Carol Fronczek
The National Institute for Occupational Safety and Health (NIOSH) has lift guidelines, where employees should not lift anything that exceeds 35 pounds, or 58 pounds “push or pull.” But unless a facility has an absolute zero lift policy, it would have an extremely difficult time meeting this requirement, according to Carol Fronczek, ARM, vice president for loss control services with the Workers’ Compensation Trust (the Trust) in Wallingford, Conn.
NIOSH acknowledges that the 35-pound limit might not always adequately protect health care workers. Even if the weight is below this threshold, workers may still need assistive devices.
A certified nurse assistant working at a long term care center can lift up to a ton per day, Fronczek says. Lifting, transferring, boosting, and repositioning all contribute to the patient-handling exposure.
The back, shoulder, and knee pain workers experience doesn’t just flare up overnight—these injuries are sustained after years of wear and tear, says Brian Downs, vice president of quality and provider relations with the Trust. “It’s not necessarily a specific event…it really comes down to the straw that broke the
camel’s back after years of repetitive microtraumas of pushing, pulling, and lifting.”
Aging of the population has exacerbated these issues, he says. It’s not just about caring for larger numbers of elderly; the workforce itself in nursing and assisted living centers is getting older as well. Women between the ages of 45 and 50 represent the average worker in a long term care center. These are the individuals whose bodies become so compromised, eventually they become at high risk of experiencing that debilitating injury, Fronczek says. Although patient-handling injuries are most often associated with nursing centers, assisted living facilities (ALFs) are also seeing a rise in workplace-related injuries, mainly because patients are staying longer. They are less ambulatory than in the past and need more hands-on care as they extend their time in ALFs, Fronczek says.

Feds, States Address Safe Patient Handling

Underutilization of mechanical equipment is a key contributing factor to workplace injuries, experts say. Federal and state laws and guidelines do address this issue, but in varying degrees.

According to the American Nurses Association (ANA), 11 states (California, Illinois, Maryland, Minnesota, Missouri, New Jersey, New York, Ohio, Rhode Island, Texas, and Washington) have safe patient-handling laws or regulations in place, 10 of which call on health care facilities to enact comprehensive measures “in which there is established policy, guidelines for securing appropriate equipment and training, collection of data, and evaluation.”

In the state of Texas, for example, the safe patient-handling law has fairly stringent standards, and the language has the force of law.

In states where no such laws exist, there are higher rates of patient handling-related injuries, Fronczek says.

At the federal level, the Occupational Safety and Health Association (OSHA) has no standard specific to patient handling, although it does have complete authority to cite or fine a facility for unsafe work practices.

The Occupational Safety and Health Act of 1970 says that employers are required to “furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

All employers have to comply with this law’s occupational safety and health standards, as well as all employees, when applicable.

Lyn Bentley, vice president of quality and regulatory affairs at the American Health Care Association, says some of its members have adopted an assisted lift policy—meaning that workers can’t manually lift someone and transfer them. They have to use a mechanical lift.

The association primarily defers to OSHA as an information source for patient safety. The agency has “voluntary guidelines about workplace safety that specifically relate to having a protocol in place to keep workers safe and to investigate when there are problems,” she says.

OSHA has numerous guidance documents on the hazards nursing centers and personal care facilities face, along with a safe patient handling guide to prevent musculoskeletal injuries in nursing centers, where it encourages the use of mechanical lifts.

The agency also offers free and confidential safety and occupational health advice to small and medium-sized businesses through its onsite consultation program. Consultants help employers identify workplace hazards, advise on complying with OSHA standards, and assist in establishing safety and health programs.

Equipment Gathering Dust

Nevertheless, “too many facilities have beautiful pieces of equipment with slings still folded into sleeves in a closet,” Downs says. A center may take steps to purchase and train workers in the equipment, but then goes back to its old ways.

According to the ANA health and safety survey, under a third of the respondents said they used lifting and transfer equipment on a regular basis.

Most of this is due to complacency, observers posit, and the urge to take short cuts. A common perception is that the equipment takes too much time to use, and if there are no consequences from management, the equipment just stays in the closet.

While it’s true that OSHA has authority to inspect based on a complaint or for other reasons, experts say it may be difficult for inspectors to cite a facility without a safe patient-handling standard.

This is what happens when there’s no safety culture in an institution, and no ongoing monitoring and compliance program in place, Downs says. “It’s like the person who doesn’t put on their safety glasses or hard hat, or use their seatbelt. It’s human nature—safety isn’t truly realized usually until after the fact.”