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December 30, 1997

Moving nursing home residents dangerous work, L&I study shows

  TUMWATER - A new study shows the techniques most commonly used to move residents in nursing homes will likely result in staff injury, according to the Washington State Department of Labor & Industries.

The study, conducted for L&I by Ohio State University, evaluated the motions typically used by nursing home staff.

Nursing homes post the second-highest number of work-related claims for disorders of the back and upper extremities in the Washington State workers' compensation system. "We wanted to see just how bad it was," said Barbara Silverstein, research director for L&I's Safety and Health Assessment and Research for Prevention (SHARP) program.

In the laboratory study, 12 experienced nursing assistants and five inexperienced subjects performed actual transfers on a 110-pound person while wearing a device called a lumbar motion monitor. Measurements from this monitor are used to evaluate stresses on the lower back and spine.

In addition, electronic activity measurements were taken on 10 major back and abdominal muscles while the subjects carried out the typical tasks used when moving residents in nursing homes. The forces on these muscles were collected and compared with the maximum tolerances for tissue tear. In all cases, the typical resident moving techniques far exceeded these tolerances.

Silverstein said such movements also lead to "micro-fractures" in the outer ends of the vertebrae (endplates), which often lead to back pain and injury.

The study found:

  • The one-person hug method is "extremely risky" and should always be avoided. More than 90 percent of those who routinely use this technique will likely suffer an injury to their lower back.
  • The two person transfers are "highly risky," if the resident cannot bear any weight, with more than a 79 percent risk of injury. There is not much difference in injury risk between the "gait belt" and "hook and toss" lift techniques.
  • One-person transfers between different furniture types are extremely risky.
  • The best method to reposition a patient in bed is the two-person, using a drawsheet - but this still represented a high probability of lower back injury, at 67 to 72 percent. Most likely a slip sheet would reduce risk further.

"Overall, patient handling was found to be an extremely hazardous job that had substantial risk of causing lower back injury," the study states.

The study was conducted last summer by Ohio State's Biodynamics Laboratory at the request of L&I's SHARP program.

Labor & Industries has also established a nursing home task force that is examining the high rates of back injuries and methods to prevent such injuries. The internal task force, initiated six months ago, will be working with nursing home associations and with the state Department of Social and Health Services to advocate "zero lift" policies, better training and the use of mechanical lift and assistance devices for residents.

For more information about the study, contact Professor William Marras at (614) 292-6770 or marras.1@osu.edu. For information about the L&I nursing home task force, contact Kevin Simonton at 360-902-5645 or at simk235@lni.wa.gov.

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