem job tasks in nursing homes

Practical solutions for problem job tasks

Gives an example of a resident assessment

What this presentation covers

Note: The solutions presented in these slides are not intended to cover every possibility. Some will work in your facility, while others will work elsewhere. We intend to give you a range of options to consider.

IntroductionCaring for nursing home residents is physically demanding work. Nursing home residents often require assistance to walk, bathe, or perform other daily activities.

Work-related musculoskeletal disorders (WMSDs) can occur with activities such as

resident carehousekeepingstocking suppliesdietary operationslaundry operations

Introduction

Use the principles of ergonomics to reduce risk factors that cause or contribute to work-related musculoskeletal disorders (WMSDs). Risk factors increase the risk of developing disorders such as

Low back pain

Sciatica

Rotator cuff injuries

Epicondylitis (elbow injuries)

Carpal tunnel syndrome

(Continued)

Introduction

Most injuries that result in lost work days are caused by manually lifting and repositioning residents.

Focusing on preventing these types of injuries may reduce injuries and workers' compensation costs.

(Continued)

Introduction

Additional benefits to both staff and residents include

• reduced staff turnover and associated training and administrative costs

• reduced absenteeism

• increased productivity

• improved employee morale

• increased resident comfort, dignity, independence and feelings of security

(Continued)

To Develop an Ergonomics Process

What is Ergonomics?

Ergonomics is the science of fitting the job to the worker.

When equipment and job tasks are designed to fit the worker’s physical capabilities, the worker is less likely to get injured.

To Develop an Ergonomics Process

1. Provide management support

2. Involve employees in these ways

– Submit suggestions or concerns

– Discuss work methods

– Participate in design of equipment, procedures, and training

– Evaluate equipment

(Continued)

To Develop an Ergonomics Process

3. Identify problem jobs

– Use systematic methods

4. Implement solutions

–Eliminate hazards

–Improve work environment

(Continued)

To Develop an Ergonomics Process

5. Analyze and review reports of injury

– Injury and illness logs

– Workers’ compensation reports

– Accident and near-miss reports

– Insurance company reports

– Employee interviews

– Workplace observations

(Continued)

To Develop an Ergonomics Process

6. Provide training

(Continued)

– recognize potential hazards in each job

– understand possible solutions

– schedule regular refresher training

7. Evaluate ergonomic efforts

To Identify Problem Job Tasks

Observe employees performing the task

Ask employees which activities and conditions are difficult

Check injury records

Identify problems

Implement solutions and improvements

To Find Solutions to Problem Job Tasks

Physically change the way to do a task or make physical modifications to the workplace.

• Engineering solutions

Change the process without making a physical change to the workplace.

• Work practice solutions

Problem Job Tasks

The next section will review some problem job tasks with risk factors and solution examples.

Lifting and Repositioning Residents

Risk factors: Force, Awkward postures

Examples of excessive force

– lifting or transferring residents

– unexpected or abrupt motions

– repeated repositioning in bed

– stopping resident falls

– lifting residents off the floor or a low bed

• Force

Amount of physical effort required to do a task or to maintain control of equipment or tools

(Continued)

Examples

– leaning while providing in-bed medical care

– bending while repositioning or turning residents in beds

– bending to lift resident’s legs during dressing tasks

• Awkward postures

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

(Continued)

Solution ExamplesLifting devices

Floor-Based Sling Lift

Sit-to-Stand Lift

(Continued)

Solution Examples Lifting devices

LateralSliding Aid

(Continued)

Transfer Board

Electric Bed

Solution ExamplesRamps, Mobility devices

Ambulation Assist

(Continued)

Weighing Scale with Ramp

Resident Care Other Than Lifting and Repositioning

Risk factors: Awkward postures

– showering and bathing– toileting– dressing or undressing– personal hygiene– feeding– making beds

Caregivers lean, bend, squat, kneel and reach when assisting residents in activities of daily living, such as

Squatting to help with shoes

Bending and reaching to make bed

Solution Examples

Height-adjustable bathtub

Height adjustable equipment

Adjusting equipment to waist height reduces bending and reaching for caregivers and housekeepers.

(Continued)

Adjustable height shower gurneyElectric or crank bed

Solution Examples

Work Practices

• Use upright, neutral postures and proper body mechanics. Bend your legs, not your back.

• Use long-handled extensions on scrub brushes and other tools when washing residents’ legs, feet, and trunk. 

• Lower rails on beds when providing personal care.

• Work with enough space to avoid awkward postures.

Good posture - straight back, bent

knees

Bad posture - far reach over rail

(Continued)

Laundry Operations

Excessive and frequent reaching, bending, and lifting laundry, which is especially heavy when wet, can result in strains and sprains to the back or shoulders.

Example activities

Risk factor: Awkward postures

– collecting and sorting soiled linens

– loading washers

– transferring wet linen to dryers

– folding

– storing linen on shelves or in carts

Solution Examples

Hampers with side opening allow easy access to the bags without having to lift the bags up to clear the frame.

Side-access hampers, Tilted hampers

Tilted laundry bins bring items closer and reduce awkward reaching.

(Continued)

Solution Examples

These carts automatically bring linen up, so it’s easy to reach. This helps reduce bending.

Spring-loaded carts

Cart floor rises as weight of linens decreases

(Continued)

Solution Examples

Front-loading washers and dryers

For deep tubs, use a rake or grabber with a long handle to pull linen closer to the door opening.

(Continued)

The door opening in front-loaders should be between hip and elbow height.

Solution Examples

• Load and unload washers and dryers in small amounts.

• Avoid twisting when handling loads. Face the load and keep the items as close to your body as possible.

• For top loading washers - handle only a few items at a time and brace your body against the front of the machine when lifting.

• Use carts that roll rather than carrying baskets of soiled linen or wet laundry.

• Avoid lifting, reaching or working aboveshoulder height.

Work Practices

(Continued)

Dietary Operations

Examples

– Frequently reaching up or far away for supplies or heavy containers

– Bending to unpack cases from the floor

– Lifting heavy food supplies

– Lifting and pouring large containers of soup

– Lifting food trays above shoulder level or below knee level

Risk factors: Lifting, Awkward postures

Solution Examples

Change the set up to eliminate upward or far reaching, and allow elbows to remain close to the body.

Worker using elevated reach Box placed on side keeps worker’s elbows down

Redesign or Reposition

(Continued)

Solution Examples

Height appropriate countertops, work stands and step stools keep elbows close to the body and reduce reaching.  

Height-adjustable work areas

Working at appropriate height

Adjustable feet raise or lower the work surface.

(Continued)

Solution ExamplesTilting Pots, Appropriate Standing Surface

Kettle, pot, and skillet tilt to easily dispense foods. This eliminates the need for lifting.

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

(Continued)

Housekeeping

Example activities

Risk Factors: Lifting, Awkward postures, Pushing/Pulling, Repetitive motion

– Mopping floors

– Dusting, sweeping

– Cleaning whirlpools, tubs

– Collecting trash

– Changing light bulbs

– Building maintenance

Solution Examples

• When mopping, change the style frequently. For instance, alternate between push and pull, figure 8, and rocking side-to-side.

• Wear rubber-soled shoes in wet areas to prevent slipping.

• Powered equipment is better than manual for jobs that take a long time. For example, use a vacuum instead of a broom.

• Use chemical cleaners and abrasive sponges to reduce hard scrubbing. (Ventilation may be needed when chemical cleaners are used).

• Use kneepads when kneeling.

Work Practices

(Continued)

Solution Examples

• Use extenders, step stools or ladders for overhead jobs.

• Avoid lifting heavy buckets. Instead, use a hose or similar device to fill wheeled buckets with water.

• Use carts to transport supplies, or carry only small quantities and lightweight supplies.

(Continued)

Work Practices

• For cleaning small objects in a deep sink, place a plastic basin or other object in the bottom of the sink so you don’t have to bend over so far.

Carts & Mobile Equipment:Design and Maintenance Issues

Risk factors: Pulling, Pushing, Forceful exertions, Awkward postures.

Heavy cart, hard to push, handles too high, limited line of sight

Examples

– Jammed or worn wheels make it harder to move and steer

– Faulty brakes can cause equipment to shift

– Handles that are the wrong size or at an inappropriate height put wrists and backs in awkward postures

– High or large carts may require bending, reaching, or twisting to load or unload

Solution Examples

Wheels

• ball-bearing, designed specifically for the floor surface

• roll easily over mixed flooring and gaps between elevators and hallways

• large, low resistance

• wheel locks for safety

Carts

• not too high or wide to see over or around

• heavy carts need brakes

Handles

• at waist height and positioned to allow neutral, comfortable wrist posture.

(Continued)

Solution Examples

Work Practices

• Put commonly used supplies in the front of cleaning carts to reduce reaching and lifting.

• Store items between mid-shin and chest height.

• Schedule regular maintenance to prevent problems

– Check brakes for their ability to lock and hold

– Oil and adjust mechanisms

– Clean or replace wheelsso they roll easily and smoothly

(Continued)

Jammed wheel, faulty brake

Summary

In this training, you learned about

The ergonomics process

Benefits of implementing ergonomics

Identifying problem job tasks in nursing homes

– Resident care

– Housekeeping

– Dietary operations

– Laundry operations

Practical solutions to address problem tasks

Factors That May Affect Solutions

• Level of assistance the resident requires

• Size and weight

• Ability and willingness to understand and cooperate

• Rehabilitation plan

• Medical contraindications

• Resident dignity and rights• An emergency

Appendix: Resident Assessment

Fred is an 80 year old resident at a nursing home.

He weighs 156 pounds and is 5’9” 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.

Resident Assessment Example

Resident Assessment Example

(Continued)

Level of Assistance? • Dependent

Can the resident bear weight?

• No, because he is not always cooperative

Does the resident have upper extremity strength?

• No, because he is unreliable in using his upper body strength

Level of cooperation and comprehension? • Unpredictable

Weight? Height? • 156 lbs; 5’9”

Other factors? • History of falls • Transfer to and from bed to chair

Selection of Equipment and Method of Transfer

Resident Assessment Example(Continued)

• Full body sling• Two caregivers

Resources

Guidelines for Nursing Homes

– developed by the Occupational Safety and Health Administration (OSHA)

Resources

DOSHhttp://www.lni.wa.gov/Safety/Topics/Ergonomics/default.asp

OSHAhttp://www.osha.gov/ergonomics/guidelines/nursinghome/index.html

NIOSHhttp://www.cdc.gov/niosh/topics/ergonomics/

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

illnesses.