OSHA Long Term Care Worker Protection Program

 Describe the OSHA Ergonomic guidelines as

they apply to long term care settings.
 Identify potential ergonomic hazards in long

term care work settings.

 Discuss practical solutions to eliminate and/or

minimize ergonomic problems in the workplace.

 The practice of designing equipment and work
tasks to conform to the physical capability of the
employee;
 A means for adjusting the work environment and

work practices to prevent injuries before they

occur.
 Strives to assure safe and healthful working
conditions;
 Mandates that each employer shall provide each

employee a place of employment which is free

from recognized hazards that are causing or likely
to cause death or serious physical harm….
 Musculosketal Disorders are the
Leading Cause of Disability
 affects ½ of the nation's work force

 30% to 40% of lost work time

injuries/illnesses are related to MSD

This is second only to common cold at 40%

 Pain in the fingers, wrists, shoulders, back, or
other parts of the body:  may include a dull aching
pain,  a sharp stabbing pain, or even a burning
sensation.
 Tingling or numbness, particularly in the hands or

fingers. 
 Swelling, inflammation, or joint stiffness.
 Loss of muscle function or weakness.
 Discomfort or pain in the shoulders, neck, or
upper or lower back. 
 Extremities turning white or feeling unusually cold.
 General feeling of muscle tightness, cramping, or

discomfort.
 Clumsiness or loss of coordination. 
 Range of motion loss. 
 Discomfort when making certain movements.
OSHA recommends minimizing
manual lifting of patients/residents
in all cases and eliminating lifting
when possible.
 Provide Management Support
 Involve Employees
 Identify hazards and problems
 Implement solutions
 Response to injuries
 Provide training
 Evaluate Ergonomics Efforts
Demonstrate a commitment to reduce or eliminate
patient lifting/moving hazards:
* establish a plan
* consistent, continuous training of employees in injury prevention
* identify appropriate methods and equipment for transfer and
lifting of residents, equipment, and supplies by all staff
* assure compliance with these methods
* help every department to identify potential ergonomic hazards
* support reporting and follow-up evaluation of signs/symptoms
of back pain or other musculoskeletal injuries
• Empowering/involving all employees
* to report unsafe working conditions
* engage employees in identifying hazards
and potential solutions
* evaluate equipment
* participate in developing/updating the organization’s
Ergonomics plan/processes.
* encourage prompt reporting of any injury
Identify existing and potential hazards through
careful and on-going assessment of work tasks
and routines.
* look for duration, frequency, and magnitude of exposure
to ergonomic stressors:
- force
- repetition
- awkward postures
- vibration
- contact stress
* do this through observation, workplace walkthroughs, talking
with employees, and periodic screening surveys
 Repetitive: repeatedly making manual adjustments to
equipment.
 Awkward positions: reaching across objects/beds to lift
patients or materials; uncomfortable positions when using
computers/chairs/desks in any areas.
 Force: pushing wheelchairs/stretchers/supply
carts/cleaning equipment across elevation changes, on/off
elevators, up ramps.
 Heavy lifting: manually lifting heavy patients or equipment
alone.
 Overexertion: trying to stop a patient or object from falling
or picking up a patient or heavy equipment who has fallen.
 Multiple lifts per shift : more than 20.
 Lifting alone: limited available staff to help.
 Moving/lifting uncooperative/combative patients.
 Moving large objects: cleaning equipment,

kitchen equipment, etc.

 Moving/lifting patients that cannot support their

weight.
 Caring for overweight (bariatric) patients.
 Ineffective training of employees.
Includes implementing and monitoring administrative and
engineering controls.
* Administrative controls: provide adequate
staffing, assessment of ergonomic hazards and needs
in all work areas, provide training and monitoring.
* Engineering controls: provide appropriate moving
and lifting equipment, provide training in
safe lifting/moving and use of equipment,
keep work areas uncluttered, good lighting of
work areas, eliminate uneven floor surfaces, and
immediate clean up of spills.
 Analyze jobs in each area and work environment.
 Modify how tasks are done, change the

environment, monitor use of appropriate

equipment.
 Training in lifting, moving for employees; training

related to computer workstations/desk areas as

appropriate.
 Involve physical therapists in training program.

* www.osha.gov/desp/success_stories/ergonomics
 Assess each resident in terms of:
* level of assistance they need.
* their size and weight.
* ability/willingness to understand and cooperate
* any medical conditions that could influence the
choice of methods for lifting or repositioning.

Standardize the process for assessment of each

resident.
 Use lifting equipment when appropriate:
* Requires training of all staff that will use it.
* Availability of technical services?
* Is “charging” of the equipment necessary – must
be assigned and checked.
* Have two staff involved in using the equipment
* Provide careful and complete explanation to the
resident before using the equipment.
 Employee feet solidly planted on ground, shoulder
width.
 Place resident or object close to you – avoid

reaching across bed/distance.

 Use lift sheet, slide board, moving equipment as

appropriate.
 Two people for a lift or repositioning.
 If moving to a wheelchair or other movable device,

be certain it is locked and in a good position.

 Use of gait belt.
 Be certain the resident transfers to their strong

side.
 Should not be used to lift.
 Secure the belt on the resident, on top of a layer

of clothing.
 Keep the resident as close to the caregiver as

possible.
 Use bath boards and transfer benches, for
residents who have partial weight-bearing.
 Be aware of any potential friction between skin

and the boards/benches.

 Have grab bars and stand bar assists.
 Long handled shower heads.
 Toilet seat risers with hand rails.

 Always important to assess the patient’s ability

and comprehension of the moving technique.
 Bending to make a bed or feed a resident.
 Lifting food trays or other items above shoulder or

below knee level.

 Collecting waste.
 Pushing heavy carts.
 Bending to remove items (laundry, etc) from large

deep carts or reaching into a deep sink.

 Removing laundry from washing machines/dryers.

These may not present problems in

all circumstances.
 Involve employees in finding the solutions that will
work for your setting.
 Encourage employees to think carefully before

lifting/moving an object or a patient: what is the

safest way to do this?
 Provide appropriate lifting equipment.
 Good work practices based on education and role-

modeling is the best!

 Other simple solutions?
That could present an ergonomic challenge?
 Do not over-estimate your ability to lift/move!
 Do not over-estimate the resident’s ability – need

to assess carefully.
 If a box looks light and easy to move, be cautious!
 Avoid reaching to move a resident or object.

 Look for ergonomic hazards in every area, with

every work task.
 Many people work with computers every day.
 May sit or stand at computers.
 Evaluation checklist (OSHA Ergonomic Solutions)

can be helpful.
 Top of monitor at or just below eye level.
 Head and neck balanced and in-line with torso.
 Shoulders relaxed.
 Elbows close to body.
 Lower back supported.
 Wrists and hands in-line with forearms.
 Adequate room for keyboard and mouse.
 Feet flat on floor.
 If using a computer on wheels: can height be
adjusted, room for mouse, lighting?
 A great, easy to use checklist developed by
OSHA.

 It is in your handouts!

 Check the website (www.osha.gov) for more

information!
Careful, comprehensive management of
employees with injuries:
* Accurate and prompt reporting of injuries.
* Early treatment of injured employees.
* “light duty” or “no lifting” work restrictions
during recovery periods.
* Monitoring of injured employees to
identify when they are ready to return
to full duty.
 Critically important to an ergonomic safety
program:
* For all employees who may encounter a hazard.
* Consistent and current.
* Provide opportunity for employees to
practice and demonstrate safe techniques.
* Review reporting of injuries.
 Occur before the employee lifts or moves or faces
any recognized ergonomic hazard.
 Review of policies and procedures.
 Include demonstrations and return

demonstrations.
 How to recognize a MSD and early recognition.
 Advantages of reporting an injury as soon as

possible.
 Critical importance of reporting any injury to a

supervisor.
OSHA requires that employers record each fatality,
injury, or illness that:
* is work related and
* is a new case, and
* meets one or more of the criteria as cited
in sections 29 CFR 1904.7 through 1904.12
of the regulations.
 Thorough review of all MSD injuries.
 How was the injury managed medically?
 Return to work process – was it easy or difficult for

the employee?
 Identification of ergonomic hazards that were not

previously recognized.
 Assess outcomes of the injuries.
 Solutions – ways to prevent a reoccurrence.
 Look for industry-wide data.