1. Ergonomics Guidelines for Nursing Homes Recommendations for preventing and reducing musculoskeletal disorders (MSDs)

2. 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.

3. 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

4. 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.

5. Introduction Caring 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 care housekeeping stocking supplies dietary operations laundry operations

6. 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)

7. 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)

8. 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)

9. 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.

10. 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)

11. To Develop an Ergonomics Process  3. Identify problem jobs – Use systematic methods  4. Implement solutions –Eliminate hazards –Improve work environment (Continued)

12. 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)

13. 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

14. 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

15. 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

16. Problem Job Tasks  The next section will review some problem job tasks with risk factors and solution examples.

17. Lifting and Repositioning Residents Risk factors: Force, Awkward postures

18. 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)

19. 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)

20. Solution Exampl es Lifting devices Floor-Based Sling Lift Sit-to-Stand Lift (Continued)

21. Solution Examples Lifting devices Lateral Sliding Aid (Continued) Transfer Board Electric Bed

22. Solution Examples Ramps, Mobility devices Ambulation Assist ( Continued ) Weighing Scale with Ramp

23. 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

24. 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 gurney Electric or crank bed

25. 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)

26. 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

27. 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)

28. 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)

29. 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.

30. 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 above shoulder height. Work Practices (Continued)

31. 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

32. 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)

33. 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)

34. Solution Examples Tilting 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 )

35. 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

36. 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 )

37. 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.

38. 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

39. 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 )

40. 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 wheels so they roll easily and smoothly (Continued) Jammed wheel, faulty brake

41. 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

42. 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

43.  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

44. (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

45. Selection of Equipment and Method of Transfer Resident Assessment Example (Continued) Full body sling Two caregivers

46. Resources Guidelines for Nursing Homes –developed by the Occupational Safety and Health Administration (OSHA)

47. Resources  DOSH http://www.lni.wa.gov/Safety/Topics/Ergonomics/defau lt.asp  OSHA http://www.osha.gov/ergonomics/guidelines/nursingho me/index.html http://www.osha.gov/ergonomics/guidelines/nursingho me/index.html  NIOSH http://www.cdc.gov/niosh/topics/ergonomics/

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