Addressing material
handling injuries
by James M. Sheridan, Risk Control Specialist
The PMA Insurance Group
For healthcare facilities, workers’ compensation and
employee absence costs can be significant expenditures. These costs are
particularly troublesome, as workers in the healthcare industry are
experiencing an increasing number of occupational injuries and
illnesses, with the rates of these injuries escalating during the past
ten years according to the National Institute for Occupational Safety
and Health. With healthcare facilities currently facing significant
financial pressures, preventing injuries among workers is more important
than ever.
What is causing injuries among healthcare workers? While
occupational hazards such as needlesticks and latex allergies are widely
publicized, the leading cause of worker injury in healthcare facilities
is attributable to strain and overexertion (Bureau of Labor
Statistics). These types of injuries, Musculoskeletal Disorders (MSDs),
are injuries and disorders of the muscles, nerves, tendons, ligaments,
joints, cartilage and spinal discs. Examples of MSDs include rotator
cuff tendonitis, herniated or ruptured lumbar discs, and carpal tunnel
syndrome. MSDs also include cumulative trauma disorder, repetitive
stress injury and repetitive motion injury.
Moving, lifting and transferring patients or residents
are the leading causes of these types of injuries in healthcare
facilities. However, patient handling is not the only source of these
ailments.
Healthcare facilities employ an extensive support staff
in areas such as environmental services, laundry and linen services,
food service, patient transport, maintenance, plant operations, and
housekeeping. The support staff routinely performs what is known as
material handling tasks—pushing and pulling hospital trash receptacles
or dietary carts, lifting mounds of laundry and moving medical
equipment. Most overexertion and strain injuries endured by healthcare
facility support staff are the result of lifting, pushing and pulling
over a long period of time. Executing these duties can pose serious
hazards and can lead to pain, injury and eventually to a disability.1
Material handling tasks become problematic when
associated risk factors make a worker more prone to injury. Risk factors
include:
• Amount of force—the effort it takes to lift, push,
pull or move any object.
• Repetition—how often a movement is performed. In
general, as repetition increases, the force a person can exert
decreases, especially as the length of time or duration of a task
increases.
• Awkward positions—lifting and doing tasks while the
body is twisted, bent, stooped or other position that could put a strain
on joints and muscles, including frequent or prolonged work over
shoulder height and repeated or sustained bending.
• Duration—the longer the period of continuous work
(sustained muscle contraction), the longer the recovery or rest time
required.
The manner in which a risk factor leads to an
injury/disorder is usually through the accumulation of repeated exposure
to the risk factor. MSDs are medical conditions that develop gradually
over time and do not typically result from a single, instantaneous
event. For example, an occurrence such as pushing or pulling a dietary
cart may stress soft tissues in the arms, shoulders, back or legs, but
the exposure may be too low for traumatic injury and the tissues
recover. However, repeated exposure to this stress may interfere with
the normal recovery process, produce disproportionate responses and
eventually lead to an MSD-type injury.
Another important consideration is the aging of the
workforce. By 2015, nearly 20 percent of workers will be at least 55
(American Association for Retired Persons). As workers age, changes
occur that can put them at risk for MSDs. These changes include loss of
strength, loss of muscular flexibility, loss of joint range of motion
and reduced grip strength. Moreover, although claim frequency on average
is lower among older workers, their injuries tend to be more severe and
costly (Workers’ Compensation Research Institute). The average
medical claims costs for twenty-something workers is $1,496 compared to
$3,738 for workers in their sixties (Workers’ Compensation Research
Institute).
To effectively prevent these injuries and reduce
workers’ compensation costs, healthcare facilities, in partnership with
their workers’ compensation insurer, need to develop a comprehensive
risk control strategy for material handling. The strategy should include
the following steps: risk identification, risk analysis, strategic risk
control planning, implementation of the action plan, monitoring results
versus goals and managing improvement strategies.
Identifying and analyzing your losses
The first step is to be acquainted with the frequency and severity
of your organization’s employee injuries, as well as the risk factors
related to material handling. Analyze the appropriate records that
contain data on workplace injuries to assist you in identifying the
trouble spots in your organization. Examine records such as your OSHA
injury & illness log, incident reports, workers’ compensation loss data,
and health insurance and sick leave usage. Another excellent source of
information is your insurer’s or third-party administrator’s risk
management information system.
It is also a good idea to perform a job hazard analysis
(JHA) on individual tasks that can assist you in identifying factors and
tasks that expose the healthcare worker to potential injury. A JHA helps
integrate accepted safety and health principles and practices into a
particular operation.
In a JHA, each basic step of the job is examined to
identify potential hazards and to determine the safest way to do the
job. For example, with hospital laundry, a JHA might reveal that staff
members are constantly bending over to retrieve dirty laundry from
laundry carts for placement into washers, putting strain on their lower
backs. An example of a corrective action in this situation might be to
use spring-loaded laundry carts to push the laundry up from the bottom
as it is placed into the washer thus reducing bending by the employee.
Risk control planning
& action plans
When problems related to material handling are identified and
analyzed, the next step is to select and implement action plans to
eliminate hazards. Workplace modifications that eliminate hazards and
improve the work environment are good steps.
Following are some changes to consider when forming an
action plan:
Engineering controls
Also referred to as job redesign, engineering controls involve
reducing or eliminating hazardous conditions through initiatives such as
improvement of workstation layout, proper selection and use of tools
and/or equipment and improved work methods.
When developing solutions, involve employees to help
ensure the solutions identified and implemented are agreed to by
employees performing the work. The use of engineering controls is the
ideal solution because it either completely eliminates or greatly
reduces the employee’s exposure when performing the task. Examples of
engineering controls or equipment controls are spring-loaded laundry
carts, ergonomically designed dietary carts, and height adjustable work
tables.
Implementation of engineering controls may necessitate
the purchase of new equipment to prevent further worker injuries. To
garner executive buy-in for these expenditures, perform a cost-benefit
analysis. Be sure to carefully evaluate all new equipment.
An important step is to operate a product evaluation
committee. When considering new equipment purchases, trial the equipment
before it is purchased to ensure employees have input into the equipment
recommendation process and it meets your needs. Once capital funding is
secured for the purchase of engineering controls, many facilities hold a
vendor fair where various equipment suppliers are brought in to the
facility to set up and display their products. Then employees can
actually use the equipment and evaluate it using a simple evaluation
tool. This gives you some valued input by the employees who will
actually be using the equipment. Many attempts fail not because the
facility did not purchase good equipment but rather because the
employees had no say in which equipment was purchased. You will have
better employee buy-in when line staff is consulted in the selection
process.
Once the equipment is acquired, ensure that regularly
scheduled preventive maintenance is performed on the equipment—both new
and existing equipment. For example, does your facility have a
preventive maintenance program in place for the wheels and/or casters on
equipment that is pushed such as trash containers, linen carts and
housekeeping carts? Simply keeping the wheels on these carts in good
working condition will minimize the force necessary to push the cart.
Administrative controls
Having the right equipment is important. However, an important
component of your program is utilizing work practices and policies that
reduce or eliminate hazardous conditions through changes in job rules,
rotation and training. Companies can expect to improve bottom-line
measures in health/safety, quality and productivity, as well as other
product and process areas by applying effective ergonomic principles.
Develop guidelines for lifting and manual material
handling. When formulating these guidelines, obtain input from
employees. For example, a policy guideline might be suppliers of dietary
products must keep the product weight to 35 lbs. or less. Another
example of a guideline is to direct employees to push carts instead of
pulling carts. Once the procedures have been developed, they must be
implemented and, most importantly, enforced throughout the facility.
Work practices
The next step is to develop and implement an employee training
program. The program should include a review of the program elements,
engineering controls, and work method controls. For example, employees
should be given step-by-step instructions on ergonomics issues, such as
proper lifting techniques and pushing and pulling activities, including
body posture and foot positioning.
Training by itself is never the total solution, but must
be used in combination with the appropriate equipment and work
practices. Another important component is to establish accountability
for all levels of management and employees to ensure the program is
executed and followed.
Given the choice between pushing or pulling wheeled
equipment, a task should be designed for pushing – pulling should be
avoided for the following reasons:
• Feet can be run over by the equipment when pulling.
• If a person pulls while facing in the direction of
travel, the arm is stretched behind the body placing the shoulder and
back at risk of injury.
• Pulling while walking backwards can cause an accident
because the person is unable to see where they are going
• People can exert higher push forces than pull forces
Managing results and improvement strategies
After implementing the program, continually evaluate its
effectiveness to ensure it is achieving measurable results. When
evaluating your program, you can benchmark your program results against
your prior OSHA log, workers’ compensation injury statistics and
employee feedback surveys.
In this environment of bottom-line pressure and
litigation, it is increasingly important for healthcare facilities to
address and carefully manage all expenditures. With worker injuries
increasing in healthcare, developing solutions to prevent these injuries
is crucial. Implementing a proactive, results-oriented approach to
address both patient and material handling will provide a safe, positive
work culture for employees and help manage your workers’ compensation
and employee absence costs.
