Enviromechanical hazards are aspects of the workplace that can cause or increase risk for accidents, injuries, strains, or discomfort (e.g., insufficient or inadequate equipment, hazardous flooring, poor workstation design).
Examples of Enviromechanical Hazards
- Most common cause of lost workdays for non-fatal occupational injury/illness is among employees working in nursing and residential care (5.7 per 100 workers) (Bureau of Labor Statistics, 2020; (Walton & Rogers, 2017).
- Most injuries are sprains, strains, dislocations, tears, fractures.
- Most incidents occur from wet floors or floors contaminated with fluids, food, grease, etc.
- Other exposure sources include poor, opened, uncovered, or leaky drainage pipes/drains, irregular indoor walking surfaces, poor lighting, absent or poorly constructed handrails and stairs, inappropriate use of ladders and floor mats, tripping hazards such as clutter, loose coils/wires/hoses, or ice-or snow-covered outdoor surfaces.
- Slips, trips, and falls can be reduced by interventions such as identifying hazards and using slip-resistant footwear and flooring materials.
- Ergonomics in patient handling refers to the design of work tasks to best suit the capabilities of workers while maximizing the safety and comfort of patients during handling.
- The single greatest risk factor for overexertion injuries in healthcare workers is manual lifting, moving and repositioning of patients, residents, or clients. This includes transferring from toilet to chair, transferring from chair to bed, assisting with ambulation, etc. (Association of Perioperative Registered Nurses, 2008).
- Mechanical equipment and safety procedures should be used to lift and move patients to avoid manual exertions by healthcare workers and thereby reduce their risk of injury.
- Compared to workers in all other industries, musculoskeletal injuries from overexertion in healthcare are among the highest with hospital workers at twice the average (68 per 10,000), nursing home workers over three times the average (107 per 10,000), and ambulance workers over five times the average (174 per 10,000).
- In 2017, BLS reported nursing assistants had the second highest rate of musculoskeletal disorder cases with an incidence rate (IR) of 166.3 per 10,000 workers (firefighters had rate of 167.5), and more than five times the rate for workers in all industries at 30.5 per 10,000 workers. Nursing assistants had the fourth highest number of days away from work with 34,210 reported compared to laborers (64,410), heavy tractor trailer truck drivers (47,860), and janitors and cleaners (35,580).
- In 2016, data from the Bureau of Labor Statistics (BLS) indicated that nursing assistants accounted for 52.8% of reported back injuries in healthcare workers occur in nursing assistants.
- Healthcare industries where workers perform patient handling tasks include the following:
- Long-Term Care – Facilities that provide skilled or non-skilled nursing care
- Acute Care – Hospitals, out-patient surgical centers, diagnostic facilities, clinics, medical offices
- Home Health Care
- The goal of safe patient handling programs should be to eliminate manual lifting whenever possible.
- The risks of manually lifting patients are compounded by the increasing weight of patients and the rapidly increasing number of older people who require assistance with the activities of daily living.
- The shape, size, and strength of the human body differs 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 home environmental conditions such as crowded living space, stair climbing, and limited or no equipment to help lift patients.
- Patient handling injuries are costly in terms of chronic pain, functional disability, and the risk of incurring repeat injuries.
- Consequences of work-related musculoskeletal injuries among nurses include higher employer costs due to medical expenses, disability compensation, absenteeism, and turnover. On average, a single worker’s compensation claim related to patient handling injuries cost $15,600. An indirect cost for replacing a nurse who leaves, factoring in the costs associated with separation, recruiting, hiring, productivity loss, orientation, and training, ranges from an estimated $27,000 to $103,000 per nurse (Li & Jones, 2012; BLS, 2016; BLS 2019a; 2019b; 2019c).
- Avoid prolonged awkward postures and standing for long periods particularly during lengthy surgical procedures at different working heights. Since employees vary in height, this can create musculoskeletal issues, fatigue, and blood pooling in extremities.
- Standing on hard work surfaces can create foot pain.
- When possible, use well-cushioned shoes, adjustable worktables and surfaces, and anti-fatigue mats.
- Poor lighting in stairwells, parking lots, and at gates is a hazard.
- Lack of physical barriers and control systems such as metal detectors, presence of security personnel, video surveillance, and alarm systems can create risk.
- Unauthorized access of individuals, especially in emergency departments, should be prohibited.
- Adequate training of staff including recognition of incidents, use of badges, and quick communication should be provided.