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Preventing Back Injuries in Health Care


The hazard: Pain and injuries to muscles, tendons, discs, and other parts of the back.

Who is at risk: Workers who lift and move patients and those with jobs in laundries, kitchens, environmental services, and others who must lift, push, and pull objects.

Prevention: Injuries can be prevented by eliminating tasks that require lifting, using equipment to perform lifts, having enough staff, employing lifting teams that use lifting equipment, and prohibiting single-person lifts.

Laws: There is no federal OSHA ergonomics standard. The state OSHA programs in California and Washington have their own standards on ergonomics. 


What back injuries do health care workers suffer?

Back injuries are the most common job-related health problem among health care workers and include:

  • low back pain,
  • herniated discs, a condition in which the discs in the spinal column bulge out, placing pressure on the nerves in the back,
  • strained muscles,
  • pulled and/or torn ligaments, and
  • discs break apart due to excessive strain (disc degradation).

The most common symptoms include pain and stiffness in the back. Other symptoms include numbness in the back, legs, or arms, and decreased mobility.

Who is most at risk for back injuries?

The health care workers that are most likely to develop a back injury and/or pain are those with jobs that require them to lift or move patients. Nursing aides, orderlies, and attendants had more back injuries and other musculoskeletal disorders (MSDs) than any other occupation in 1999, according to data from the United States Bureau of Labor Statistics.

There are many other tasks in health care besides lifting or moving patients that can cause back problems. Workers in environmental services, laundry, food service, central transport and other operations are also faced with working conditions that cause injuries.

What causes back injuries?

Most back injuries are the result of lifting, pushing, and pulling over a long period of time. The working conditions that cause back injuries are called risk factors. The main risk factors for back injuries in health care are:

  • Force, the effort it takes to lift, move, or reposition a patient or object.
  • Repetition, how often a movement must be performed.
  • Awkward positions, lifting or doing other tasks while the body is in a twisted, bent, stooped or other position that puts a strain on muscles and joints.

Shortage of staff, mandatory overtime, or extended hours increase the risk of back injuries. These conditions cause fatigue and result in increased exposure to the risk factors that cause injuries.

How can an ergonomics program prevent back injuries?

"Ergonomics" means changing jobs to fit the abilities and needs of the workers rather than trying to fit the worker to the job. An ergonomics program prevents injuries by identifying and controlling the risk factors that put a harmful strain on workers' bodies. Health care employers need to develop an ergonomics program with the involvement of their workers to identify and control risks. An effective ergonomics program should have all of the elements described below.

  • MANAGEMENT COMMITMENT AND WORKER INVOLVEMENT The employer can demonstrate its commitment by assigning responsibility and providing resources to implement the program. Workers need a way to report signs and symptoms, and to be encouraged to do so. Workers need to be involved in the development, implementation, and evaluation of the ergonomics program.
    The risk factors that pose a risk of back injuries or other MSD need to be identified. Employer records that can be helpful in identifying problems include: 

         - injury logs, 
         - incident reports, 
         - workers comp, 
         - health insurance and sick leave usage.

    Other methods that can be used to identify risk factors and injuries include: 

         - a survey of the workers, 
         - a job hazard analysis to assess risk factors such as the: 

                - force required to move the patient, 
                - posture of the worker when performing the task, 
                - position of the patient's center of gravity with respect to the worker, 
                - number of times a patient must be moved or lifted, 
                - physical and mental ability of the patient to help with the move, 
                - workplace layout-how far a patient must be moved, and obstacles in the path.
    Changes in job design to reduce the strain on workers' backs and limbs should be made in the following order: 

         - Eliminate hazards where possible. Jobs should be reviewed to see if there are any tasks or movements that can be avoided. 
         - Use equipment to lift and move patients and objects (engineering controls). Examples include: 

                - overhead track lifts, 
                - portable total lifts, 
                - sit-to-stand lifts, 
                - devices for lateral transfer, 
                - easy to slide inflatable mattresses, 
                - reduced friction sheeting, 
                - transfer boards, 
                - gait belts with handles that fit around the patient's waist.

           Moving patients is not the only type of job that can cause back injuries and other repetitive motion injuries. Equipment can make jobs lifting or moving objects easier as well. Examples of equipment that is available include: 

                - Light weight food service items and carts, 
                - Adjustable height laundry carts, 
                - Ergonomically designed mops and other cleaning equipment.

         - Change procedures and policies (administrative controls). 

                - Use "lifting teams" for lifting or moving patients. Lifting teams are made up of workers that perform patient handling using lifting equipment. 
                - Increase staffing. 
                - Train workers on the use of mechanical devices and lifting techniques. 
                - Implement no-lift, or no single-person lift policies, 
                - Alternate lifting tasks with tasks that do not require lifting. 
                - Breaks, job rotation, and other means off giving workers enough time to give workers the chance to rest their backs. 

    It is extremely important that workers receive proper medical treatment at an early stage. Proper medical management requires that: 

    • Workers are trained to recognize the symptoms of back injury. 
    • Workers are trained and encouraged to report injuries as soon as they occur. 
    • Prompt and conservative treatment is provided by a medical provider that is familiar with back injuries. 
    • Jobs are redesigned to eliminate exposure to risk factors, including changes in equipment and duties.
    • Workers are provided with sufficient time away from work or are reassigned to light duty jobs with no loss of pay, benefits, or seniority.

Do back belts and lifting techniques prevent injuries?

  • Back belts have not been proven to prevent back injuries. Some research suggests that back belts may even cause problems, give workers a false sense of security or make them believe they can lift more weight safely.
  • The Limits of "Safe Lifting Techniques" Employer back injury prevention programs commonly only involve giving workers training on "safe" lifting techniques to use for patient-handling tasks. Although lifting techniques can help reduce the chances of injury, they are not a substitute for a program that relies on equipment, adequate staffing, and other measures that reduce risk factors. The usual recommendations for safe lifting are often not practical when moving patients.

Are there any laws to prevent back injuries?

There is no federal law. The state OSHA programs in California and Washington have their own standards on ergonomics.

March 2002

This material was produced under Grant Number 46C9-HT15 from the Occupational Safety and Health Administration, U.S. Department of Labor. It does not necessarily reflect the view or policies of the U.S. Department of Labor, nor does mention of trade names, commercial products or organizations imply endorsement by the United States Government.

For more information about protecting workers from workplace hazards, contact the AFSCME Health and Safety Program at (202) 429-1215, or 1625 L Street, N.W., Washington, DC 20036.

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