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Vol. 2 - No. 7 - September 1, 2007
Editor's note
Dear Subscriber,
Welcome to the latest issue of Safe Lifting News. This pro bono electronic newsletter is designed to keep you abreast of what’s happening in the world of safe patient lifting and caregiver injury prevention. Please help us by making suggestions for topics you want covered in the future. Also, one of the best ways YOU can help protect nurses against back injuries is by sharing your experiences with our readers – so please take a moment to fill out the "Comments" form at the end of the newsletter. And, if you’ve got a specific question, just "Ask the Lift Doctor" in the link below. As always, we look forward to your participation!
Warm regards,
Melissa Nowitz
Editor, Safe Lifting News
e-mail: melissa.nowitz@liko.com
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POTPOURRI
from
"The Reading Room"
- Survey of Patient Mobility and Lift Technologies Toward Advancements and Standards (Bostleman & Albus, National Institute of Standards and Technology, Dec., 2006) This exhaustive report (94 pps.) focuses on lift devices, wheelchairs, combination devices, rehabilitation, and standards. Visit http://www.isd.mel.nist.gov/healthcaremobility/
Survey_of_Lift_Assist-Final.pdf
- Bariatric care: If the sheet fits A recent article in Healthcare Equipment and Supplies (UK) by Anita Rush, discusses use of repositioning sheets with bariatric patients. "In some instances, one patient may require six members of staff to undertake care and nursing tasks, while the time taken to complete these tasks could be as much as two hours, depending on the patient's mobility and body dynamics." Visit http://www.hesmagazine.com/story.asp?
sectionCode=184&storyCode=2044569
- Designing for the Obese As hospitals and nursing homes struggle to serve the growing number of overweight patients, design experts offer tips on creating bariatric-friendly healthcare spaces. Visit http://www.bdcnetwork.com/university/
article/CA6281248.html
- SPHM Guidelines The University of Texas Medical Branch publishes on-line "Guidelines for Safe Patient Handling and Movement," including policy, practice, and accountabilities. Visit http://www.utmb.edu/Policies_And_Procedures/
Health__Safety_and_Security/PNP_077791
- Ergonomics and economics of safe patient lifting This brief article from Healthcare Purchasing News (March 2007) is based on an interview with Karen Strenger, RN, MA, CCRN, (Univ. of Iowa Hospitals & Clinics). It documents savings from workers’ compensation costs and concludes that administrative support and education are required to make the change to safe patient handling. http://www.hpnonline.com/inside/
2007-03/0703-PO-SafePatientLifting.html
- CTDs, SLE & ROI If your safety committee or risk management department needs to be convinced about the advisability of going forward with a safe lifting environment (SLE) or other caregiver injury prevention program, here’s an unbiased solution. The Ohio Bureau of Workers’ Compensation’s Web document, "Ergonomic Best Practices for Extended Care Facilities," at
https://www.bwc.state.oh.us/downloads/
brochureware/publications/ExtCareSafeGrant.pdf, discusses the number of Cumulative Trauma Disorders (CDTs) in various scenarios along with calculated Return-on-Investment (ROIs) as part of their "best practices" recommendations for nursing homes. Several case histories are offered that document an ROI for floor lifts of as little as 2.5 months. Another helpful hint: use our handy online ROI calculator to find out how much you can save by having a comprehensive program. Click here to access the interactive web tool, and fill in the request form to ask for a formal ROI analysis complete with anticipated payback projections offered FREE by our sponsor Liko. (
- Ergonomics in Action: The Art and Science of Limiting Patient Lifting Injuries to Reduce Health Care Worker Back Injuries (A Joint Commission Standard and OSHA Regulation) "So serious is the problem of worker injury caused by transferring patients that the Joint Commission implicitly included it among its National Patient Safety Goals for long term care, assisted living facilities, and other health care organizations." This is a "must read" document for anyone trying to justify a safe lifting program. Visit http://www.jcrinc.com/11374/
- An overview of national efforts aimed at promoting safe patient handling and movement practices (National Institute for Occupational Safety and Health, Tom Waters, PhD.) http://www.dwd.state.wi.us/healthcare/powerpoint/
waters_overview_nationaleffortspromotingsafelift
_uwm042007.ppt
News from Our Sponsor...
Over the past several months, numerous subscribers to Safe Lifting News have requested periodic updates about emerging new products and services. As a result, our sponsor, Liko North America, has initiated a new quarterly E-newsletter designed to keep subscribers informed about new product introductions, services, and educational opportunities. Called simply "Update," the newsletter will go beyond straightforward product stories and will carry application type information as well....yet another way for readers to stay informed about the rapidly evolving field of safe lifting and caregiver injury prevention. Click here to sign up for Liko’s "Update" newsletter.
Ask the Lift Doctor...
Ask the Lift Doctor - Training employees to assist in transfers
"If the company I work for has a zero lift policy and the employees assist with a transfer from a wheel chair to normal chair, would this be in violation? Should our employees be trained with assisting transfers? I have employees that used to work in a nursing home, however our company has not trained the individual. I just need to know what we can do to protect our employees yet help accommodate the patients that just might need a little extra help."
Janelle Cecchini
BGH
Dear Janelle:
Your question raises an interesting point. When we coined the phrase "safe lifting environment," we specifically avoided using the words "zero lift" or "no lift." That’s because we believe that in the real world of day-to-day healthcare, situations always exist that demand some degree of manual assistance to patients or residents. Simply put, it is not always practical to completely prohibit manual assistance. Instead, you might want to recommend adoption of a culture of safety within the entire patient handling environment. Through training and mutual support, caregivers should be made to understand that the outdated process of manually lifting, repositioning, or physically manipulating patients - of any size or age - is no longer acceptable within their entire work environment. Their safety and the safety of their patients is at stake, thus in each situation where lifting or repositioning is involved, caregivers should back off, take the time to obtain the proper assistive equipment, and use the equipment in the safest, most effective manner possible.
In your specific case, "zero lift" can be interpreted to mean that lifting is totally prohibited. Thus employees should be informed that they are only allowed to provide the proper equipment to "assist" in a chair-to-chair transfer, but they are NOT allowed to manually lift the patient!
Further, employees should realize that even the act of steadying a patient ("when we provide the "little extra help" you mentioned) is extremely dangerous. In a worst case scenario, the patient might suddenly begin to fall, thus initiating a spontaneous and potentially injurious reaction on the part of the caregiver. What's at stake is both the patient's safety and the caregiver's possible injury and loss of livelihood. To accommodate those patients who might need a little extra help, please make sure assistive equipment is available, instruct your employees regarding its proper use, and, of critical importance, enforce your policies universally and consistently. If no equipment is available, the caregiver in a culture of safety must take the extra time to recruit other staff members to assist.
We hope you can encourage your personnel to recognize that risk assessment is a vitally important part of manual handling. To help them remember, you might want to adopt an acronym such as TILE...
Task (assess the Task to be performed)
Individual Capacity (assess the capacity of each Individual patient to provide assistance)
Load (assess the Load, both weight and distribution)
Environment (assess the working Environment including space to maneuver, barriers, and attached medical devices)
Finally, we cannot overemphasize the importance of each facility training its own staff, both on the equipment and on its "zero lift" policy.
Stay Safe,
The Lift Doctor.
Ask the Lift Doctor - One person transfers when using ceiling lifts
"We have recently installed about 150 Liko ceiling lifts with plans to add a similar amount this year. Would you please give me your opinion on whether we can revise our lifts and transfers policy to allow one person transfers when using a ceiling lift? With all other lifting equipment (floor lifts, sit/stand) we require two persons to be present."
Sandra Anholt
Bethany Care Society
Dear Sandra:
While policy recommendations may differ from one manufacturer to another, Liko does recommend allowing single-caregiver assistance when using ceiling lifts assuming the caregiver has conducted an assessment and is fully confident that the lift-and-transfer operation can be conducted safely for both the patient and the caregiver! It is important to note that NOT ALL SITUATIONS ARE SAFE FOR SINGLE-PERSON ASSISTANCE.* For example, following are situations that might require two persons to assist:
- If medical equipment is attached to or accompanies the patient, two caregivers should be present during the transfer.
- If the transfer is being made to a wheelchair or other unstable equipment, a second caregiver should be present to stabilize and properly position the chair.
- Bariatric patients require a two person team.
*Please note that the patient's weight is not the only factor to consider when determining how many caregivers are needed. Even if the patient is not particularly heavy, he/she can be very difficult to turn to the side, or to keep on the side, when placing the sling into position. For example, the patient may be stiff, spastic, violent due to dementia, etc. Thus a risk assessment should always be performed and a decision made regarding whether the task requires one, two, or more caregivers, no matter whether the lift is a ceiling lift or a mobile lift. The objective of safe lifting should be to save caregivers, not to save on caregivers.
Stay Safe,
The Lift Doctor
Ask the Lift Doctor - Sling washing instructions
"Washing of slings is a real issue for our LTACH. Washing Instructions state -- wash in hot water with soap. I do not believe this will kill C.Dif. and other pathogens.
What do you suggest?"
Thomas Henderson
Transition Health Services
Dear Thomas:
Thank you for your question. I am interested to better understand the background behind the issue of washing slings at your LTACH.
Specific to C. Difficile the literature states the following:
Clostridium difficile, C. difficile [klo-STRID-ee-um dif-uh-SEEL] is a bacterium. The bacteria are found in the feces. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact. For safety precautions the following may be done to reduce the chance of spread to others: Wash hands with soap and water, especially after using the restroom and before eating. If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients with C. difficile-associated disease as alcohol-based hand rubs may not be as effective against spore-forming bacteria. Clean surfaces in bathrooms, kitchens and other areas on a regular basis with household detergent/disinfectants. Dedicate equipment whenever possible.
Hospital cleaning products can be used for routine cleaning. Hypochlorite-based disinfectants (e.g., household chlorine bleach) have been used with some success for environmental surface disinfection in those patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. difficile. Note: EPA-registered hospital disinfectants are recommended for general use whenever possible in patient-care areas. At present there are no EPA-registered products with specific claims for inactivating C. difficile spores, but there are a number of registered products that contain hypochlorite.
In the United States, liquid chemical germicides (disinfectants) are regulated by EPA and FDA. In health-care settings, EPA regulates disinfectants that are used on environmental surfaces (housekeeping and clinical contact surfaces), and FDA regulates liquid chemical sterilants/high-level disinfectants (e.g., glutaraldehyde, hydrogen peroxide, and peracetic acid) used on critical and semi critical patient-care devices.
Laundering information from the CDC - June 2003 is as follows:
IV. Laundry Process
A. If hot-water laundry cycles are used, wash with detergent in water >160ºF (>71ºC) for >25 minutes (1,270). Category IC (AIA: 7.31.E3)
B. No recommendation is offered regarding a hot-water temperature setting and cycle duration for items laundered in residence-style health-care facilities. Unresolved issue.
C. Follow fabric-care instructions and special laundering requirements for items used in the facility (364). Category II.
D. Choose chemicals suitable for low-temperature washing at proper use concentration if low-temperature (<160ºF [<70ºC]) laundry cycles are used (365--370). Category II.
E. Package, transport, and store clean textiles and fabrics by methods that will ensure their cleanliness and protect them from dust and soil during interfacility loading, transport, and unloading (270). Category II
Therefore, it appears that soap and water along with household and hospital detergents/disinfectants and cleaning products can be effectively used for routine cleaning for C. difficile. Chlorine bleach based disinfectants are recommended in patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. difficile. Specific to slings, most manufacturers recommend washing with hospital cleaning products used for routine cleaning/disinfecting with the exception of chlorine bleach based agents, as bleach will degrade the strength of the fabric.
As is indicated in italics above, it is recommended to dedicate equipment whenever possible. Reusable fabric slings are designed for single patient use, with cleaning/disinfecting between patients. The sling is meant to be kept with the specific patient using it, for the duration of that patient's hospital stay. It is sent to the laundry after the patient is discharged, or if it becomes grossly contaminated during the patient's stay. However, if laundering slings is an issue as you have stated, perhaps single patient use disposable slings would be an appropriate solution for your facility. Once the patient is discharged, or if the sling becomes grossly contaminated during the patient's stay, it is disposed of and a new disposable sling is obtained to fulfill the next need.
Once again, thank you for your question. Please do not hesitate to contact us with any questions or concerns regarding this information.
Stay safe,
The Lift Doctor
Ask The Lift Doctor - Use of ceiling lifts with hip surgery patients
"Our Hospital has been working hard to decrease over exertion injuries through our Safe Lift Program. Orthopaedics which is one of the heaviest in- patient units continues to have a high number of staff over exertion injuries In an effort to reduce these injuries, we have recently installed overhead ceiling lifts but they are not being used. One of the barriers appears to be with the Orthopaedic Surgeons who feel it is not safe to use lifts with patients who are recovering from hip surgery as hip alignment can be compromised. We have provided hammock slings which are designed to be used for these patients. Do you have any research or experience using lifts with this type of patient that may be helpful or are they correct in determining this can be unsafe? Do you have any suggestions for other assistive devices to help us reduce our injuries? "
Arlene Gladstone
North York General Hospital
Dear Arlene:
Obviously there are many different types of hip surgery. Hip replacement is one of them, and in the following comments we refer to the most common type of hip replacement. It is important to be informed regarding the type of hip surgery in order to choose the proper equipment to be used if the patient needs to be lifted.
One of the most common problems that might arise soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest and letting the leg cross the midline of the patient's body. Therefore it is important that the sling you select provides a hip angle with no more than 90 degrees flexion, for example a Comfort or a Highback sling (Liko products). Note, however, that the Comfort sling does press the knees together when lifting, but the legs are not crossed over the midline. In order to separate the knees, a wedge pillow is probably advisable. Or, if there is a need to separate the knees even more, a sling with separate leg supports such as the Highback Original is a good choice.
Another possibility is to decrease the hip angle even more by using an Amputee sling in size medium together with side bars.
One final recommendation that often works: We recommend you invite the surgeon to attend a situation where the caregivers perform a lift using the proper sling. You may even wish to invite the surgeon to be lifted himself in order to demonstrate the safety and convenience of this solution which is used extensively throughout the world.
Thanks for your interesting question
The Lift Doctor
Ask The Lift Doctor - Standard Gait Belt Policy
"Our facility is just starting with safe patient handling devices. Is there a standard gait belt policy available to review before writing ours?"
A. Gayle Atwell RN
CHC
Dear Gayle:
Following is a basic policy statement you might wish to consider adopting.
Description: Gait belts/transfer belts with handles
When to Use: Gait belts may be used when transferring patients who are partially dependent, are cooperative, and who have some weight-bearing capacity. Typical transfer maneuvers include the following: bed to chair, chair to chair, or chair to car; when repositioning residents in chairs; supporting residents during ambulation; and in some cases when guiding and controlling against falls or assisting a patient after a fall.
Points to Remember: Belts should not be used for lifting patients. More than one caregiver may be needed. Lower bedrails, remove arm-rests and foot-rests from chairs, and move other items that may obstruct the transfer. Belts with padded handles are easier to grip and increase security and control. Always transfer to patient's strongest side. Use good body mechanics and a rocking and pulling motion rather than lifting when using a belt. Belts are not suitable for ambulation of heavy patients or those with recent abdominal or back surgery, abdominal aneurysm, etc. Ensure belt is securely fastened and cannot be easily undone by the patient during transfer. Ensure a layer of clothing is between patients' skin and the belt to avoid abrasion. Keep patient as close as possible to caregiver during transfer.
When gait belts are used after a fall, always assess the patient for injury prior to movement. If patient can regain standing position with minimal assistance, use gait or transfer belts with handles to aid patient, remembering to keep back straight, bend legs, and stay as close to resident as possible. If patient cannot stand with minimal assistance, use a powered portable or ceiling-mounted lift device to move patient. Caution: Caregivers risk injury if their hand gets stuck in a handle of the belt, particularly if the patient is unstable or starts to fall. The caregiver should always be prepared to withdraw the supporting hand if the patient begins to fall and use it to control the fall in as gentle a manner as possible.
I hope this helps.
The Lift Doctor
Ask The Lift Doctor - Maneuvering floor lifts on carpeted surfaces
"Our facility is carpeted and we find it difficult pushing hoists over this surface - do you have any solutions, maybe around wheels on hoists?"
Lesley Lennie
MercyAscot Hospitals (NZ)
Dear Leslie:
This is a wide ranging topic and I will attempt to provide as much information as possible in a limited amount of space. I am making an assumption that the wheels on your hoists are clean, move freely, and are the largest diameter available while still allowing access under beds and furniture. Further, even though this may not apply for your facility, readers need to remember that one of the major advantages of ceiling mounted lifting systems is that they avoid complications arising from carpeting, furniture placement, medical equipment, and other complications.
Following are some general guidelines to employ when maneuvering a floor lift over a carpeted surface:
- Pushing is most often easier on your back than pulling. When pushing you can lock your arms, maximize use of your legs, and put all of your weight into the lift.
- When you push a patient in a lift, try to use your leg muscles more than your back or your arm muscles. Try the following technique to use your legs more: "lock" your arms in place by holding them into the starting push position. Try to keep your arms close to your trunk. Use your legs and shift your weight on them. Weight shifting requires that you have a wide base of support; feet should be at least a shoulder’s width apart. Generally, forward to back weight shifting is preferable with your legs in a diagonal stance and weight shifted from front leg to back leg (think of it as a "lunge" type movement).
- Changing direction. In order to change direction when stopped, lock one wheel and walk in a circular direction in order to reorient the lift rather than trying to push the lift sideways. Sideways pushing is a dangerous maneuver involving twisting of the back and high pressure on the lower spine, especially if the feet remain in a fixed position. And, remember, the most stressful time is when starting the lift in motion, so always be cautious when starting out. Once the lift is in motion, the effort decreases.
- Try to avoid twisting of the spine. Twisting puts a torque-type force on your low back. To avoid twisting point both your feet and arms in the same direction as the object you are trying to move. Instead of twisting your back, move your feet by taking small steps in the direction in which you are trying to move.
One final observation: The use of carpets in care facilities is diminishing over time due to modern facility hygiene standards and the difficulty in cleaning carpets versus cleaning hard surfaces. Carpets are also less desirable from an ergonomic point of view due to the difficulty in moving any equipment with wheels such as beds, patient lifts, and wheelchairs. Given a choice, the Lift Doctor would recommend against use of carpets in healthcare facilities for the above reasons.
Stay safe,
The Lift Doctor
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