Ergonomic approach
to
Moving and Handling
What is Ergonomics?
Ergonomics’ is derived from two Greek
words
• Ergon meaning work
• Nomos meaning principles or laws
Ergonomics = The Science of Work
Ergonomics is not a new science, although the
term has become more common lately. The
phrase was first coined in 1857.
Definition
Ergonomics is essentially fitting the
workplace to the worker and with the
design of safe systems of work. . The
better the fit the higher the level of safety
and worker efficiency.”
Grandjean 1990
Work station assessment
What are the consequences
of poor Ergonomics?
Occupational Disorders (some first documented in
the 17th century):
•
•
•
•
•
•
•
house-maid’s knee
washer woman’s thumb
writer’s cramp
clergyman’s knee
weaver’s bottom
dustman’s shoulder
tailor’s ankle
Postural Analysis
• Spatial arrangement of individual body
sections
• Assessment of postural tolerability
(Columbini and Occhipinti, 1985)
Ovako working Posture Analysis System
Reducing Musculoskeletal Injuries
in Patient Handling
Successful strategies have involved
changes in:
• Work organisation
• Working practices
• Design of the environment
(Hignett 2003)
Physiotherapy Injuries (2005)
• 67.5% of physiotherapists report work-related
musculoskeletal disorders
of these:
• 48% affect the lower back
• 40% report hand, thumb & wrist problems
• 33% report neck problems
Costs to the NHS
• Back injuries among staff cost £400 m a
year
• 80,000 nurses injure their backs at work
• 3,600 healthcare workers retire early due
to injuries
BackCare 2011
Cost of Back Pain
• NHS spends more than £1billion per year on
back related costs
• £565m spent in private sector on back pain
treatments
• Back pain & musculoskeletal disorders cost UK
employers between £590 & £624 per year (HSE)
• Total cost of back pain = 1-2% of GNP
www.Backcare.org
Predictors of Back Pain in
Health Care Professionals
• Transferring patients between bed and
chair
• Static postures in supporting/treating
patients
• Assisting patients to walk / fall risk
What would you do?
• Mrs Groves , (who weighs 85 kgs) needs help to
change position in bed
• Ms. Close (who has a history of falls) needs help
to walk to the toilet.
• Mrs Green (who has had a stroke) has slipped
down in her chair and is in danger of sliding onto
the floor
Legal Aspects of Moving and Handling
There is legislation that encompasses
manual handling at work:
• Ensure compliance with the relevant law on
moving and handling
• Understand responsibilities of the employer in
relation to moving and handling of patients
• Know responsibilities of health care professionals
in relation to moving and handling of patients and
follow safe practice
Where does legislation come
from?
• Acts of Parliament
• EC Directives and Legislation
• Common Law (Case Law, Judicial
Decisions, Leading Law from the Law
lords)
English Legal System
Criminal Law
Civil Law
-Deterrent & Punishment
-State v Offender
-Statues, Acts , Regs
-Compensation
-2 parties in dispute
-Some Acts, Regs
-Prosecuted
-Sued (can be insured against)
-Higher burden of proof
-Lower burden of proof
Beyond reasonable doubt -
Balance of probablities
Innocent until proven guilty
Common Law of Negligence
• Duty of Care was owed
• The Dutyof Care was breached due to a
careless action or omission
• The breach directly caused harm
• It was reasonably foreseeable (Bolam Test)
Key Legislation
 Health and Safety at Work Act (HASAW) 1974
 EC Directives
Management of Health and Safety at Work Regulations
(MHSAW) 1992
Workplace (Health,Safety & Welfare) Regulations, 1992
Provision and Use of Equipment Regulations (PUWER)
1998
Display Screen Equipment Regulations, 1992
Personal Protective Equipment at Work, 1992
Manual Handling Operations Regulations (revised
1998) (MHOR) 1992
Lifting Operation and Lifting Equipment Operations
(LOLER) 1998
Other Relevant Legislation
• Reporting of Incidents, dangerous
diseases or Occurrences Regulations 1995
• Human Rights Act 1998
• Disability Discrimination Act 1995
• Mental Capacity 2005
Implementation of Legislation
The Health and Safety
Commission (HSC) oversees
the Heath and Safety
Executive (HSE) which holds
responsibility for the
enforcement of regulations at a
practical workplace level.
– Advisory committees.
– Guidelines
– Codes of Practice.
Government
HSC
HSE
A number of professional bodies have
produced documents in response to the
legislation:
– Royal College of Nursing
– Chartered Society of Physiotherapists
– College of Occupational Therapists
– Society of Radiographers etc.
We must be aware of the following issues in
relation to moving and handling in the caring
environment:
– There is an inherent risk of injury for people who are
involved in the regular handling of loads.
– As a physiotherapist, your most common ‘load’ will
probably be people.
– For numerous obvious reasons, people are amongst
the most difficult and demanding of all loads.
– As a carer you are more at risk from injury caused by
manual handling than people in any other occupation.
MHOR ~ Duties of employers…
Avoid hazardous manual handling so far
as is reasonably practicable
Make suitable and sufficient
assessment of any hazardous manual
handling operations that cannot be
avoided
Reduce the risk of injury from those
operations as far as is reasonably
practicable
Duties of employees…
 Take reasonable care for their own health
and safety and that of others who may be
affected by their activities
 Co-operate with their employers to enable
them to comply with their health and safety
duties
 Make use of appropriate equipment provided
for them
 Follow appropriate systems of work laid
down
Students on Clinical Placements
Health and Safety at Work Act &
Manual Handling Regulations apply to
ALL workers including
students on work experience
i.e. students on clinical placements
The range of what we think and do is limited
by what we fail to notice.
And because we fail to notice there is little
we can do to change until we notice how
failing to notice shapes our thoughts and
deeds
(R.D Laing - cited by Daniel Goleman in
Vital Lies, Simple Truths)
Anatomy and Biomechanics
Typical Lumbar Vertebra
Pressure measured
in L3 / L4 disc
during different
postures
Some Predisposing Factors to
Back Pain
•
•
•
•
•
•
Genetic inheritance
Unaccustomed work
Injury
Fatigue
Ageing
Smoking
Handling Definitions
• Manual Handling involves transporting or
supporting a load lifting/lowering/pushing/pulling/carrying
• Treatment Handling = manual handling in
a treatment programme
i.e. any treatment where force is applied
through any part of the therapist’s body to
or from any part of the patient.
TASKS
• List 3 tasks where you might be vulnerable
to back ache
• Identify the underpinning factors
• What PRINCIPLES could you apply to
avoid back ache
Common Causes of Back Pain
• Loading
• Twisting
• Repetition
• Sudden jerky movements
• Sustained poor posture
Guide to the Handling of People
• Assess and identify risks
• Decide on safe system of work – risk is
unlikely to be ZERO
• Prioritise actions - need for assistance,
further advice, equipment
• Use of 'personal handling profiles'
• Use recognised, accepted manoeuvres
Assessment of risk
Task
Individual Capability
Load
Environment
Equipment
Risk Assessment
• Generic - for potentially
hazardous situations
• Specific - for patients whose
treatment programme may
involve potentially hazardous
manual handling
ASSESSMENT OF RISK…
THE TASK…
Will it involve…
Holding or manipulating the load at a distance
from the trunk?
Unsatisfactory body movement or posture,
especially:
• twisting?
• stooping?
• reaching upwards?
ASSESSMENT OF RISK…Will it involve?
Excessive movement of the load, especially:
– excessive raising or lowering distance?
– excessive carrying distance?
– excessive pulling or pushing?
Risk of sudden movement of the load?
Frequent or prolonged physical effort?
Insufficient rest or recovery periods?
A rate of work imposed by a process?
INDIVIDUAL CAPABILITY
…Does the job
• Require unusual strength, height, etc?
• Create a hazard for those who are pregnant or
have health problems?
• Have you…
– The capacity to move the load?
– Any disabilities that could affect safety?
– The skills required for this task?
• Are you wearing any hazardous clothing,
jewellery or shoes that could get caught or
cause injury?
Appropriate
clothing
and
footwear
The Load – Is it…
•
•
•
•
Heavy
Bulky or unwieldy
Difficult to grasp
Unstable or with contents that are likely to
shift?
• Sharp, hot or otherwise potentially
damaging
Maximum Safe Loads for Lifting and
Lowering
Under the Health and Safety Regulations the
maximum safe loads for an individual
for lifting and lowering are:
For two persons working
together the maximum
load is equal to 2/3 the
combined safe load.
The Working Environment …Are there?
•
•
•
•
•
Space constraints or obstacles?
Uneven, slippery or unstable floors?
Variations in level of floors or work surfaces?
Extremes of temperature or humidity?
Conditions causing ventilation problems or
gusts of wind?
• Poor lighting conditions?
• Distractions, e.g.: noises?
• Pieces of equipment available that would
help?
Equipment
Hoist
Moving and Handling Aids
•
•
•
•
•
•
Profiling beds
Slide sheet
Sliding boards
Turntables
Hoists
Standing aid
hoists
• Riser/recliner
chairs
• Bath seat or
boards
• Bath lift or hoist
THE PATIENT or CLIENT…
• Think about the person…
– What are their abilities?
– What is their size, weight and shape?
– Consider their age, gender and cultural
and religious background
– What is their medical condition? Do they
have any painful areas, discomfort,
fractures or wounds, skin conditions etc?
– Any special problems?
THE PATIENT or CLIENT…
• What clothing are they wearing? Is this a
hazard?
• Do they have any attachments?
• Ensure privacy if they are in a state of
undress
• Can the patient/client understand you?
• What are their attitudes/feelings about being
moved or handled?
• What are their previous experiences of being
assisted?
Possible reasons for injury to
patients during moving and handling
1.Friction
2.Joint damage
3.Resistance from the client
4.Falls.
What About Emergencies?
• Emergency situations where people are
being cared for, are foreseeable and
Risk Assessments should be carried out
for these
• A hospital/institution should expect that
people (patients, visitors & staff) may
collapse in any
location.
Falling and recovery from the
floor
• Don’t catch ~ let
person fall, save head
only if safe to do so.
• Patient must initially be
assessed by a Registered Practitioner.
If no injury, encourage patient up using
chair for support.
Teamwork
One person
should give the
commands
All should
understand
manoeuvre
(including the
patient).
EFFICIENCY of MOVEMENT
• Keep a stable stance & avoid twisting
• Keep as close as possible to the weight – keep
hands within your base
• Put effort into moving Centre of Gravity of load
or person
• Use head movement to initiate movement
Efficiency of Movement
• Keep vertical effort to a minimum
• Use major muscle groups for effort
• Use smooth movements / avoid excessive
muscular tension
• Reduce friction for horizontal movements
Standards of Physiotherapy Practice
• Patient partnership
• Clear Communication
• Comprehensive risk assessment
• Safe working practice – evidence based
• Accurate Documentation
• CPD
References
Grandjean (1990) Fitting the Task to the Human
The Health and Safety Commission (1997)
Statistics
RCN (2009) The Guide to The Handling of People
6th Edition
CSP (2008) CSP Manual Handling Guidance