Ergonomics Guidelines for Nursing Homes

1. Ergonomics Guidelines for Nursing Homes Recommendations for preventing and reducing Work Related Musculoskeletal Disorders (WMSDs) Module 2

2. What this presentation covers • Identifying some problem tasks in nursing homes • Resident care (other than manual lifting and repositioning) • Housekeeping, stocking supplies • Dietary operations • Laundry operations • Recognizing practical solutions to address problem tasks See Module 1 for problems addressing manual lifting and repositioning of residents.

3. What this presentation covers Note: The recommended solutions presented in these slides are not intended to be an exhaustive list, nor are they all expected to be used in any given facility. The information represents a range of available options that a facility can consider using.

4. Introduction There are significant numbers of work-related musculoskeletal disorders (WMSDs) that occur in activities other than manual lifting and repositioning of residents in the nursing home: • Resident care(other than manual lifting and repositioning) • Housekeeping, stocking supplies • Dietary operations • Laundry operations

5. Identifying Problem Jobs/Tasks Job Assessment: • Observe employees perform task • Discuss with employees about activities and conditions that they associate with difficulties • Check injury records • Identify problems • Implement solutions/improvements

6. Resident Care Other Than Lifting and Repositioning Problems: Reaching, Leaning, Bending, Kneeling, Squatting, etc.) Caregivers may find themselves working in awkward postures when assisting residents in activities of daily living and related activities, such as Bending and reaching to make bed • showering and bathing • toileting • dressing or undressing • performing personal hygiene • feeding a resident • making a bed Bending to help with shoes

7. Resident Care Other Than Lifting and Repositioning Solution: Height-adjustable beds, bathtubs, lift bath carts, shower gurneys Adjusting equipment/ devices to waist height eliminates bending and reaching for caregivers and for those who clean tubs and make beds.

8. Resident Care Other Than Lifting and Repositioning Solution: Work Practices • Use upright, neutral working postures and proper body mechanics. Bend your legs, not your back. • Use long-handled extension tools on hand-held shower heads, wash or scrub brushes, and other items to eliminate bending, twisting, and long reaching when washing residents’ legs, feet, and trunk.  • Lower rails on beds/gurneys when feeding residents or providing other care to eliminate extended reaching. • Work with enough space to avoid awkward postures. Good posture - straight back, bent knees Bad posture - Extended reach over rail

9. Laundry Operations Problems: Lifting, Bending, Reaching, Twisting Excessive reaching, bending, and/or lifting laundry (especially heavy when wet) can cause work-related MSDs such as strains and sprains to the back or shoulder area. • collecting and sorting soiled linens • placing in washers • transferring wet linen to dryers • folding and storing on shelves or placing in carts for transport

10. Laundry Operations Solution: Side-access hampers, tilted hampers Hamper with platform under the laundry bag allows easy side access to the bag without having to lift the bag up to clear the hamper. Tilted laundry bins bring items closer and reduce awkward reaching.

11. Laundry Operations Solution: Spring-loaded carts Spring-loaded carts automatically bring linen within easy reach and help reduce the amount of bending over and pulling on linen that the worker has to do. Carts should have wheel locks. Heavy carts should have brakes. Cart floor rises as weight of linens decreases

12. Laundry Operations Solution: Front-Loading Washers and Dryers Front-loading washers and dryers with bottom of door opening between hip and elbow height For deep tubs, use a rake with a long or extendable handle to pull linen closer to the door opening.

13. Laundry Operations Solution: Work Practices • Load and unload washers and dryers in small amounts. • Avoid lifting and twisting when handling loads. Face the load and keep the items as close to the body as possible. • If you must use top loading washers: handle small loads of laundry, handle only a few items at a time, and brace your body against the front of the machine when lifting. • Use easy-to-move carts on wheels rather than picking up baskets of soiled linen or wet laundry. • Avoid lifting/reaching or working aboveshoulder height.

14. Dietary Operations Problems: Lifting, Reaching, Bending • Frequent elevated and extended reaches for supplies or heavy containers • Bending and unpacking cases from the floor • Lifting heavy food supplies to and from storage areas • Lifting and dispensing large containers of soup, food • Lifting food trays above shoulder level or below knee level

15. Dietary Operations Solution: Redesign or reposition Redesigning or repositioning tasks eliminates extended and elevated reaching, and allows elbows to remain close to the body (e.g., turn boxes over on side to allow for easier access). Kitchen worker using elevated reach Box placed on side allows for less reaching.

16. Dietary Operations Solution: Height-adjustable countertops, work stands Work at a height appropriate for the task being performed to keep elbows close to the body and thus reduce reaching.   • Height-adjustable countertops • Step stool or work stand to avoid reaching above shoulders Work station with adjustable feet that raise/lower work surface to fit worker. Working at appropriate height

17. Dietary Operations Solution: Kettle, pot, and skillet tilts Anti-fatigue mats or insoles or shock-absorbing floors to minimize back and leg strain   Kettle, pot, and skillet tilts allow for easy dispensing of foods, as well as for cleaning. This eliminates the need for lifting.

18. Housekeeping Problems: Lifting, Reaching, Pushing/Pulling, Bending, Kneeling The housekeeping staff performs many tasks that may result in forceful exertion, repetition, and awkward postures: • Mopping floors • Dusting, sweeping • Cleaning whirlpools, tubs • Collecting trash • Changing light bulbs, other building maintenance work

19. Housekeeping Solution: Work Practices • When mopping, alternate mopping styles frequently (e.g., push/pull, figure 8, and rocking side-to-side). Wear rubber-soled shoes in wet areas to prevent slipping. • Use powered devices over manual equipment (e.g., vacuum instead of broom) for moderate-to-long duration use. • Use chemical cleaners and abrasive sponges to minimize scrubbing force (may need to ventilate rooms when chemicals are used). • Use kneepads when kneeling.

20. Housekeeping (Continued) Solution: Work Practices • Use extension handles, step stools, or ladders for overhead jobs. When dusting overhead, use an extender. • Avoid lifting heavy buckets, e.g., lifting a large, full bucket from a sink. Use a hose or similar device to fill wheeled buckets with water. • Use carts to transport supplies, or carry only small quantities and weights of supplies. Instead of lifting a large full bucket (left), fill a wheeled bucket (below). • For cleaning small objects in a deep sink, place a plastic basin or other object in bottom of deep sink to raise the work surface.

21. Carts, Other Mobile Equipment:Design and Maintenance Issues Carts: • moving • food trays • cleaning supplies • equipment, tools • laundry, linens • dispensing medications Cart to transport cleaning supplies, tools, etc. Food tray cart Other equipment, such as: • beds, gurneys • wheel chairs • mobile medical equipment • large wheeled containers for cleaning Mobile medical equipment Medication dispenser

22. Carts, Other Mobile Equipment:Design and Maintenance Issues Problems: Holding, pushing, or handling equipment can cause forceful exertions or awkward body postures. Some of the ways equipment can cause problems include: • Jammed or worn wheels, which make it harder to move and steer • Faulty brakes, which cause equipment to shift • Handles on beds, carts, or other equipment, which are either the wrong size or placed at an inappropriate height • High or heavy medical, food, or linen carts, which require bending, reaching, or twisting to load or unload Hard to push: heavy cart, handles too high, hard to see over

23. Carts, Other Mobile Equipment:Design and Maintenance Issues Solution: • Use well maintained carts and equipment with large, low rolling, low resistance wheels for easier maneuvering, and that can roll easily over mixed flooring as well as gaps between elevators and hallways. This can decrease the force. • Carts should have full-bearing wheels of a material designed for the floor surface. • Make sure that cart or equipment is not too high or wide to see over or around. • Make sure handles are at waist height and positioned to allow neutral posture. Adjust if needed.

24. Carts, Other Mobile Equipment:Design and Maintenance Issues (Continued) Solution: • Make sure that storage or retrieval of items does not require bending too low or reaching too high or far. • Organize cleaning carts to avoid lifting and reaching over the cart. Place commonly used supplies in front. • Have scheduled systematic preventative maintenance: • Check brakes for their ability to lock and hold • Oil and adjust mechanisms to work easily • Clean or replace casters or wheelsso they roll easily and smoothly Jammed wheel, faulty brake

25. Summary In this module, you learned about the following: • Identifying some problem tasks in nursing homes • Resident care (other than manual lifting and repositioning) • Housekeeping, stocking supplies • Dietary operations • Laundry operations • Recognizing practical solutions to address problem tasks

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

27. Resources • WISHA http://www.lni.wa.gov/Safety/Topics/Ergonomics/default.asp • OSHAhttp://www.osha.gov/ergonomics/guidelines/nursinghome/index.html • NIOSH http://www.cdc.gov/niosh/topics/ergonomics/

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