Back Injury Prevention

Transcription

1 Texas Department of Insurance Division of Workers Compensation Workplace Safety Goal HS02-014C (1-08) Back Injury Prevention This program provides information on proper care of the back to help reduce the potential for back injuries in the workplace and at home. Objective The participant will understand how to care for their back by learning about body mechanics, ways to change lifestyle, the difference between a strain and sprain, some common mistakes made when lifting, and the eight steps to proper lifting. Introduction Everything we do affects our back. Unfortunately, the back is not very resilient. Once the back has been injured, it will never be as strong as it was before the injury. How many times a day do we lift, push, pull, stretch, and otherwise put a strain on our back? Prevention is the key to protecting our back from injury during these activities. Body Mechanics Body mechanics is the proper way to move and position the body for different activities in order to prevent injuries. It is important to remember that our bodies do not stop functioning when we go home from work. We need to follow the same guidelines both at work and home. The natural position of the back is an S curve. This is referred to as the neutral position. To keep the neutral position and for good posture, we need to learn to maintain a straight line, from midline of the ears - to the shoulders - to midline of the hips - to midline of the knees - to midline of the ankle. This means standing tall, pulling in our stomach, and tightening our buttocks. Think of it as a plumb line from the ears to the knees. This will keep our back in a natural S curve. Our back needs to be maintained in the neutral position when sitting, standing, sleeping, reaching, and pushing. Many of us spend a large part of our day sitting. Sitting increases weight on the spine. Slouching can place an additional pressure on the back. Some possible solutions for proper sitting might include: have a chair with maximum adjustability; maintain neutral position; move frequently (take micro breaks); and have adjustable work surfaces. If your job includes long periods of standing, you should place one foot on a footrest. This technique raises the front of the pelvis and reduces the possibility of a swayback condition. Alternate from one foot to the other frequently. Adjust your work surface height to keep from bending over while working. If your work area is a cubicle, you can adjust the desk height. If you have a regular desk, and cannot find a way to correct the height, adjust your chair to fit the desk and use a footrest. When arranging your work area or the company storage room, consider each object carefully in order to avoid reaching overhead or bending over. Think about how often the object is used as well as the weight of the object. The best lifting zone is between the shoulders and waist. Place heavy and frequently used objects near waist height to reduce bending and twisting to reach the object. Place lighter objects higher or lower. Use dollies or carts to move heavy objects rather than carrying them. Pushing an object is much better for your back than pulling it. If you push, you can see over your load and use your legs, not your back. Keep the object in front of you and stay as close to the object as possible, as this gives you more control and direction. Sleeping is very important to maintain physical and mental health. Most of us sleep between 6-8 hours per day. Even while asleep, you can injure your back if you do not maintain good back posture. To sleep properly you need to: Use a firm mattress. Avoid sleeping on your stomach. This can cause the back to sway. Place a pillow under your knees when sleeping on your back. When sleeping on your side, place a pillow between your knees and keep your knees bent. Changing Lifestyle Some simple changes to your lifestyle can help protect your back from injury. When attempting to change your lifestyle, be realistic. A little bit of change is better than none at all. Try making small changes over a period of time. Make a commitment to walk around the block everyday as opposed to running five miles. Regular exercise can help you

2 Eight Steps to Proper Lifting strengthen your stomach muscles, lose a little weight, and increase your flexibility. Cut down on your food portions rather than going on a liquid or strict diet. Be willing to try something different - new recipes, new sports, meditation, or low-impact aerobics. Strain or Sprain? Strain and sprain both mean something has been stretched beyond its limits. A strain refers to a muscle. When a muscle is strained, it has been forced to exceed its ability to work. Regular exercise can strengthen muscles and allow them to work harder longer, which is important considering muscles are the spine s workhorses. A sprain can occur in ligaments (fibrous bands connecting bones together) or in tendons (bands of tissue attaching muscles to bones). A sprained ankle is a common example of a sprained ligament. The symptoms of strains and sprains are sudden, sharp, and persistent pain at the injury site, followed by swelling. Common Lifting Mistakes Some common lifting mistakes are: Bending forward at the waist with legs straight. When you bend forward at the waist with legs straight, you require the use of the muscles in your lower back and the weight of the object being lifted will include the weight of your upper body. Using fast jerky motions. This puts stress on your lower back muscles and may cause sprains and strains. Bending and twisting when lifting forces the spine into a position of weakness and removes the natural S curve of strength from the lifting process. Handling the load too far away from the body. The back is like a lever system. The distance between the load and the fulcrum (point of support) can be considered the distance between the body and the object being lifted. Failure to plan the lift. You need to check the path of travel to be sure it is clear. Size up the load and if it is too heavy or bulky for you to lift alone, ask for help. There are eight steps to follow in doing a safe lift. They may seem very simple but if you do all of them each time you lift, your chances of an injury will be greatly diminished. When you do a lift, make sure you: 1. Size up the load - check to ensure the load is stable and balanced. Test the weight. Try moving it with your foot, if you cannot, you probably need to ask for help. 2. Plan the job - consider all possibilities. Is the path clear? What is the weight of the load? How much stress will be placed on your back? Is there traffic, a tripping hazard, a doorway to go through, or a stairway to go up or down? Avoid carrying an object that requires two hands to hold, either up or especially down, a flight of stairs. Use the elevator. Plan a rest stop, if needed. 3. Establish a base of support - use a wide, balanced stance with one foot in front of the other. Make sure you have firm footing and that your feet are a shoulders-width apart. This staggered stance gives you the stability of not falling over and being able to secure the load. 4. Bend your knees, keep your heels off of the floor and get as close to the object as possible. Always lift with your legs and not your back. 5. Get a good grip with your palms and make sure you have an adequate hold on the object. Be certain you will be able to maintain a hold on the object without having to adjust your grip later. You can use gloves to help maintain an adequate grip, but don t rely on gloves because they can de-sensitize the fingers making you unable to feel the object. 6. Lift gradually with your legs without using jerky motions. By using your leg strength, your chance of lower back injury is greatly reduced. 7. Keep the load close to prevent arching your lower back. As you begin the lift, tighten your stomach muscles and keep your head and shoulders up. The closer the load is to your spine, the less force will be placed on your back. 8. Pivot - don t twist. Move your feet in the direction of the lift. This will eliminate the need to twist at the waist. Summary You cannot always avoid lifting, but it is important to know your body s limitations and how to use proper techniques for protecting your back against strains and sprains. The best

3 way to prevent back injuries is to develop good health habits. Learn to use good body mechanics, including standing, sitting, pushing, pulling, and sleeping. Make some changes in your lifestyle, such as healthy eating habits and exercise regularly. Avoid common lifting mistakes and use proper lifting procedures. Review 1. Body mechanics is the proper way to move and position the body for different activities to prevent injuries. True/False 2. When storing objects, store the heaviest objects on the top shelf. True/False 3. It is important to sleep on a firm mattress. True/False 4. Sitting in the correct posture increases weight on the spine more than standing. True/False 5. The back is very resilient and repairs itself quickly. True/False Answers 1. True 2. False (near waist height) 3. True 4. True 5. False (once injured, it will not be as strong) Resources The Texas Department of Insurance, Division of Workers Compensation (TDI, DWC) Resource Center offers a workers health and safety video tape library. Call (512) for more information or visit our web site at http: // Disclaimer: Information contained in this training program is considered accurate at time of publication. The Texas Department of Insurance, Division of Workers Compensation (TDI, DWC) resourcecenter@tdi.state.tx.us or call for more information. Safety Violations Hotline safetyhotline@tdi.state.tx.us

4 Workplace Athletics Proper Lifting Techniques According to the Bureau of Labor Statistics (BLS), more than one million workers experience back injuries each year. One fourth of all workers compensation indemnity claims are a result of back injuries. Low back pain is one of the most common reason that people miss work, second only to the common cold. In America, we spend more than $100 billion annually in medical bills, disability and lost productivity at work from back injuries and illnesses. More importantly, this problem causes unnecessary discomfort and pain to workers which can have a devastating effect on their lifestyle and ability to work. A BLS survey shows that 75% of back injuries occurred while performing lifting tasks, which underscores the importance of reducing back injuries caused by lifting. Safety First Work Smart Always warm-up your back and legs before performing any lifting task! We are ALL athletes in life, so we need to warm-up our body to improve performance and to reduce risk of injury. It s important to prepare your body for work. Low Back Rotation Stretch - Stand with hands on hips. Stabilizing the hips and legs, gently roll your upper body forward, right, backward, and left to stretch your lower back. Perform 5 slow circles gradually expanding the circle each time. Repeat in the opposite direction. Hamstring & Achilles Stretch - Position your body with one leg forward and the toes of that foot raised up. Keep your back straight while you bend forward at the waist. You should feel a stretch in the back of your thigh and knee. Then shift your weight onto your forward leg and bend knee, keep the back leg straight and heel on floor. Hold each stretch for 20 seconds. Perform each stretch 2 times for each leg. Safety FIRST USE PROPER LIFTING TECHNIQUE Before You Lift PLAN AHEAD Know what you are lifting and how you will lift it. Be aware ofthe weight ofthe object. Determine whether or not it s safe tolift onyour own. Make sure the work area is flat, dry and clear of debris. CHECK YOUR PATHWAY Make sure the lift pathway is clear. Remove any tripping hazards or debris. Check for any wet or slick surfaces. USE ERGONOMIC EQUIPMENT Use lift assists, forklift, dolly, cart, hand truck or hoist. Make sure you are trained before using the equipment. GET HELP WHEN NEEDED When lifting awkward or heavy loads, utilize a two person lift. Make sure you lift at the same time and keep the load level. WEAR PROPER PPE Wear proper required protective shoes and gloves. Ergonomics Plus, Inc Ergo-Plus.com

5 Workplace Athletics Proper Lifting Techniques PROPER LIFTING WARM-UP POWER ZONE Safety FIRST GET HELP LIFT ASSISTS PLAN AHEAD Lifting Do s and Don ts DO Know or test the object weight. Use ergonomic lift assists when possible. Plan the lift and clear your path. Get help for heavy or awkward loads. Keep the object in the power zone. Use a wide stance for balance. Use your legs to lift. Pivot your feet to avoid twisting. DON T Don t hold your breath. Don t bend or twist at the waist. Don t use a partial grip (1-2 fingers). Don t obstruct your vision when carrying. Don t jerk or lift quickly. Don t pinch you fingers or toes. Don t pull a load if you can push it. Don t forget to wear proper PPE. Basic Diagonal Lifting Technique 1. Get as close to the object as possible. 2. Use a wide stance with one foot forward and to the side of the object for good balance. 3. Keep your back straight, push your buttocks out, and use your legs and hips to lower yourself down to the object. 4. Slide the object as close to you as possible. 5. Put the hand (same side of your body as the forward foot) on the side of the object furthest from you. 6. Use this basic lifting technique for small objects when you can straddle the load and use a wide stance. 7. Put the other hand on the side of the object closest to you. Your hands should be on opposite corners. 8. Grasp the object firmly with both hands. 9. Prepare for the lift, tighten your core muscles, look forward and upward, keep a straight and strong back. 10. Lift slowly and follow your head and shoulders. Hold the load close to your body. Lift by extending your legs with your back straight, and breathe out as you lift. Ergonomics Plus, Inc Ergo-Plus.com

6 Texas Department of Insurance Division of Workers Compensation Safety Education and Training Programs Back Injury Prevention Techniques For Reducing Back Injuries In the Healthcare Industry HS96-093C (3-08) Goal This program provides information on proper patient handling techniques to help reduce the potential for back injuries to healthcare workers. Objectives The participant will learn about lifting devices and their uses, demonstrate safe lifting techniques for moving or repositioning patients, and will know what to do when a patient falls. Introduction Lifting and moving patients is a large part of the job performed by occupational/physical therapists, nurses, nursing aides, orderlies, and attendants. These workers suffer one of the highest back injury rates in the nation, second only to construction workers. The 2002 rate for injuries that caused employees to take days away from work, be placed on restricted duty or transferred to other jobs (DART rate) was 4.1 for hospitals. The DART rate for home healthcare professionals was 3.1 and for nursing and personal care facilities According to the California Compensation Insurance Fund, Workers Compensation claims involving back strain can cost $4,000. The average back injury case costs $25,000. The more serious cases requiring surgery can cost $85,000. Based on the above figures, back injuries among Healthcare Professionals could total billions in workers compensation claims. This will not be the final cost of these injuries. The indirect costs of these injuries can be at least four times the direct costs. When lifting and moving patients, there are four factors which can lead to back injuries or aggravation of back injuries: 1. physical demands of work; 2. equipment; 3. work practices; and 4. personal factors. The physical demands of work for healthcare workers include forceful exertions, awkward position or postures, and repetition. The use of lifting devices/equipment (holding, pushing, or handling) can cause forceful exertions or awkward body postures. Some work practice issues could include: lifting or moving patients without help (equipment or team lifting); using poor body mechanics; and performing unaccustomed physical work (standing for long periods, working more than one shift, covering for other employees). Home and recreational activities can also lead to or aggravate back injuries (sports and home repair). Individuals who are not in good physical condition tend to be more susceptible to back injuries. The most successful approach to prevent back injuries to healthcare professionals is to develop a plan to address the specific lifting and moving requirements of the workers and the types of equipment they use. The following elements should be included in the plan: 1. assessment of patients; 2. assist equipment and devices; 3. safe work practices; 4. lift teams; and 5. comprehensive training. Lifting Equipment/Devices Lifting aids are designed to reduce the biomechanical stress exerted on the worker while lifting and transporting a patient. Some common lifting aids are: draw or transfer sheets; slide boards; transfer belts or gait belts; figure 1 trapeze bars; and mechanical lifts (total-body, stand-assist, compact). Draw or transfer sheets are heavy cotton bed linens which are placed under a patient (see figure 1). They are used to slide patients between horizontal surfaces or for repositioning in beds or chairs. Slippery sheets or large plastic bags can also be used in place of draw or transfer sheets. 1 Bureau of Labor Statistics, 2002

7 Slide boards are thin, lightweight plastic boards that are bed length. The patient is slid or rolled onto the board and the board is then pushed or pulled to complete the transfer. Gait belts are canvas belts without handles. They are used to support patients being moved. The belts are fastened securely around the patient s waist and the healthcare provider grips the belt. Transfer belts are used like the gait belts but transfer belts are wider and have padded handles on each side. This allows better control in case of a fall (see figure 2). figure 2 A trapeze bar is a triangle-shaped device that is suspended above the bed. Patients who are able can use the trapeze bar to position themselves in bed, or to assist when being transferred (see figure 3). A trapeze bar should always be adjusted so that the patient s elbows are slightly bent while grasping the bar. figure 3 There are various types of mechanical equipment. Totalbody lifts are used to move and lift patients who are fully dependent. Stand-assist lifts are used for moving patients to and from chairs, toilets, beds, or into and out of showers. Compact lifts are a smaller version of total-body or stand-assist lifts. These lifts are convenient to use for home care (see figure 4). Ambulation lifts are used to support a patient during walking. The patient pushes the lift along as they walk. A strap across the back prevents the patient from falling backward. Techniques figure 4 Healthcare workers must have comprehensive classroom, demonstrations, and hands-on training in safe lifting methods, as well as the proper use of any mechanical lifting devices used in the facility. When lifting or transferring a patient, remember to: use your leg muscles, not your back; bend your knees, not your waist; maintain a neutral back posture; and have someone help you whenever possible. The following techniques will help ensure your back s safety, the safety of your patients, and should be part of safe work practices. Turning Patient in Bed, With or Without a Draw Sheet position the bed at thigh level; lower the bed rail; place your knee on the bed; cross the patient s arms over the chest and cross the legs; and with one hand on the patient s shoulder and one on the hip, roll the patient toward you. Reposition Patient in Bed Using a Draw Sheet Requires Two Workers position one worker on each side of the patient; adjust the bed height to waist level of the shortest worker; lay the bed flat; bend your knees and point one foot in the direction of the move; each worker grasps the draw sheet with both hands; and lift and move in unison. Bed to Gurney Transfers get a partner to help if possible; place a slide board or plastic bag under the draw sheet to slide the patient more easily; position the bed and gurney next to each other and lock wheels in place; adjust bed and gurney to thigh level; get close to the patient by placing your knee on the gurney or by getting on the gurney; and slowly and gently slide the patient onto the gurney. When transferring a patient by yourself using this method, alternate between sliding the legs and torso. Bed to Wheelchair Transfers use a transfer belt, if possible; figure 5 adjust the bed to its lowest height; position the wheelchair at the head of the bed and lock the wheels; bend your knees and spread your feet a shoulder width apart; help the patient sit up on the edge of the bed by placing one of your hands under the neck and shoulder blades, and the other under the knees;

8 with both hands, grasp the patient around the waist or grasp the transfer belt; brace your knees against the patient s knees to help the patient stand up and lock their knees; rock the patient to a standing position (the patient can help by pushing down on the bed with their arms as you rock forward); and bend your knees and move your feet to turn and lower the patient into the chair (have the patient reach for the chair arms for support). Wheelchair to Table or Bed Transfers adjust the table or bed height to the patient s hip level; position wheelchair close to the table or bed and lock wheels; bend your knees and wrap your arms around the patient s waist, or grasp the transfer belt with both hands; lift the patient to a standing position, (the patient can help by pushing down on the arms of the chair); sit the patient on the edge of the table or bed; help the patient lay down on the table or bed; and use a draw sheet to comfortably reposition the patient. Assisting Falling Patients don t try to catch the patient or prevent the fall; try to slow the fall by lowering the patient to the floor (try to maintain a neutral body posture); protect the patient s head as much as possible as you help them gently to the floor; and get help to lift the patient from the floor. Using proper handling techniques will help protect the back of healthcare professionals and ensure the safety of the patients. Review 1. When transferring a patient from a bed to a wheelchair, a mechanical lift should be used. T F 2. When transferring a patient from a bed to a gurney, a slide board or plastic bag should be used. T F 3. A draw sheet should be used when repositioning a patient in a bed. T F 4. Try to catch the patient if they are falling. T F 5. Healthcare workers do not need training to learn to use mechanical lifting devices. T F 1. T 2. T 3. T 4. F 5. F Summary The following points are important in preventing back injuries during patient transfers: communicate the plan of action to the patient and other workers to ensure that the transfer will be smooth and without sudden, unexpected moves; before beginning a transfer, remove any obstacles, and correctly position all required equipment and furniture, and lock wheels; maintain eye contact and communication with the patient; be alert for trouble signs; always request assistance before attempting a transfer; and record any transfer problems on the patient s chart to alert workers on other shifts; also note the need for special equipment and devices. The Texas Department of Insurance, Division of Workers Compensation (TDI, DWC) resourcecenter@tdi.state.tx.us or call for more information. Resources The Texas Department of Insurance, Division of Workers Compensation (TDI, DWC) Resource Center offers a workers health and safety video tape library. Call (512) for more information or visit our web site at http: // Disclaimer: Information contained in this training program is considered accurate at time of publication. Safety Violations Hotline safetyhotline@tdi.state.tx.us