Back Safety Healthcare Version #09-066 I. Introduction A. Scope of training This training program applies to healthcare employees whose job requires them to lift patients or other heavy objects. Lifting and moving patients is a large portion of the job tasks performed by healthcare workers and results in one of the highest back injury rates in the nation. Based upon recent statistics there are 67,000 back injuries each year among healthcare workers. These injuries total as much as $1.7 billion in workers compensation claims. In spite of this problem, many healthcare institutions have successfully prevented many back injuries. Lets learn how! B. Overview of training This training program will instruct employees regarding: a. Structure of the back b. Common back problems c. Proper lifting techniques d. Maintaining a healthy back. II. III. Structure of the Back The back is made up of many components. The primary components are the spine, spinal cord and muscles. i. The spine is the part of the back that supports the trunk and head. It protects the spinal cord as well as giving flexibility to the body. Vertebrae are small bones that form the spine. They are connected together by discs which act like shock absorbers. ii. The brain, along with the spinal cord, makes up the central nervous system. There are 31 pairs of nerves that extend out of the spinal cord and into the body. iii. There are approximately 400 muscles that help stabilize the spine and help with proper posture. More than 1000 tendons connect these muscles to the spine. Common Back Problems There are several injuries that can occur to the back. Injuries are often the result of years of neglect until the back becomes weak then any sudden movement or improper lifting technique can cause injury. Back pain can last a few days or even several years. Some back injuries include: i. Strains-caused by over stretching, bending and lifting incorrectly, slouching and carrying extra body weight.
1. Strains come from ligaments in the back that are continually misused by poor posture, unused muscle or being overweight. 2. Repeated or over strain can cause a herniated disc or slipped disc. This is when the jelly-like fluid in the disc leaks and puts pressure on the nerves. The loss of fluid in the disc then allows the vertebrae to rub against each other. ii. Overflexion-bending over too far which causes pressure on the discs resulting in pain and stiffness. iii. Sprains-caused by sudden movements or twisting. Sprains are usually ligament injuries because the muscles don't have time to react. Such injuries are usually the result of accidents or falls. iv. Overextension-arching backwards too far and putting all the weight of the load on the facets between the vertebrae. v. Ruptured disc-the disc is torn open and the jelly-like substance pours out. vi. Pinched nerve-problems with the alignment of the spine or a growth on the vertebrae can cause a pinched nerve that can send pain down the legs or causes numbness, tingling or pain in the arms, hands or fingers. vii. Muscle spasms-when the muscle receives too many impulses from the nerves causing it to contract beyond normal capacity. IV. Proper Lifting To minimize the possibility of back injury, employees need to practice safe and correct lifting techniques. The following techniques should be utilized when lifting. We will first discuss general safe lifting techniques for any workplace lifting, then we will apply those techniques specifically to the lifting of patients: A. General lifting guidelines i. Plan ahead Before lifting an object, know where it will be placed. The path should be clear of any obstacles. This will help prevent any awkward movements while carrying the load. If lifting with another person, agree on the plan before hand. ii. Bend at the knees and keep the back straight. Focus on keeping the spine straight to shift most of the weight off the back and onto the legs. Keep eyes up and look straight ahead. This will help keep the back straight. iii. Keep feet shoulder width apart. Having a more solid base will help provide more support. If feet are too close together, good balance will be difficult to achieve; too far apart, and movement will be reduced. When turning, move feet. Never twist your back. iv. Tighten the abdominal muscles. Keeping the abdomen tight will help the back stay in a good lifting position and help keep from straining the back.
v. Lift the object close to the body This will keep the body stabilized while lifting. When the object is too far from the body, additional stress is placed on the back. Get a firm grip on the object to help keep it balanced. vi. Lift with the legs The legs are stronger than the back. Use the strong leg muscles in your favor. When lowering the object, bend the knees and keep the back straight. B. Lifting of Patients Lifting of patients is the most strenuous activity for most healthcare workers. When lifting or moving patients or other heavy objects, always use available equipment. When using equipment it is always important that you have been properly trained on the use of that equipment. It is especially important that you have a had properly supervised practice before you use equipment to lift patients. However, the use of equipment will not always be an option. When manual lifting is necessary, please follow these guidelines. i. General patient lifting guidelines a. Communicate your plan with the patient and with co-workers that are assisting. b. Remove any obstacles and correctly position any furniture or equipment and lock the wheels. c. Always use equipment or assistance when available. ii. Lateral transfers / repositioning a. Lower the rails on both surfaces (e.g. bed and gurney) and lay both surfaces flat. b. Position surfaces as close to each other as possible. Both surfaces should be at approximately waist height. c. Use draw sheets or incontinence pads in combination with frictionreducing devices (e.g. slide boards, slippery sheets or plastic bags, etc.) d. Get a good hand-hold by rolling up draw sheets or incontinence pads. e. Kneel on the bed or gurney to avoid extended reaches and bending of the back. f. Have team members on both sides of the beds. Count down and lift at the same time. Use a smooth, coordinated push-pull motion. Do not reach across the person you are moving. g. Repositioning is done is a similar method, but the patient remains on the same bed. iii. Bed to wheelchair a. Lower the bed to its lowest positions b. Position the wheelchair at the head of the bed and lock the wheels. c. Use and attach a transfer belt when possible.
d. Help the patient sit up on the edge of the bed by placing one of your hands under their neck and shoulders and the other under the knees. e. Bend your knees and spread your feet shoulder width apart f. With both hands, grasp the patient around the waist or grasp the transfer belt. g. Brace your knees against the patient s keens to help the patient stand up and lock their knees. h. Using a gentle rocking motion, lift the patient to a standing position (the patient can help by pushing down on the bed with their arms) i. Bend your knees and move your feet to turn and lower the patient into the chair (the patient can reach for the chair arms for support) iv. Wheelchair to bed a. Adjust the bed to the patient s hip level. b. Position the wheelchair close to the bed and lock the wheels. c. Use and attach a transfer belt when possible. d. Bend your knees and wrap your arms around the patient s waist or grasp the transfer belt with both hands. e. Lift the patient to a standing position. f. Turn your feet and sit the patient on the edge of the bed. g. Help the patient lay down. h. Use a draw sheet to comfortably position the patient. v. Assisting falling patients a. Don t try to catch the patient or prevent the fall b. Try to slow the fall by lowering the patient to the floor. c. Protect the patient s head as much as possible as you help them gently to the floor. d. Get help to lift the patient from the floor. Using proper lifting and handling techniques will help protect your back and ensure the safety of the patients. V. Posture Good posture is important for a healthy back. When sitting or standing for long periods of time, posture can effect the back either positively or negatively. It is important to learn the correct way to sit and stand, things to do to support the back while sitting or standing and exercises to perform while sitting and standing. A. When sitting, keep knees at a 90 degree angle and feet flat on the floor. Slide back in the chair and sit up straight. Putting a pillow behind the lower back will help provide support. Exercise while sitting by tightening the stomach and buttock muscles and holding for 5-10 seconds. Occasionally, get up and walk around if sitting for prolonged periods.
B. Make sure when standing, to not slouch with the back bent. Keep the back straight, shifting weight from leg to leg every few seconds. Hold shoulders slightly back and keep chin, abdomen and buttocks tucked in. Standing puts less stress on the back than sitting. Shift positions frequently. Raise one foot on a stool or step when standing stationary for long periods of time. VI. VII. Maintaining a Healthy Back. Preventing back injuries requires proper lifting, good posture, exercise and proper diet. The back deteriorates with age and it is important to do everything possible to keep the back healthy. Performing certain exercises will strengthen the back, stomach muscles and leg muscles increasing the chances of maintaining a healthy back for many years. Here are three things you can do to help your back. A. Shoes: Wear comfortable and supportive shoes. B. Weight: Maintaining your proper weight will reduce stress to your back. C. Exercise: Exercising on a daily basis will strengthen the back and increase flexibility. i. Shoulder shrugs are one way to stretch the upper back. Stand or sit with arms at sides. Shrug shoulders up toward the ears and hold for 10 seconds then relax. ii. The pelvic tilt is done by laying on the floor with knees bent and feet flat. Tighten the stomach and buttock muscles to press lower back against the iii. Conclusion A. When lifting floor. The hip flexor stretch is done by laying on the back with one leg straight and the other bent at the knee. Slowly bring the bent knee up to the chest and press the back firmly on the floor. Hold for 5 seconds, bring knee back down, then switch legs. i. Plan ahead before lifting. ii. Communicate with others and use proper techniques and equipment. iii. Bend at the knees when lifting or setting the object down. iv. Keep feet shoulder width apart v. Lift the object close to the body. vi. Tighten the abdominal muscles. vii. Lift with legs B. Maintain good back posture whether lifting, sitting or standing. C. Stretching before work or exercise will reduce strain on the back.