1 slip , trip , and fall Preventionfor Healthcare WorkersDEPARTMENT OF HEALTH AND HUMAN SERVICESC enters for Disease control and PreventionNational Institute for Occupational Safety and HealthSlip, trip , and fall Prevention for Healthcare WorkersDEPARTMENT OF HEALTH AND HUMAN SERVICESC enters for Disease control and Prevention National Institute for Occupational Safety and HealthiiAuthorsJennifer Bell, Epidemiologist Division of Safety Research National Institute for Occupational Safety and Health Centers for Disease control and Prevention Morgantown, WVJames W. Collins, , MSMEA ssociate Director for Science Division of Safety Research National Institute for Occupational Safety and Health Centers for Disease control and Prevention Morgantown, WVElizabeth Dalsey, MAHealth Communication Specialist Office of Research and Technology Transfer National Institute for Occupational Safety and Health Centers for Disease control and Prevention Cincinnati, OHVirginia Sublet, Health Scientist Office of Health Communication and Global Collaborations National Institute for Occupational Safety and Health Centers for Disease control and Prevention Washington, DCiiiThis document is in the public domain and may be freely copied or of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH).
2 In addition, citations to Web sites external to NIOSH do not constitute NIOSH endorse-ment of the sponsoring organizations or their programs or products. Further-more, NIOSH is not responsible for the content of these Web InformationTo receive documents or other information about occupational safety and health topics, contact NIOSH atTelephone: 1 800 CDC INFO (1 800 232 4636) TTY: 1 888 232 6348 E-mail: visit the NIOSH Web site at a monthly update on news at NIOSH, subscribe to NIOSH eNews (NIOSH) Publication Number 2011 123 December 2010 Safer Healthier PeopleTMvContentsPart I. Introduction.. 1 slip , trip , and fall (STF) Prevention for Healthcare Workers 3 Part II. Top 10 Hazards.. 71. Contaminants on the Floor.. 92. Poor Drainage: Pipes and Drains.. 143. Indoor Walking Surface Irregularities.. 164. Outdoor Walking Surface Irregularities .. 175. Weather Conditions: Ice and Snow .. 196. Inadequate Lighting.. 207. Stairs and Handrails.. 218.
3 Stepstools and Ladders.. 239. Tripping Hazards: Clutter, Loose Cords, Hoses, Wires, and Medical Tubing .. 2410. Improper Use of Floor Mats and Runners .. 27 Part III. Tools for STF Prevention .. 29 Examine Employee Slips, Trips, and Falls Injuries: The First Steps Toward Prevention .. 31 Employee Communication: Training and Involvement .. 34 Slips, Trips, and Falls Checklist.. 35 Literature Cited.. 40viContributors and ReviewersThis work emerged from a multi-institution-al, multi-disciplinary research partnership including NIOSH, BJC Health System, the Finnish Institute for Occupational Health, Liberty Mutual Research Institute for Safety, the Johns Hopkins School of Public Health, the Veteran's Health Administration, and Washington University School of Medicine. The authors of this document would like to convey special thanks to the following indi-viduals for their review of and contribution to the document:Barbara I. Braun, Director, Department of Health Services Research Department of Health Services Research The Joint Commission Oakbrook Terrace IL Theodore K.
4 Courtney, MS, CSPD irector, center for Injury Epidemiology Liberty Mutual Research Institute for Safety Hopkinton, Massachusetts Kathy GerwigVice President, Workplace Safety and Environmental Stewardship Kaiser Permanente Oakland, CA Joshua M. Harney, MS, CIHD irector, Occupational Safety & Environmental Health Cincinnati Children's Hospital Medical center Cincinnati, OHviiMichael J. Hodgson, MD, MPHC hief Consultant, Occupational Health, Veteran's Health Administration Washington, DC Wayne S. Maynard, CSP, CPE, ALCMM anager, Technical Services & Product Development Ergonomics and Tribology Liberty Mutual Group Hopkinton, MA Gary Sorock, Associate Professor center for Injury Research and Policy Johns Hopkins Bloomberg School of Public Health Glyndon, MD Laurie Wolf, MS, CPEE rgonomist BJC Health System St. Louis, MissouriThe authors would also like to thank the safety and health professionals who partici-pated in the focus groups and evaluated the content and format of this document, as well as the healthcare facilities that participated in the hazard demonstration and hazard cor-rection Credits Alex Telfer, , for the use of the nurse image on the cover Part I.
5 IntroductionSlip, trip , and fall Prevention | 3 IntroductionFigure 1. Percent distribution of hospital employee injuries by injury typeSlip, trip , and fall (STF) Prevention for Healthcare WorkersWork-related slip , trip , and fall incidents can fre-quently result in serious disabling injuries that im-pact a healthcare employee s ability to do his or her job, often resulting in lost workdays, reduced productivity, expensive worker compensation claims, and diminished ability to care for patients. According to the Bureau of Labor Statistics , the incidence rate of lost-workday injuries from slips, trips, and falls (STFs) on the same level in hospitals was per 10,000 employees, which was 90% greater than the average rate for all other private industries combined ( per 10,000 em-ployees). STFs as a whole are the second most com-mon cause of lost-workday injuries in hospitals. 39%25%14%10%5%4%2%1%OverexertionSTFsCont actAll otherExposureViolent eventsRepetitive motionTransportationFires / explosionsOverexertionSTFsInjury Event4 | slip , trip , and fall PreventionAn analysis of workers compensation injury claims from acute-care hospitals [Bell et al.]
6 2008] showed that the lower extremities (knees, ankles, feet) were the body parts most commonly injured after STFs (Table 1) and the nature of injury was most often sprains, strains, dislocations and tears (Table 2). In addition, STFs were significantly more likely to result in fractures and multiple injuries than were other types of is the Purpose of this Workbook?This workbook identifies the top 10 STF hazards specific to healthcare facilities. For each hazard this workbook will:1. Explain how the hazard contributes to STFs, 2. Identify where the hazard is likely to occur, and 3. Provide recommendations to reduce or elimi-nate the hazard. Slips, trips, and falls are preventable. This work-book provides guidance on implementing a STF Prevention program to protect healthcare workers. The goal of the workbook is to familiarize you with common STF hazards in healthcare facilities so you are able to recognize and reduce the risk to em-ployees. Throughout the workbook, pictures show either Prevention strategies or hazards in healthcare facilities.
7 Pictures outlined in red are hazards. In addition, both visitors and patients will benefit from an STF Prevention program in your facility reducing their risk as well. To further assist you, a checklist is provided on page 35 to help you identify different hazards in your healthcare facility. Who Should Use the Workbook?The Workbook is intended for healthcare facility administrators, safety and health professionals, facil-ity managers, housekeeping managers, food service managers, and workers who are responsible for , trip , and fall Prevention | 5 Table 1. slip , trip and fall (STF) workers compen-sation claims by body part injured, 1996 partn% of total STF claimsLower body : Bell et al. 2008 Table 2. STF workers compensation claims by nature of injury, 1996 of injuryn% of total STF claimsSprains, strains, dislocations, , contusions, non-specified , lacerations, punctures, and scalds (thermal, chemical, electrical)1<1 Other injuries1< Bell et al. 20086 | slip , trip , and fall PreventionResearch Supports a slip , trip , and fall Prevention Program in Healthcare Facilities Research conducted by the National Institute for Occupational Safety and Health and its collaborators [Bell et al.]
8 2008] has shown that implementating a comprehensive STF Prevention program in hospitals can lead to significant declines in STF-related work-ers compensation claims. Researchers worked with hospital staff to design, implement, and evaluate a comprehensive STF Prevention program over a 10-year period from 1996 through 2005 in three acute-care hospitals. The hospitals total STF workers compensation claims declined 59% after implemen-tating the comprehensive STF Prevention 2. slip , trip , and fall worker's compensation claim rate by time 1996 1999 Intervention phase-in 2000 2002 STF claim rate pe r 100 workersPost-intervention phase-2003 2005 Part II. Top 10 HazardsSlip, trip , and fall Prevention | 9 What is the hazard?Contaminants on the floor are the leading cause of STF incidents in healthcare facilities [Courtney et al. 2006, Bell et al. 2008]. Water, grease, and other fluids can make walking surfaces slippery. Well-documented housekeeping procedures, correct floor cleaning, proper usage of mats and signs, accessible clean-up materials, and slip -resistant shoes will help to minimize the risk of slipping (ANSI 2001).
9 Where does the hazard occur? Food services areas: kitchen, cafeteria, serving line, buffet, ice machines, freezers, dishwashers, sinks, and drains (please refer to the drainage sec-tion for additional information on page 14) (see Figures and ) Decontamination area: when wet equipment is transferred from one area to another Soap dispensers Drinking fountains Building entrances, where rain and snow are tracked insideFigure Standing water on floor in dishwashing areaFigure Water on floor caused by pipe splashing water. Contaminants on the Floor (Water, Grease, Oil, Fluid, Food)1. 10 | slip , trip , and fall PreventionPrevention StrategiesProvide and maintain a written housekeeping written housekeeping program can help ensure the quality and consistency of housekeeping proce-dures. A copy of the housekeeping program should be provided to all employees and they should know where to find additional copies. The program should describe How to immediately contact the housekeeping de-partment Where and how cleaning materials and products are stored When to use wet floor signs and barriers and where signs are stored When specific areas of the healthcare facility should be cleaned What cleaning methods are appropriate for differ-ent areas and surfacesKeep floors clean and dry.
10 Encourage workers to cover, clean, or report spills promptly. Hang or place spill pads (see Figures , , ), paper towel holders, pop-up-tent wet floor signs (see Figures , ) in convenient locations throughout the healthcare facility so employees have easy access to products to clean, cover, and highlight a spill. Advertise phone/pager numbers for housekeep-ing through emails, posters, and general aware-ness campaigns. Place water-absorbent walk-off mats where water, ice, or soap may drip onto the floor (see Figure ). Use beveled-edge, flat, and continuous mats. (For more information on mats, please refer to the section on Improper Use of Floor Mats). Provide walk-off mats, paper towel holders, trash cans, and umbrella bags near entrances and water fountains to minimize wet floors (see Figure , page 12).Figure Wall-mounted spill pads for use by employees and vistorsFigure Wall-mounted spill padsFigure Spill pads for use in building entrywaySlip, trip , and fall Prevention | 11 Mats should be large enough so that several footsteps will take place on the mat; if there is water around or beyond the mat, it means that the mat is not large enough and/or is saturated and needs to be replaced.