Back Safety in Healthcare - Learn How to Prevent Injury

According to OSHA, costs associated with back injuries in the healthcare industry are estimated to be over 20 billion dollars annually. More than any other sector, healthcare workers report the highest number of days away for injury, citing the back as the most common reason.

Every year there are over 67,000 back injuries among healthcare workers because of their high risk of injury due to the lifting and transferring of patients. Employers are obligated to address these risks by implementing the required occupational health and safety training.
 

The Vulnerable Back
 

The back encompasses the spine, spinal chord, vertebrae, spinal discs for cushion, and over 1400 ligaments, tendons and muscles to stabilize. As a result, the back is susceptible to injuries caused by everyday tasks for healthcare workers. The most common risks of injury include:
 

• Improper lifting and carrying techniques.
• Rotating, lifting, and transferring heavy patients.
• Lifting combative and physically limited patients.
• Bathing and dressing patients.
• Carrying and handling medical equipment.
• Stopping falls or transfers from the floor.
• Standing or sitting still for long periods of time.

In addition to work specific risks, everyday habits such as poor posture, poor sleeping position and lack of exercise, flexibility and back strength can increase the risk of on-the-job injury. Improper lifting is the single most common cause of back injury. With preparation and the use of proper lifting, carrying, and placing procedures, the risk of injury is significantly reduced.

General Techniques and Best Practices

Preparation begins by first assessing a situation to decide the appropriate assist equipment, proper techniques and number of people needed to reduce the risk of injury to patients and staff. Assessments should take place every time a patient is moved as their condition, effects of medicines and fatigue can change often.
 

Patient considerations should include weight, medical condition, recent surgery, body strength, and ability to see, hear or follow instructions. When appropriate, get assistance from other staff. Confirm you and colleagues have been properly trained with supervised practice if using specialized equipment for lifting.

• Decide the destination and choose the shortest, most obstacle-free route. 
• Prop open any doors on the route.
• Eliminate hazards and obstacles, position any furniture or equipment and lock any wheels involved.
• Agree on any plan prior to any moving or lifting a patient or equipment.
• If using the patient’s assistance provide clear, simple instructions on how they can help.
• You should always face the patient during a lift or move.
• Keep your head up to maintain contact until they’re secure and in the desired location. 
• Move the patient toward, not away from you.

This is true of moving items as well. 

• Bending at the hips and knees, keep your back straight and use your legs, not your back to lift.
• Lift them close to your body with your legs shoulder width apart for stabilization all while maintaining a grasp of the patient from between your waist and shoulders.
• Shift your feet to turn instead of twisting your back
• Avoid uneven and slippery surfaces.

When placing a patient or item, set them down standing as close to the destination as possible. When lifting and lowering, bend at the legs, not at the waist. Bending at the waist will multiply the weight and apply pressure on the vertebrae in your spine.

Do not lift directly after sitting for a long time. Encourage new employees, those returning from long absences, or those performing unfamiliar physical work to gradually increase the pace or difficulty of their activities.

Try to use proper techniques for all physical labor at work and at home.

Lateral Transfer Techniques

When performing a lateral transfer or repositioning when equipment is not available, follow these steps to ensure the best protection against back injury.
 

• Move rails down on both surfaces of the bed or gurney to make it flat and without barriers.
• Arrange the surfaces as near to each other as possible and at waist height.
• Apply draw sheets or incontinence pads in concert with slide boards or plastic bags to reduce friction for a smoother move.
• Roll up draw sheets or incontinence pads with hands to gain a good grip.
• Kneel onto the surface to reduce back involvement.
• Position team members on both sides of the beds or gurneys and count down to lift simultaneously.
• Slide the patient smoothly in a joint push-pull motion.
• Do not reach across the person being moved.

Use this practice in similar fashion when repositioning the patient.

Bed to Wheelchair Transfer Techniques

When transferring a patient from a bed to a wheelchair, safeguard your back by following these steps.
 

• Lower the bed to a position as close to equal height to the wheelchair as possible and place the wheelchair near the head of the bed.
• Be sure to lock the wheels on the chair.
• When possible, secure a transfer belt to the patient.
• Assist the patient to a sitting position on the edge of the bed by placing your hands under their neck and shoulders and under their knees.
• With your feet shoulder width apart, bend your knees and use both hands to grasp the patient around the waist or transfer belt.
• Prop your knees against the patient’s knees to help them stand up and lock their legs in place.
• If able, the patient may assist by using their arms to push off from the bed.
• Bend your knees and move your feet to turn and lower the patient into the wheelchair.
• Again, if they are able, the patient may help by placing their hands on the armrests for support.

Wheelchair to Bed Transfer Techniques
 

When transferring a patient from a wheelchair to a bed, safeguard your back by following these steps.
 

• Move the wheelchair close to the bed and lock the wheels.
• Position the bed to hip level of the patient.
• When possible, secure a transfer belt to the patient.
• Use the same method to move the patient back to a sitting position on the edge of the bed.
• Help lower the patient to lie down and use a draw sheet to comfortably position them.

Back Injury Prevention: Falls
 

It is always the goal to prevent falls from happening. Review patient assessments and watch for signs of weakness to prevent falls. If a patient starts to fall, you want to protect their head and as gently as possible guide them slowly to the floor while attempting to maintain a neutral posture.  Trying to stop the fall is a very likely way to get injured. If a patient has fallen, get help to lift the patient from the floor and when medically appropriate, use a mechanical assist device.
 

Back Injury Prevention:

Posture, Sleep and Ergonomics

Posture
 

Injuries can occur from sitting or standing for long periods of time with poor posture. Slouching or twisting at the waist puts pressure on back ligaments instead of muscles. The ligaments stretch and strain while putting pressure on vertebrae. A neutral posture is achieved when muscles and joints are resting and relaxed, placing minimal stress on body parts.

To keep a neutral posture and reduce pain while standing, always do the following:

• Keep the spine aligned and shoulders back.
• Avoid slouching.
• Shift weight from one leg to another when standing for long periods.

To maintain correct neutral sitting posture and reduce pain you should:

• Refrain from protruding the head in front of the body.
• Keep shoulders back and relaxed, not hunched.
• Keep forearms and thighs parallel to the floor.
• Adjust the back of your chair for support.
• Place a pillow behind the back for lumbar support.
• Sit at the back of the chair instead of the front edge.

Sleep

The best sleep position is on the back.  It evenly distributes weight across the body and reduces pressure points. Side sleepers should alternate sides to decrease pressure points and place a pillow between the knees to align the spine. Avoid sleeping on the stomach as it puts pressure on the spine and places the neck in an unnatural position. When sleeping on a soft mattress, place plywood between the mattress and box spring for better support. Follow recommended guidelines for turning and replacing your mattress so that you are not making your back vulnerable while you sleep.
 

Ergonomics

There are simple ways to structure work areas to help prevent back injuries. Before beginning work tasks, take time to identify activities that create potential back strain or injury and adjust the worksite for them.

• Identify hazards, work practices, equipment and other risk factors and report them to management.
• Make suggestions to supervisors about reducing hazards.
• When possible, adjust chairs, beds, and other surfaces to keep work between waist and shoulder height.
• Use a lumbar supporting chair, anti-fatigue floor mats and footrests to reduce injuries.
• Avoid lifting from the floor or lifting higher than your shoulders without proper equipment.
   

Back Injury Relief

Workers who are suffering from acute back pain should seek medical attention.

However if you have sustained a minor back injury that does not need medical care you can use or do the following to alleviate stiffness and soreness.

• Take non-steroidal anti-inflammatories like aspirin or ibuprofen to help with pain and inflammation.
• Use ice and heat on the affected area of the back.
• Lay flat to rest the back.
• Stretch and exercise, but only as tolerated. Gentle exercise may be the most effective way to speed up recovery from lower back pain. 

 Follow some of these exercises to reduce back pain:
 

• For flexibility and to treat back spasms, bring the knees toward the chest to stretch the lower back muscles.
• Do back strengthening exercises.
• Engage in low impact activity like walking, swimming and bike riding.
• Stop stretching or exercise if you experience sharp pains.
• Wear well-cushioned, slip resistant footwear.
• Remove wallets or other objects from back pockets before sitting.
• Avoid high impact activities.
• If your back continues to give you trouble, see your doctor or consult a physician especially before beginning any exercise program or diet.
   

Conclusion

Back injury prevention training and use of proper lifting and other techniques is critical in the healthcare industry. The nature of the work makes healthcare workers especially vulnerable to injury when proper guidelines are not followed.

Proper training can help prevent injury, which in turn, reduces absenteeism, medical expenses, worker’s compensation and disability claims, turnover and operating costs. The protection and well-being of healthcare workers improves the quality of their lives and allows them to focus their attention on the well-being of the patients they serve.