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High-Risk ManualHandling of Patientsin HealthcareWorkers’ Compensation Board of B.C.Patients in HC cover.indd 18/29/06 12:32:17 PM

About WorkSafeBCWorkSafeBC (the Workers’ Compensation Board) is an independent provincial statutory agencygoverned by a Board of Directors. It is funded by insurance premiums paid by registered employersand by investment returns. In administering the Workers Compensation Act, WorkSafeBC remainsseparate and distinct from government; however, it is accountable to the public through governmentin its role of protecting and maintaining the overall well-being of the workers’ compensation system.WorkSafeBC was born out of a compromise between BC’s workers and employers in 1917 whereworkers gave up the right to sue their employers or fellow workers for injuries on the job in returnfor a no-fault insurance program fully paid for by employers. WorkSafeBC is committed to a safeand healthy workplace, and to providing return-to-work rehabilitation and legislated compensationbenefits to workers injured as a result of their employment.WorkSafeBC Prevention Information LineThe WorkSafeBC Prevention Information Line can answer your questions about workplace healthand safety, worker and employer responsibilities, and reporting a workplace accident or incident.The Prevention Information Line accepts anonymous calls.Phone 604 276-3100 in the Lower Mainland, or call 1 888 621-7233 (621-SAFE) toll-free inBritish Columbia.To report after-hours and weekend accidents and emergencies, call 604 273-7711 in theLower Mainland, or call 1 866 922-4357 (WCB-HELP) toll-free in British Columbia.Patients in HC cover.indd 28/29/06 12:32:19 PM

AcknowledgmentsWorkSafeBC would like to thank Barbara Purdy, MSI Prevention Program Coordinator, ProvidenceHealth Care, and Marjorie Brims, Manager Injury Prevention, Interior Health, who reviewed this bookletand contributed valuable comments and information.WorkSafeBC publicationsMany publications are available on the WorkSafeBC web site. The Occupational Health and SafetyRegulation and associated policies and guidelines, as well as excerpts and summaries of the WorkersCompensation Act, are also available on the web site: WorkSafeBC.comSome publications are also available for purchase in print:Phone:604 232-9704Toll-free phone: 1 866 319-9704Fax:604 232-9703Toll-free fax:1 888 232-9714Online ordering: WorkSafeBC.com and click on Publications; follow the links for ordering 2005, 2006 Workers’ Compensation Board of British Columbia. All rights reserved. The Workers’Compensation Board of B.C. encourages the copying, reproduction, and distribution of this documentto promote health and safety in the workplace, provided that the Workers’ Compensation Board of B.C.is acknowledged. However, no part of this publication may be copied, reproduced, or distributed forprofit or other commercial enterprise, nor may any part be incorporated into any other publication,without written permission of the Workers’ Compensation Board of B.C.2006 editionLibrary and Archives Canada Cataloguing in Publication DataMain entry under title:High-risk manual handling of patients in healthcare. -- 2005 Irregular.“Worksafe BC.”ISSN 1715-7676 High-risk manual handling of patients in healthcare1. Patents - Positioning - Safety measures. 2. Lifting and carrying - Safety measures.3. Transport of sick and wounded - Safety measures. 4. Medical personnel - Wounds and injuries- Prevention. I. Workers’ Compensation Board of British Columbia.RD100.H53610.73C2005-960213-9

ContentsIntroduction .1Transfers and Repositions .3Fore/aft lift . 4Chicken or drag lift . 5Cradle lift or basket lift . 6Three-person lift . 7Belt lift (raising a fallen patient from the floor) . 8Blanket lift . 10Two-person through arm lift or towel lift . 11One-person through arm lift (repositioning a patient in bed) . 12Australian shoulder lift (repositioning a patient in bed) . 13Pivot Transfers . 15Two-person pivot transfer . 16One-person pivot transfer (hands around neck) . 18One-person pivot transfer (hands around waist) . 19Appendix . 21Questions to consider when evaluatingpatient-handling situations . 22High-Risk Manual Handling of Patients in Healthcare- iii -

IntroductionThis guide has been written to provide information on patientmoving and handling techniques that present higher risks ofmusculoskeletal injury (MSI) to healthcare workers. Informationon safer patient-handling strategies is also reviewed.An Appendix provides readers with a series of questions to considerwhen determining whether or not proper patient-handling practices arebeing used.For further information on the process of identifying, assessing,and controlling the risks of MSI associated with patient handling,see Handle with Care: Patient Handling and the Application of theErgonomics (MSI) Requirements. This WorkSafeBC publication isintended to help health care employers, managers, and workersinterpret and apply the requirements of the Occupational Health andSafety Regulation, including factors to consider when performing apatient-handling risk assessment. A copy of Handle with Care can belocated at WorkSafeBC.com.MSI’s are injuriesor disorders of themuscles, tendons,ligaments, joints,nerves, bloodvessels, or relatedsoft tissue, includingsprains, strains, andinflammation.Types of patient-handling activitiesIn this guide, “patient handling” refers to the lifting, lowering, holding,pushing, or pulling of the patient using bodily force of the careprovider. The term “patient” is used to describe a client or resident.Patient handling can be divided into two objectives, both of which mayrequire manual lifting:1. Transferring—moving the patient from one surface to another2. Repositioning—moving the patient on the same surfaceThese objectives can be achieved by: Assisting the patient to move independently Providing minimal/moderate assistance with transfer assist devices Using mechanical liftsHigh-Risk Manual Handling of Patients in Healthcare-1-Manual lifting isdefined as liftingthe whole or largepart of the patient’sweight. Eliminating/reducing the forcesin these activities willsignificantly reduce therisk of injury.

High-risk, patient-handling practicesIt may be necessary tomanually lift patients: In life-threateningsituations Where the use ofmechanical liftingdevices is medicallycontraindicated forpatient careThe following pages show specific patient-handling practices that aresometimes used when transferring or repositioning patients in a careenvironment. For each patient lift and transfer technique, the MSIrisk factors are listed and an overall level of MSI risk (High, Moderate)is given.Examples of safer patient-handling alternatives to high-risk practices areprovided at the end of each lift or transfer technique. There are a numberof options available to the employer depending on the degree of patientdependence (such as, ceiling lift, slide sheet, or pivot disc).High-Risk Manual Handling of Patients in Healthcare-2-

Transfers andRepositionsThis section describes nine transfers andrepositioning techniques: Fore/aft lift Chicken or drag lift Cradle lift or basket lift Three-person lift Belt lift (raising a fallen patient from the floor) Blanket lift Two-person through arm lift or towel lift One-person through arm lift (repositioning a patientin bed) Australian shoulder lift (repositioning a patient in bed)

Fore/aft liftThis two-person lift has been used to move a patientfrom bed to chair or vice versa.Risk factorsLifting force Risk level: highThe rear-facing worker applies most of the liftingforce, taking most of the patient’s weight.The patient is supported at a distance away fromthe base of both workers’ spines. This long levereffect places high levels of compression force on theworkers’ spinal discs and associated support tissues.Awkward postures The Fore/aft lift is stillroutinely used byEmergency MedicalServices personnel.However, this shouldonly occur in situationsof last resort, wherean assessment hasdetermined that thereis no alternative tothe manual lifting ofpatients. The front-facing worker is required to adopt an awkward posture,flexing forward at the waist while lifting, supporting, and carrying thepatient's legs.In the final stages of the transfer, both workers may adopt awkwardpostures—twisting and lateral bending at the waist—while positioningthe patient on the bed.Safer patient-handling alternatives A mechanical lift provides a safer method of transfer.High-Risk Manual Handling of Patients in Healthcare-4-

Chicken or drag liftThe chicken lift has been used for transferring a patientfrom bed to chair, lifting a patient up from the floor afterfalling, and repositioning the patient. Variations on thismethod employ the use of transfer belts, which are usedto bind the patient’s knees and thighs together to act as"handles." The use of belts does not eliminate or reduce theMSI risk factors.Risk factorsLifting force The load is taken at a distance from the spine.Risk level: highAwkward postures The worker has to forward flex and rotate the spine while supportingthe weight of the patient.The workers lift the patient by placing their arms under theaxilla of the patient.This type of lifting can result in patient pain and shoulder dislocation.Accordingly, patients may react and strike backagainst the workers.Safer patient-handling alternatives Transfer from bed to chairA sit/stand mechanical lift can be used if the patient has sittingbalance, can hold onto the lift handles, position and hold their feet onthe lift footplate, and follow instructions. If the patient cannot do allof the above, then a mechanical lift should be used. Reposition in bedA low-friction slide sheet, or a mechanical lift and repositioning sling,can be used to reposition a patient in the bed.High-Risk Manual Handling of Patients in Healthcare-5-

Cradle lift or basket liftThis high-risk technique has been used to transfer a patientfrom bed to chair or reposition a patient in a chair. Twoworkers lift the patient by placing their hands under thethighs and axilla of the patient or clasping hands behind thepatient’s back.There are variations of this lift that involve placing a transferbelt around the waist and/or thighs of the patient. (The use ofthe transfer belt does not eliminate or reduce the risk of MSI.)Risk factorsLifting force Risk level: high The weight of the patient is at a distance from the worker’sspine, resulting in high levels of force being supported bythe worker’s spinal discs.Workers must lift, hold, and carry the patient.Awkward postures This lift requires the workers to flex and bend sideways at the waistwhile supporting the patient.At the end of the lift, the workers have to twist at the waist.Safer patient-handling alternativesA sit/stand lift can be used if the patient has sitting balance, can holdon to the handles, position and hold their feet on the lift foot plate, andfollow instructions. If the patient cannot do all of the above, then amechanical lift should be used.High-Risk Manual Handling of Patients in Healthcare-6-

Three-person liftThe three-person lift has been used to transfer apatient from bed to stretcher. This lift requiresdistributing the patient’s weight between threeworkers.Risk factorsLifting force Reaching under the patient results in the loadbeing supported at a distance from the spinesof the workers, placing excessive strain onRiskthe workers’ spinal discs, shoulders, andupper backs.The patient may also be in pain and therefore more likely to reactduring the lift. This changes the patient’s centre of gravity, thusincreasing the risk.Most of the load is taken by one or two workers.Awkward posturesThis lift requires workers to bend forward at the waist while holdinga load.Safer patient-handling alternativesThere are many types of sliding boards/sheets that are designed to reducethe force during the lateral transfer from one surface to another. Formore information on slide sheets, see Transfer Assist Devices for the SafeHandling of Patients at WorkSafeBC.com.High-Risk Manual Handling of Patients in Healthcare-7-level: high

Belt lift(raising a fallen patient from the floor)The transfer belt lift is a two-person lift used for raising a fallenpatient from the floor. The lift involves the use of interlockingtransfer belts. One belt is put around the patient, and the other isattached to the belt around the patient to act as a long lever armfor the worker to pull on.When a patient falls to the floor, workers should not feelcompelled to move a patient quickly, unless there is a lifethreatening situation. Workers should make the patientcomfortable and call for medical assistance.Risk factorsStanding workerRisk level: highLifting force The worker has to apply force primarily by pulling on thetransfer belt.The worker has a degree of lateral (sideways) bending atthe waist.Awkward postures Pulling on the transfer belt results in the worker’s shoulder adoptingan awkward abducted posture.Lateral bending increases in the course of pulling the patient to anupright posture. This twisting under load increases the risk of injuryto the worker’s lower back.Squatting workerLifting force The worker is required to support the patient during the raisingprocess.The worker should act as a guide, though there is a temptation toassist by trying to lift the patient.High-Risk Manual Handling of Patients in Healthcare-8-

Safer patient-handling alternatives If the patient can assist enough to get into a four-point kneelingposition, then a chair can be used to provide a support for the patientas they assist themselves to their feet or to a sitting position. Thisshould require minimal assistance from the workers. Care workerscan be trained in methods of assisting patients to a sitting or standingposture using a chair as a support device for the patient. This,however, requires specific training in this technique. This techniquemay be an alternative in a domestic environment.If the patient cannot or will not assist, then a mechanical lift shouldbe used.High-Risk Manual Handling of Patients in Healthcare-9-

Blanket liftThe blanket lift has been used to lift patientswhen physicians indicate that there are medicalcontraindications for a mechanical lift.A blanket is placed under the patient. Then, four to sixworkers each grab one corner of the blanket, and liftthe blanket with the patient onto a stretcher or bed.Risk factorsLifting forceRisk level: moderateThe force required to lift the patient places a high levelof stress on the muscles and soft tissues of the wrist,shoulders, and back.Awkward posturesThe workers must bend forward at the waist while lifting.Safer patient-handling alternativesThis technique is notwithout risk, both to theworker and the patient,and should only beused as a technique oflast resort.If the patient cannot stand up with minimal assistance, then a mechanicallift with a supine support frame that has the ability to go to the floorshould be used.In an attempt to minimize the risk of injury, workers may place thepatient on a stretcher on the floor and then lift the stretcher. Thistechnique will not eliminate the lifting force required during lift.High-Risk Manual Handling of Patients in Healthcare- 10 -

Two-person through arm lift or towel liftThis technique has been used to reposition the patient in bed orlift the patient from one surface to another. It involves placinga towel under the thighs of the patient to act as a sling support.Transfer belts are sometimes used as an additional handle, eventhough they should not be used this way.Risk factorsLifting forceThe workers lift the patient manually by applying force throughthe patient’s arms, shoulders, and under the thighs.Awkward posturesThe worker lifts with an extended reach, with lower back flexedat the waist.Safer patient-handling alternatives Risk level: highPatient able to assistIf able, the patient should be encouraged to assist in turning andmoving in bed. Transfer assist devices (such as, slider [repositioning]sheets, bed handles, bed ladders) can be used to assist such patients.Patient not able to assist (dependant)In order to minimize the risk of injury when repositioning, dependentpatients require a transfer assist device, such as a low-friction slidesheet, mechanical lift, or roller board.High-Risk Manual Handling of Patients in Healthcare- 11 -Soaker (incontinence)pads are still routinelyused for repositioningpatients in bed.Soaker pads are notdesigned for useas transfer devices.Even with good bodymechanics, there is stilla high degree of forceneeded to completethe movement. Assuch, their use doesnot reduce the riskof injury to workerscompared to that oflow-friction transferassist devices.

One-person through arm lift(repositioning a patient in bed)The through arm lift (one-person) has been used to reposition apatient in bed, or transfer a patient from bed to chair.Risk factorsLifting forceBecause the worker cannot use leg muscles to perform aneffective weight shift, the application of force is generated by a“shrugging” of the worker’s shoulders.Awkward posturesThe worker’s lower back can be in a forward flexed andtwisted posture.Safer patient-handling alternatives Risk level: high Patient able to assistIf able, the patient should be encouraged to assist in turningand moving in bed. Transfer assist devices (such as, slider[repositioning] sheets, bed handles, bed ladders) can beused to assist such patients.Patient not able to assist (dependant)In order to minimize the risk of injury when repositioning, dependentpatients require a transfer assist device, such as a low-friction slidesheet, mechanical lift, or roller board.High-Risk Manual Handling of Patients in Healthcare- 12 -

Australian shoulder lift(repositioning a patient in bed)The shoulder lift has been used to reposition apatient in bed or to transfer a patient from bed tochair. Workers link one arm around the waist orunder the thighs of the patient and support thepatient’s trunk by placing their shoulder under thepatient’s axilla. The worker’s free arm is placed onthe bed for support.Risk factorsLifting force Each of two workers must lift the patient byusing one shoulder as the support for the load.RiskThis puts a high level of force through theshoulder of the patient and the lower backs of the workers.Elbows and wrists are also exposed to high levels of lifting force.The load is supported at a distance from the base of theworkers’ spines.Awkward postures The workers must adopt a forward flexed position at the beginningand end of the lift.The workers can twist their lower backs while supporting the load ofthe patient.The arm that supports the unloaded shoulder/arm of the worker (thestrut arm) twists as the patient is moved up in bed.The workers are supporting and carrying an unbalanced load on oneside of their trunk.Safer patient-handling alternativesSafer patient-handling alternatives are the same as those on page 12.High-Risk Manual Handling of Patients in Healthcare- 13 -level: high

Pivot

Types of patient-handling activities In this guide, “patient handling” refers to the lifting, lowering, holding, pushing, or pulling of the patient using bodily force of the care provider. The term “patient” is used to describe a client or resident. Patient handling can be divided into two objectiv

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