Patient Handling &

Back-carePresented by:

P WIOSH Trainer

BackCare999

Learning

Tell me and I will forget

Show me and I may remember

Involve me and I will understand

Course objectives

By the end of the course, participants will:

Be able to demonstrate a working knowledge of

key people handling.

Have a basic knowledge of human anatomy.

Understand principle-led moving and handling

best practice.

Manual handling operations

“any transporting or supporting of a load by hand or bodily force

Includes:Lifting, putting down, pushing, pulling, carrying or

moving thereofUsing mechanical aids, e.g. trolleys

Photos removed to reduce size

Photos removed to reduce size – boxes in a factory setting

Photos of bins removed to reduce size

Driving forces

Addressing manual handling issues can lead to benefits:Legal compliance: criminal lawSocial: fewer sick days and less absenteeismMoral: should not be injured for workMarket: bad H&S = bad publicityFinancial: accidents cost money - civil liability

Personal: avoid pain, loss, ongoing problem

Backs! 2012 campaign

5 million lost working days p.a. due to back painBack pain is the nation's leading cause of disability

with 1.1 million people disabled by it.

www.hse.gov.uk/betterbacks/index.htm

Wider context – 2008/9:180 fatalities at work130,000 other major injuries

Manual handling quiz

What proportion of reported workplace accidents result from manual handling?

2008/9 reported injuries

Other 13%

Falls 8%

Struck by 15%

Slips trips 26%

Handling 38%

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Manual handling quiz

Which of the following types of workplace has the highest proportion of accidents resulting from manual handling?

a. Health care

b. Retail

c. Construction

d. Agriculture

% Injuries caused by manual handling

0% 10% 20% 30% 40% 50% 60%

Agriculture

Chemicals

Retail

Textiles

Furniture

Construction

Health care

Sites of >3 day injury caused by handlingBack 47% etcGraphic removed to reduce size

Types of injury from manual handling

FracturesDamage to muscles, ligaments and tendonsSpinal disc injuriesTrapped nervesAbrasions and cutsBurnsWork related upper limb disordersHerniasDeath

Work related upper limb disorders

WRULD or repetitive strain injuries (RSI)• Tennis elbow• Carpal tunnel syndrome• Frozen shoulder

Caused by:• Repetitive activities • Carrying out an activity for a long period of time

without adequate rest intervals • Poor posture / non-neutral joint positions

Cause of injury

Traumatic stress

Cumulative stress

Degenerative change

Psychological causes

Vulnerable groups

OldYoungObeseUntrainedThose with existing injuryTiredPregnant women

3 most important things

FamilyHomeRelationshipsWealth / ability to earnLeisure / sportsHealth

Practice lift

Demonstrate a typical liftDemonstrate a good liftWhat are the changes?

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Skeleton photo removed to reduce size

Vertebrae & discs

NucleusCartilage

Discs Photos removed to reduce size

www.spineuniverse.com/displayarticle.php/article1431.html

Prolapsed disc

Stresses without a load

The lever principle

Centre of gravityGraphic removed to reduce size

Centre of gravityGraphic removed to reduce size

Centre of gravityGraphics removed to reduce size

Centre of gravity Photos removed to reduce size

Principles of efficient handling

Dynamic stable baseNeutral position of bodyShort levers – centre of gravity closeCorrect secure hand holdGood commands and communication

MusclesRelaxed musclesBody in neutral positionStatic muscle fatigueUse of major muscle groups

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Team handlingWhat are the problems?

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Team handlingPlanning of liftCommunication

• How to grasp• When to lift• What level to carry• Which route• Set down points on route?

Co-ordinationDisparity of individuals: size, speed, strengthAwkward areas

Team handling

1 person = 100%

2 people = 66% of individual capacity

3 people = 50% of individual capacity

1 = 60

2 = 80

3 = 90

Team handling

Consider other options• Avoid• Mechanise• Use manual handling aids

Run through sequence of events verballyWalk the routeOne person take charge of giving instructionsStick to established teams if possible

Problem loads

Inanimate objectsUnexpected issues

• Light• Heavy• Centre of gravity

Intrinsically harmful• Sharp edges• Acids

Unpredictable behaviour• Partly fixed load• Liquids – centre of

gravity• Poor sealing of container

PeopleUnexpected issues

• Light, heavy, C of G• Weak side / strong side• Collapsing

Intrinsically harmful• Teeth & nails• Hygiene

Unpredictable behaviour• Change of mind• Struggling• Aggression

F L U E N C Y

A mnemonic

Feet

Load

Unlock

Even

Natural

Control

Your back

Photos removed to reduce size man handling extinguishers

Pushing and pulling

Pushing generally preferable:Operator slip or trip – no load impactLess risk of pulling load onto feet & anklesNo twisting to see where you are goingBetter position for arm jointsCan often use both handsCage less likely to tip if fixed wheels leading

But:Visibility may be hinderedhttp://www.hse.gov.uk/research/rrpdf/rr009.pdf

Pushing and pulling considerations Wheels:

• Initial direction & obstructions• Size• Fixed or rotating

Load:• Stability / safety• Visibility

Route• Obstructions• Slopes

Hands• Between waist and shoulder height• Neutral position• Avoiding impacts

Legs: “A” frame to overcome inertia Travel

• Slow speed• Avoid starting & stopping

Pushing a wheelchair

Pre-use checksWheelsFoot restsClothing of clientBrakesClient understands what is happening

UseDynamic stable baseShort levers

Health and Safety at Work etc. Act 1974

Section 2(1) general duty "to ensure, so far as is reasonably practicable, the

health, safety and welfare at work of all his employees"

Health and Safety at Work etc. Act 1974

s3: duty to others who may be affected; contractors, visitors, neighbours & public

s7: employees duties:• Take reasonable care of themselves and others • Co-operate with employer • s8: Not intentionally or recklessly interfere with or

misuse anything provided for health and safety

Management of H&S at Work Regs 1999

Every employer shall make a suitable and sufficient assessment of the risks to health and safety of employees & non-employees.

Must implement suitable preventative and protective measures.

Management of H&S at Work Regs 1999

Regulation 4: hierarchy of control measures:

• E – Eliminate• R – Reduce• I – Isolate• C – Control• S – Signage• P - PPE

Provision & Use of Work Equipment Regulations 1998 (PUWER)

Work equipment must be:SuitableAdequately maintainedInspected if necessary at regular intervals by a

competent personAdequate information & training must be providedRisks adequately controlled, e.g. guarding

Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)

Lifting equipment:Any equipment used at work for lifting or

lowering loads including attachments used for anchoring, fixing or supporting it

Loads can include a person

Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)

What documentation / marking?Safe working load marking (SWL)Thorough examination

• Every 6 months for lifting people• Otherwise 12 months

Lifting Operations and LiftingEquipment Regulations 1998 (LOLER)

Lifting operations must be:Properly planned by a competent personAppropriately supervisedCarried out in a safe manner

Human Rights Act 1988

Blanket “no lifting” policy unlawful

Regulations to not prescribe no risk regime

Some manual handling inescapable at work

Employees must accept greater risk if lifting people rather than objects

All risk assessments based on individual needs and circumstances

Manual Handling Operations Regulations 1992

Identify manual handling tasks with significant potential for injury • Can task be avoided?• Can it be mechanised?

If not, conduct risk assessment to reduce risk to lowest level reasonably practicable• Identify remedial actions• Prioritise these actions• Assign responsibility and target date

Manual Handling Operations Regulations 1992

Employers responsibilityConduct risk assessmentsReduce risk of injury as far as to lowest level

reasonably practicable

Employees responsibility• To use safe systems and procedures coming from the

risk assessment

Control measures

Eliminate the need for taskAutomateManual handling aidsPeople measures

• Safe handling techniques• Team handling• Personal protective equipment

Risk assessment

A logical and consistent way of assessing a situation and finding ways of making it safer

Logical: justify outcomes to regulatorLead to action plan and improvementConducted by a competent personRegularly reviewed

• After an accident• If workplace or practices change

Risk assessment

Hazard• Something with the potential to cause harm

Risk• Likelihood of the harm occurring and its severity

Risk assessment – 5 steps

Identify the hazardsIdentify who may be harmed and howEvaluate the risk & decide on actionsImplement and documentReview

What factors contribute to manual handling risk?

TaskLoadWorking environmentIndividual capability

OrTaskIndividual CapabilityLoadEnvironment

Is it necessary / urgent / how often? Can the client help or does it involve taking the full

body weight? What is the distance to be travelled? Is there height difference? Will it involve stooping, twisting or turning? Are other handlers necessary? Is the client accessible? What is the safest and most effective way of

completing the task? 61

The Task

Size of carer Have they been trained? Previous injuries / lack of fitness / pregnancy Inflexibility of attitude / techniques. Am I being asked

to do something unsafe? Unsuitable clothing / shoes Are they used to the environment Time available Are they able to work as part of a team

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Individual Capability

Physical condition: - Size, weight and shape Pain Mobility of limbs Skin condition Conscious / unconscious Can they balance / weight

bear? Attachments e.g. catheters

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Load

Psychological State: - Understanding Anxiety / Fear Uncooperative Unpredictable

Awkward tight spaces

Floor surfaces uneven, slippery or wet

Temperature / lighting / noise

Obstacles e.g. steps

Adjustable furniture e.g. profiling bed

Privacy

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Environment

Controversial techniques

Drag lift

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Controversial techniques

The Australian lift Orthodox lift

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Controversial techniques

Through-arm lift with two handlers

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Controversial techniques

Arm and leg lug / hammock transfer

Bear hug / pivot transfer

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