Guidelines for Nursing Homes - osha.gov

1 Guid eline sforNur sin gHomesOSHA3182-3R2009 Ergo nom icsfo r thePr event ionofMu scu los ke let al DisordersGuidelines for Nursing HomesErgonomics for the Preventionof Musculoskeletal Department of LaborElaine L. Chao, SecretaryOccupational Safety and Health AdministrationJohn L. Henshaw, Assistant SecretaryOSHA 3182-3R 2009 Guidelines for Nursing Homes12 Guidelines for Nursing HomesTableofContents5 Executive Summary7 SECTION I:Introduction9 SECTION II:A Process for Protecting Workers9 Provide Management Support9 Involve Employees10 Identify Problems10 Implement Solutions10 Address Reports of Injuries11 Provide Training11 Evaluate Ergonomics Efforts12 SECTION III:Identifying Problems and Implementing Solutions for ResidentLifting and Repositioning12 Identifying Problems for Resident Lifting and Repositioning Figure 1. Transfer to and from: Bed to Chair, Chair to Toilet,Chair to Chair, or Car to Chair Figure 2.

2 Lateral Transfer to and from: Bed to Stretcher, Trolley Figure 3. Transfer to and from: Chair to Stretcher Figure 4. Reposition in Bed: Side-to-Side, Up in Bed Figure 5. Reposition in Chair: Wheelchair and Dependency Chair Figure 6. Transfer a Patient Up From the Floor17 Implementing Solutions for Resident Lifting and Repositioning Transfer from Sitting to Standing Position Resident Lifting Repositioning in Chair Ambulation Lateral Transfer; Repositioning Lateral Transfer in Sitting Position Transfer from Sitting to Standing Position Weighing Transfer from Sitting to Standing Position; Ambulation Repositioning Bathtub, Shower, and Toileting ActivitiesGuidelines for Nursing Homes327 SECTION IV:Identifying Problems and Implementing Solutions forActivities Other than Resident Lifting and Repositioning Storage and Transfer of Food, Supplies, and Medications Mobile Medical Equipment Working with Liquids in Housekeeping Working with Liquids in Kitchens Hand Tools Linen Carts Handling Bags Reaching into Sink Loading or Unloading Laundry Cleaning Rooms (Wet Method) Cleaning Rooms (Electrical)31 SECTION V:Training31 Nursing Assistants and Other Workers at Risk of Injury31 Training for Charge Nurses and Supervisors31 Training for Designated Program Managers33 SECTION VI:Additional Sources of Information35 References36 Appendix.

3 A Nursing Home Case StudyTableofContents4 Guidelines for Nursing HomesThese Guidelines providerecommendations for Nursing homeemployers to help reduce the numberand severity of work-related muscu-loskeletal disorders (MSDs) in theirfacilities. MSDs include conditionssuch as low back pain, sciatica,rotator cuff injuries, epicondylitis,and carpal tunnel syndrome. Therecommendations in these guidelinesare based on a review of existingpractices and programs, State osha programs, as well as availablescientific information, and reflectcomments received from representativesof trade and professional associations,labor organizations, the medicalcommunity, individual firms,and other interested parties. osha thanks the many organizationsand individuals involved for theirthoughtful comments, suggestions,and remains to be learned aboutthe relationship between workplaceactivities and the development ofMSDs.

4 However, osha believesthat the experiences of many nursinghomes provide a basis for takingaction to better protect the understanding of these injuriesdevelops and information andtechnology improve, the recommenda-tions made in this document maybe these Guidelines aredesigned specifically for nursinghomes, osha hopes that employerswith similar work environments, suchas assisted living centers, Homes forthe disabled, Homes for the aged,and hospitals will also find thisinformation also recognizes that smallemployers, in particular, may nothave the need for as comprehensive aprogram as would result fromimplementation of every action andstrategy described in these , osha realizes thatmany small employers may needassistance in implementing anappropriate ergonomics is why we emphasize theavailability of the free osha consultation service for smalleremployers. The consultation service isindependent of osha s enforcementactivity and will be making specialefforts to provide help to the nursinghome Guidelines are advisory innature and informational in are not a new standard orregulation and do not create any newOSHA duties.

5 Under the OSH Act,the extent of an employer s obligationto address ergonomic hazards isgoverned by the general duty clause,29 654(a)(1). Guidelines for Nursing Homes5An employer s failure to implementthe Guidelines is not a violation, orevidence of a violation, and may notbe used as evidence of a violation, ofthe general duty clause. Furthermore,the fact that osha has developedthis document is not evidence andmay not be used as evidence of anemployer s obligations under thegeneral duty clause; the fact that ameasure is recommended in thisdocument but not adopted by anemployer is not evidence, and maynot be used as evidence, of aviolation of the general duty addition, the recommendationscontained herein should be adaptedto the needs and resources of eachindividual place of , implementation of the guide-lines may differ from site to sitedepending on the circumstancesat each particular specific measures maydiffer from site to site, osha recommends that: Manual lifting of residents beminimized in all cases andeliminated when feasible.

6 Employers implement an effectiveergonomics process that: provides management support; involves employees; identifies problems; implements solutions; addresses reports of injuries; provides training; and evaluates ergonomics Guidelines elaborate onthese recommendations, and includeadditional information employerscan use to identify problems andtrain employees. Of particular valueare examples of solutions employerscan use to help reduce MSDs in theirworkplace. Recommended solutionsfor resident lifting and repositioningare found in Section III, whilerecommended solutions for otherergonomic concerns are in SectionIV. The appendix includes a casestudy describing the process onenursing home used to reduce for Nursing HomesNursing Homes that haveimplemented injury prevention effortsfocusing on resident lifting andrepositioning methods have achievedconsiderable success in reducingwork-related injuries and associatedworkers compensation costs.

7 Pro-viding a safer and more comfortablework environment has also resulted inadditional benefits for some facilities,including reduced staff turnover andassociated training and administrativecosts, reduced absenteeism, increasedproductivity, improved employeemorale, and increased residentcomfort. These Guidelines providerecommendations for employers tohelp them reduce the number andseverity of work-related musculoskele-tal disorders in their facilities usingmethods that have been found to besuccessful in the Nursing care to Nursing homeresidents is physically demandingwork. Nursing home residents oftenrequire assistance to walk, bathe, orperform other normal daily some cases residents are totallydependent upon caregivers formobility. Manual lifting and othertasks involving the repositioning ofresidents are associated with anincreased risk of pain and injury tocaregivers, particularly to the back (2,3).

8 These tasks can entail high physicaldemands due to the large amountSECTIONII ntroductionof weight involved, awkward posturesthat may result from leaning over abed or working in a confined area,shifting of weight that may occur if aresident loses balance or strengthwhile moving, and many otherfactors. The risk factors that workersin Nursing Homes face include: Force - the amount of physicaleffort required to perform a task(such as heavy lifting) or to main-tain control of equipment or tools; Repetition - performing the samemotion or series of motions contin-ually or frequently; and Awkward postures - assumingpositions that place stress on thebody, such as reaching aboveshoulder height, kneeling,squatting, leaning over a bed, ortwisting the torso while lifting (3).Wyandot County Nursing Home in UpperSandusky, Ohio, has implemented a policyof performing all assisted residenttransfers with mechanical lifts, and haspurchased electrically adjustable to Wyandot, no back injuriesfrom resident lifting have occurred in overfive years.

9 The Nursing home also reportedthat workers compensation costs havedeclined from an average of almost$140,000 per year to less than $4,000 peryear, reduced absenteeism and overtimehave resulted in annual savings ofapproximately $55,000, and a reduction incosts associated with staff turnover hassaved an additional $125,000 (1). (seeReference List) Guidelines for Nursing Homes7 Excessive exposure to these riskfactors can result in a variety ofdisorders in affected workers (3, 5).These conditions are collectivelyreferred to as musculoskeletaldisorders, or MSDs. MSDs includeconditions such as low back pain,sciatica, rotator cuff injuries,epicondylitis, and carpal tunnelsyndrome (6). Early indications ofMSDs can include persistent pain,restriction of joint movement, or softtissue swelling (3, 7).While some MSDs develop gradu-ally over time, others may resultfrom instantaneous events such as asingle heavy lift (3).

10 Activities outsideof the workplace that involvesubstantial physical demands mayalso cause or contribute to MSDs (6).In addition, development of MSDsmay be related to genetic causes,gender, age, and other factors (5, 6).Finally, there is evidence that reportsof MSDs may be linked to certainpsychosocial factors such as jobdissatisfaction, monotonous work,and limited job control (5, 6). Theseguidelines address only physicalfactors in the workplace that arerelated to the development of implementing a program designedto eliminate manual lifting of residents,Schoellkopf Health Center in NiagaraFalls, New York, reported a downwardtrend in the number and severity ofinjuries, with lost workdays droppingfrom 364 to 52, light duty daysdropping from 253 to 25, and workers compensation losses falling from$84,533 to $6,983 annually (4).At Citizens Memorial Health Care Facilityin Bolivar, Missouri, establishment of anergonomics component in the existingsafety and health program was reportedlyfollowed by a reduction in the number ofOSHA-recordable lifting-related injuries ofat least 45% during each of the next fouryears, when compared to the level ofinjuries prior to the ergonomics number of lost workdays associatedwith lifting-related injuries was reportedto be at least 55% lower than levelsduring each of the previous four Memorial reported that thesereductions contributed to a direct savingsof approximately $150,000 in workers compensation costs over a five yearperiod (8).