Safe Patient Handling and Mobility

Patient Handling Hazards

Rates of musculoskeletal injuries from overexertion in healthcare occupations are among the highest of all U.S. industries. Data from the Bureau of Labor Statistics (BLS) show that in 2014, the rate of overexertion injuries averaged across all industries was 33 per 10,000 full time workers. By comparison, the overexertion injury rate for hospital workers was twice the average (68 per 10,000), the rate for nursing home workers was over three times the average (107 per 10,000), and the rate for ambulance workers was over five times the average (174 per 10,000).  The single greatest risk factor for overexertion injuries in healthcare workers is the manual lifting, moving and repositioning of patients, residents or clients, i.e., manual patient handling.

Patient Handling Ergonomics

Occupational safety and health programs have fostered research to identify injury risk factors and safety interventions to prevent injuries during patient handling. Evidence-based research has shown that safe patient handling interventions can significantly reduce overexertion injuries by replacing manual patient handling with safer methods guided by the principles of “Ergonomics.” Ergonomics refers to the design of work tasks to best suit the capabilities of workers. In the case of patient handling, it involves the use of mechanical equipment and safety procedures to lift and move patients so that health care workers can avoid using manual exertions and thereby reduce their risk of injury. At the same time, patient handling ergonomics seeks to maximize the safety and comfort of patients during handling.

Patient Handling and the Revised NIOSH Lifting Equation (RNLE)

One question that has been raised about patient handling is, “How much weight can be safely lifted without using assistive equipment?” When it comes to questions about lifting, many safety professionals rely on the Revised NIOSH Lifting Equation (RNLE). NIOSH researchers developed the RNLE to determine weight limits for preventing back injuries caused by manually lifting objects on the job. Research studies have validated the equation’s usefulness for computing safe weight limits when lifting inanimate objects such as boxes and other packages. As a matter of policy, NIOSH recommends its use for that purpose.

The RNLE is not intended to be used for determining safe weight limits when lifting people. The shape and size of the human body differ from person to person, and patient handling situations are often complicated by many other factors such as the potential for unpredictable movements, the patient’s medical condition, and so on.  Since the equation was designed to be used for more stable and predictable lifting tasks, it is generally considered to be impractical for patient handling tasks.

As the field of safe patient handling grew over the years, practitioners increasingly expressed interest in trying to determine how much weight can be lifted safely using manual methods, and how much weight requires using lifting equipment.  When lifting a box or other inanimate object, the lifter can usually get quite close to the object, which helps minimize strain caused by reaching while lifting. It is usually not possible to get as close when lifting a patient. In order to accommodate the added space needed when lifting a person, Dr. Waters increased the equation’s minimum horizontal distance of 10 inches (between the lifter’s spine and the object) to 14.5 inches (between the lifter’s spine and the patient). After including this change in the equation, he applied the RNLE and determined that under the assumption of an otherwise “ideal” patient handling situation, the maximum recommended weight limit is 35 lbs.

Based on Dr. Waters’ calculation, lifting algorithms developed by the Veterans’ Health Administration and the Association of periOperative Nurses state that assistive equipment should be used if the weight to be lifted by any single person exceeds 35 lbs. However, the guidance provided along with the algorithms advises that the 35 lb. limit is not, by itself, sufficiently protective under all circumstances. As explained below, assistive devices are still needed in most situations, even when the weight to be lifted is less than 35 lb.

Reference: https://www.cdc.gov/niosh/topics/safepatient/