1. health and fitness

BackCare999
Patient Handling
&
Back-care
Presented by:
PW
IOSH Trainer
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 thereof
Using 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 law
Social: fewer sick days and less absenteeism
Moral: should not be injured for work
Market: bad H&S = bad publicity
Financial: accidents cost money - civil liability
Personal: avoid pain, loss, ongoing problem
Backs! 2012 campaign
5 million lost working days p.a. due to back pain
Back 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 work
130,000 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%
Chart removed to reduce size
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
% Injuries caused by manual handling
c. Construction
d. Agriculture
Health care
Construction
Furniture
Textiles
Retail
Chemicals
Agriculture
0%
10%
20%
30%
40%
50%
60%
Sites of >3 day injury caused by handling
Back 47% etc
Graphic removed to reduce size
Types of injury from manual handling
Fractures
Damage to muscles, ligaments and tendons
Spinal disc injuries
Trapped nerves
Abrasions and cuts
Burns
Work related upper limb disorders
Hernias
Death
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
Old
Young
Obese
Untrained
Those with existing injury
Tired
Pregnant women
3 most important things
Family
Home
Relationships
Wealth / ability to earn
Leisure / sports
Health
Practice lift
Demonstrate a typical lift
Demonstrate a good lift
What are the changes?
Photos removed to reduce size
Skeleton photo removed to reduce size
Vertebrae & discs
Cartilage
Nucleus
Discs Photos removed to reduce size
www.spineuniverse.com/displayarticle.php/article1431.html
Prolapsed disc
Stresses without a load
The lever principle
Centre of gravity
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Centre of gravity
Graphic removed to reduce size
Centre of gravity
Graphics removed to reduce size
Centre of gravity Photos removed to
reduce size
Principles of efficient handling
Dynamic stable base
Neutral position of body
Short levers – centre of gravity close
Correct secure hand hold
Good commands and communication
Muscles
Relaxed muscles
Body in neutral position
Static muscle fatigue
Use of major muscle groups
Graphic removed to reduce size
Team handling
What are the problems?
Photos removed to reduce size
Team handling
 Planning of lift
 Communication
•
•
•
•
•
How to grasp
When to lift
What level to carry
Which route
Set down points on route?
 Co-ordination
 Disparity of individuals: size, speed, strength
 Awkward 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 verbally
Walk the route
One person take charge of giving instructions
Stick to established teams if possible
Problem loads
Inanimate objects
 Unexpected issues
• Light
• Heavy
• Centre of gravity
 Intrinsically harmful
• Sharp edges
• Acids
 Unpredictable behaviour
• Partly fixed load
• Liquids – centre of gravity
• Poor sealing of container
People
 Unexpected issues
• Light, heavy, C of G
• Weak side / strong side
• Collapsing
 Intrinsically harmful
• Teeth & nails
• Hygiene
 Unpredictable behaviour
• Change of mind
• Struggling
• Aggression
FLUENCY
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 impact
 Less risk of pulling load onto feet & ankles
 No twisting to see where you are going
 Better position for arm joints
 Can often use both hands
 Cage less likely to tip if fixed wheels leading
But:
 Visibility may be hindered
 http://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 checks
Wheels
Foot rests
Clothing of client
Brakes
Client understands what is happening
Use
Dynamic stable base
Short 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:
Suitable
Adequately maintained
Inspected if necessary at regular intervals by a
competent person
Adequate information & training must be provided
Risks adequately controlled, e.g. guarding
Lifting Operations and Lifting
Equipment 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 Lifting
Equipment 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 Lifting
Equipment Regulations 1998 (LOLER)
Lifting operations must be:
Properly planned by a competent person
Appropriately supervised
Carried 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 responsibility
Conduct risk assessments
Reduce 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 task
Automate
Manual handling aids
People 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 regulator
Lead to action plan and improvement
Conducted by a competent person
Regularly 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 hazards
Identify who may be harmed and how
Evaluate the risk & decide on actions
Implement and document
Review
What factors contribute to manual handling
risk?
Task
Load
Working environment
Individual capability
Or
Task
Individual Capability
Load
Environment
The Task
 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?
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Individual Capability
 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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Load
Physical condition:  Size, weight and shape
 Pain
 Mobility of limbs
 Skin condition
 Conscious / unconscious
 Can they balance / weight
bear?
 Attachments e.g. catheters
Psychological State:  Understanding
 Anxiety / Fear
 Uncooperative
 Unpredictable
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Environment
 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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Controversial techniques
Drag lift
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Controversial techniques
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The Australian lift
Orthodox lift
Controversial techniques
Through-arm lift with two handlers
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Controversial techniques
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Arm and leg lug /
hammock transfer
Bear hug / pivot transfer