News | Published July 10, 2014 | Written by Scott DeHart, MD, PhD, medical director, occupational health, Mount Nittany Physician Group

Musculoskeletal injuries in the healthcare setting

Which of the following areas of work involve the most musculoskeletal (MSD) injuries: construction, mining, manufacturing, or healthcare? If you guessed healthcare, you guessed right. Healthcare workers, especially those who are involved with the care of less ambulatory patients in hospitals, long care facilities, or those homebound are particularly prone to injuries involved with lifting or repositioning patients who have decreased mobility. Although many facilities have lift and transferring devices on hand, situations often arise where healthcare workers have to quickly react, often with odd postures, to a patient who may have slipped or is in danger of falling. Other impediments to the use of the devices is that they may be stored away in places not easily accessible and that even when available, some workers believe they can do the lifts more rapidly by manual means. In many instances, the workspaces involved are cramped and not easily adaptable for the lift devices or for correct posture for lifting.

Two factors are operating that can increase the injury risk. First of all, the workforce of healthcare workers is aging with an average age of 46.8 years and increasing, which predisposes to greater musculoskeletal injury risk. Secondly, the obesity epidemic also contributes to a higher injury risk with a special risk from those morbidly obese (over 300 pounds, which is often the safety limit of many lifting devices). Direct and indirect costs of MSD injuries to healthcare workers are estimated at 20 billion dollars annually and up to 12 percent of nurses leave their profession due to back injuries or problems. Close to 90 percent of these healthcare workers at risk are female, and the weight of most patients far exceeds the capacity to manually lift.

Unfortunately, there is no OSHA standard for lifting in the healthcare setting at this time. NIOSH, however, has studied the issue and has a publication on the matter called Safe Lifting and Movement of Nursing Home Patients available on their website.

The most effective means in preventing MSDs in the healthcare setting are the use of mechanical lifts, training programs in safe lifting, and the establishment of ergonomic teams onsite (with employee involvement) to evaluate the best means for patient transport and positioning at the workplace. The initial costs of mechanical lifts (estimated to be $50-60,000 for a 100 bed facility) can be recouped in two to three years by reduction in worker injuries, according to studies done by NIOSH. There is no evidence that the use of back belts prevents back injuries, either in this industry or others. While it is true that manual lifting can often be faster than a lifting device, the latter is safer and generally more comfortable for the patient. Safety in regards to patient handling is a difficult issue that is best approached by worker training and awareness as well as the availability of appropriate lifting devices.