Health Care

More than Love Handles

Beth-Stowell-lg2 Posted by Beth Stowell, BS, MPH, COHN‐S, CHSP

Emily Post’s book of etiquette indicates that a gentleman should put his hand under a women’s elbow as she steps off the curb to prevent any risk of falling. This courtesy may have started as early as the 1800’s with ladies’ large petticoats.  At the time, who would have thought about the potential damage this support could cause to the shoulder girdle?  In the 21st century this is a concern, particularly to caregivers in the healthcare industry.

The shoulder joint is a ball and socket held in place with ligaments.  Tendons then connect muscles to the skeletal structure.  As we age, this overused joint can be damaged by helpful loved ones and/or caregivers.  We may not only need help stepping off the curb, but rising out of a chair, moving onto a toilet, and getting into the car.

The shoulder girdle is not designed for the stress incurred when the arm is used as a “handle” to raise a person out of a seated posture.  This is hazardous to both the resident/patient and the caregiver.  MEMIC has long recognized the injury exposure “lifting” places on healthcare workers.  Preventing lifting injuries to both caregivers and patients starts with eliminating the act of “lifting”.

The traditional gait belt was used by physical therapists to help guide and assist patients when re-learning to ambulate. Over the years, caregivers have mutated its use into handles for assisting patients/residents to a standing posture.  In January 2016, MEMIC committed to provide our healthcare industry policyholders a different type of gait belt.  We call this product the Safe Assist Belt (SAB).  The SAB includes vertical handles on a wide padded belt with slip resistant material on the inside.  The padding makes it much more comfortable for the patient/resident, and the handles allow a more neutral wrist posture.  However, it is not just the vertical handles and padding that is significant.  The SAB is intended to replace the traditional gait belt, but also requires a new method to assist residents/patients. Now the mechanism to elevate a seated person is a push/pull using the legs and not a “lift” which required the use of the bicep and lower back. 

The new device requires training for all caregivers.  The training not only addresses the change in technique, but an explanation as to why this change will improve the safety of the caregiver and improve quality of care for patients/residents. Training the frontline caregivers is rewarding as they learn the technique and realize this new tool makes their job safer and easier. Changing the technique comes with challenges.  A new habit must be developed.  However, taking the lift out of the maneuver is imperative.  Below you can see the” right pull” and the “incorrect lift”. 

For further assistance with training, including a demonstration video, check out the resources in the MEMIC Safety Academy or contact your MEMIC Safety Management Consultant.

  

Pic 1The "right pull" technique.

 Pic2The "incorrect lift." 


Bloodborne Pathogens – When is a Program Required?

SylvesterPosted by Rob Sylvester, CEHT

A Bloodborne Pathogens (BBP) program is a given for healthcare organizations, but what about other industries? Requirements may apply to more than just bloodborne pathogens.  OSHA identifies a host of “other potentially infectious materials.” Taken directly from CFR1910.1030:

Other Potentially Infectious Materials means

(1) The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids; 

Many of you may be thinking, “My employees don’t come into contact with that stuff!Generally, if you work in a machine shop or a grocery store you would be correct, but there may be exceptions. For example, an employee, visitor, or customer cuts themselves. The injured person is unable to clean up their own blood as they were whisked off to the urgent care clinic. Who then is responsible for cleanup?  How about your designated first responders or those providing first aid? If so, they are covered by the standard. Injuries like these are fairly common, and the business disruption while the cleanup takes place can be significant. Safe and expeditious cleanup comes from personnel thoroughly trained in proper cleaning methods and personal protection. 

Housekeepers in the hospitality industry may also be covered by this standard. It’s likely that these workers will encounter human body fluids while cleaning hotel rooms, bathrooms, and other public spaces. OSHA’s letters of interpretation don’t dictate either way, but put the responsibility on the employer to make this determination. Providing awareness training is prudent in this case. You can find additional letters of interpretation here

In closing, ask yourself this simple question: “Is there a reasonable expectation that employees will come into contact with blood or other potentially infectious materials?” If the answer is “no” then a program is likely not required. If the answer is “yes”, or even “maybe” then a program compliant with CFR 1910.1030 is required.

MEMIC customers have access to program templates and training located in the Safety Director along with additional training in the Safety Academy. Additional information is available from your MEMIC Safety Management consultant, your broker/agent, third party consultants, or OSHA/DOL Consultation Department.

 


OSHA & Healthcare: Update 2017

DarnleyPosted by David Darnley, MS, CHSP

People ask many questions when it comes to healthcare facilities.  Hospitals and nursing homes are under scrutiny and many want to know, “How do they compare?” This is often surrounding patient care issues, but OSHA wants everyone to be aware of incident rates as well.  How do accident histories compare to competitors and other like operations?  Similarly, prospective patients or residents and/or potential employees are often interested in this information. “How safe is it to work in that facility?” Thanks to OSHA’s new rule on electronic tracking and posting of injury data, everyone will have access to this information.

Beginning July 1, 2017, any healthcare facility with 20 or more employees is required to electronically submit the injury and illness data from their OSHA 300A summary logs.  For the following year, employers will be required to submit data from the 300A summary, 300 log, and 301 or equivalent.  Check out Adam Levesque’s recent post addressing the new requirements for many industries.  

This, and other information such as OSHA’s five points of emphasis for healthcare, safe patient handling, standard enforcement, and what to expect during an OSHA inspection will be discussed in our upcoming webinar, “OSHA & Healthcare: Update 2017”. 

MEMIC customers are welcome to join us for the live webinar on February 16th at 10:00am EST. To register, please click here.

 


Safe Patient/Resident Handling and Mobility Program Pulse Check

Sylvester Posted by Rob Sylvester, CEHT

With the recent concentration of OSHA on healthcare facilities, along with state initiatives and the increasing risks in healthcare, have you asked your team lately if your program up to speed? Programs are shown to reduce patient injury, reduce staff injury along with associated costs and absenteeism. In addition, they improve recruitment, retention and morale of staff!

The Healthcare industry is growing rapidly and so are the risks associated with it. We can help you focus on the areas where injuries happen all too often. In most cases, patient/resident handling injuries are the leader. We partner with our clients to concentrate on sustainable policies and procedures to help reduce injuries. We offer (free of charge) and strongly encourage that our healthcare clients partner with us to conduct our Safe Patient/Resident Handling and Mobility workshop. This didactic workshop includes discussion on patient handling challenges, ergonomic basics in the healthcare environment and high risk tasks, developing solutions including discussion of various patient handling equipment and provides assistance with establishing a safe patient handling committee. See our healthcare safety topics here.

In 2010, nursing homes and personal care facilities had one of the highest rates of injury and illness among industries for which lost workday injury and illness (LWDII) rates are calculated. According to the Bureau of Labor Statistics, nursing and personal care facilities experienced an average LWDII rate of 4.9 compared with 1.8 for private industry as a whole, despite the fact that feasible controls are available to address hazards within this industry.

Has your team:

  • Developed a written policy?
  • Conducted a patient handling hazard assessment?
  • Provided initial training to all current employees and built into new hire orientation?
  • Developed an annual training program?
  • Developed a process to utilize for incident investigation and post-accident review?
  • Developed a process to conduct an annual performance evaluation of your program to determine its effectiveness?
  • Developed a process to review and incorporate architectural plans as they relate to SPH?
  • Developed a process by which employees may refuse to perform or be involved in patient handling if they feel it exposes the patient of employee to an unacceptable risk of injury?

For more information on this topic, MEMIC policyholders can access our recorded webinar entitled “Safe Patient Resident Handling and Mobility Program” via MEMIC’s Safety Director.

 


The ABCs of Dementia - A Caregiver's Guide

MEMIC recently invited Dementia Care Specialist Heather McKay to lead a policyholder webinar series and the response has been overwhelming. This is no surprise as Heather is an incredibly knowledgeable and dynamic presenter and millions of families struggle to support a loved one with Alzheimer's or other forms of dementia.

As presented in this series, dementia is an umbrella term that describes many diseases that are extremely challenging, both for the patient and the caregiver. Symptoms can vary greatly day to day, even hour to hour. “Sundowning” is an increase in behavioral problems beginning at dusk. Sometimes early morning is most difficult with the combination of dementia, fatigue, and low blood sugar levels. Physical exhaustion due to lack of sleep can greatly increase the frustration of both the patient and caregiver.

In this video excerpt, Heather shares a story of how a simple change to the morning routine, giving her husband a glass of juice first thing before making breakfast, created an entirely different morning experience. These videos also cover how memory changes take place, how caregivers can approach and communicate effectively, methods of dealing with distress and recognizing changes, and providing end-of-life care. This eight-part Dementia Care Training Video Series is available to assist not only professional caregivers, but anyone who has someone in their life suffering from dementia.

MEMIC policyholders can view the video training series any time by logging on to the MEMIC Safety Director. Here is what some of our policyholders have to say about the series:

“It is the best presentation on dementia that I have ever watched. I think anyone working with people suffering from dementia should see this series.”

“I really enjoyed Heather’s stories and how they relate to dementia and treatment. She was very lively and engaging!”

”The presenter was excellent in her teaching methodology and the information she presented was invaluable!"

“The sessions were both engaging and informative – I had many positive comments regarding the training from all of the nursing staff who attended. I witnessed many of them have ‘aha’ moments during the training and it was a beautiful thing to then watch them return to their units and actually apply the techniques that were taught.”


OSHA Safe Patient Handling Inspections

Rob Sylvester 2013 Posted by Rob Sylvester, CEHT
  

OSHA has previously issued guidance directed to the health care industry for safe patient handling procedures and now intends to enforce this guidance. With its recent announcement OSHA is indicating they will now inspect the facility’s patient and/or resident handling programs. They will be reviewing program management, program implementation, and employee training. Are you prepared?

The healthcare industry is growing rapidly and so are the risks associated with it. MEMIC can help you focus on the areas where injuries happen all too often. In most cases, patient/resident handling injuries are the leader. We partner with our clients to concentrate on sustainable policies and procedures to help reduce injuries. We offer (free of charge) and strongly encourage that our healthcare clients partner with us to conduct our Safe Patient/Resident Handling and Mobility workshop. This six hour didactic workshop includes patient handling challenges, ergonomic basics in the healthcare environment, and high risk tasks, developing solutions including discussion of patient handling equipment and providing assistance with establishing a safe patient handling task force and committee. Additional healthcare information can be found on our Popular Safety Topics page.

In addition, the Safety Director includes a safe patient handling policy template, program implementation timeline, bloodborne pathogens information, PowerPoint presentations, and videos (including quizzes to ensure comprehension), along with other resources such as recorded Workplace Violence webinars. Sign up here to ensure you don’t miss any of our workshops and webinars!

Did you know that a hospital is one of the most hazardous places to work? According to OSHA, in 2011 U.S. hospitals recorded 253,700 work-related injuries and illnesses, a rate of 6.8 work-related injuries and illnesses for every 100 full-time employees. This is almost twice the rate for private industry as a whole. More information can be found in this OSHA resource Worker Safety in Hospitals.

In 2010, nursing homes and personal care facilities had one of the highest rates of injury and illness among industries for which lost workday injury and illness (LWDII) rates are calculated. According to the Bureau of Labor Statistics, nursing and personal care facilities experienced an average LWDII rate of 4.9 compared with 1.8 for private industry as a whole, despite the fact that feasible controls are available to address hazards within this industry. (Source: https://www.osha.gov/SLTC/nursinghome/index.html)

OSHA offers additional resources with an e-tool for Hospitals and an e-Tool Experts section that outlines applicable standards.


OSHA Healthcare Inspections

Rob Sylvester 2013 Posted by Rob Sylvester, CEHT

Did you know OSHA issued a memorandum to its regions on June 25, 2015, providing further inspection guidance for inpatient healthcare settings? Are you prepared? This applies to North American Industry Classification System (NAICS) Major Groups 622 (hospitals) and 623 (nursing and residential care facilities).

OSHA is indicating that regardless of how they may come to inspect a hospital or nursing home they will focus on hazards included in the recently-concluded National Emphasis Program - Nursing and Residential Care Facilities, CPL 03-00-016 (NH-NEP). This can include a scheduled inspection, an employee complaint about another issue, a report of a serious injury, a referral by another agency, or other resources. Those hazards include:

  • Musculoskeletal disorders (MSDs) relating to patient or resident handling. BLS data for CY 2013 demonstrates that almost half (44 percent) of all reported injuries within the healthcare industry (NAICS 622 and 623) were attributed to overexertion-related incidents. In comparison, that rate equates to almost one and a half times the total MSD rate (33 percent) for all reported injuries for all industries.
  • Workplace violence (WPV), these industries have four times the rate of incidents compared to other industries. MEMIC policyholders can click here to register for a free webinar entitled “Workplace Violence in Acute Care Settings” at 10:00 a.m. on October 15, 2015.
  • Bloodborne pathogens (BBP), one of the most frequently cited standards in nursing and residential care facilities is 29 CFR 1910.1030, the Bloodborne Pathogens Standard.
  • Tuberculosis (TB), employees working in nursing and residential care facilities have been identified by the CDC as being among the occupational groups with the highest risk for exposure to TB due to the case rate of disease among persons 65 years of age.
  • Slips, trips and falls (STFs). Overexertion together with slips, trips, and falls accounted for 68.6% of all reported cases with days away for CY 2013 in this industry.

In addition to the focus hazards listed above, other hazards that may be encountered in inpatient healthcare settings include, but are not limited to:

  • Exposure to multi-drug resistant organisms (MDROs), such as Methicillin-resistant Staphylococcus aureus (MRSA).
  • Exposures to hazardous chemicals, such as sanitizers, disinfectants, anesthetic gases, and hazardous drugs.

State Plans are expected to follow the guidance provided in this memorandum. State Plans may have an existing State Emphasis Program (SEP), or, similar to OSHA’s Regions, determine that an SEP is warranted after reviewing relevant state data. Additional information regarding inspections can be found on the OSHA website.

The goal of this policy is to significantly reduce overexposures to these hazards through a combination of enforcement, compliance assistance, and outreach.

Clipboard.Inspection.Healthcare


Taking Care of Those Who Take Care of Us

Beth Stowell Posted by Beth Stowell, BS, MPH, COHN-S, CHSP

As highlighted in a recent NPR series on injured nurses, those who take care of us professionally have not always received the best injury prevention training and technology while on the job. Healthcare workers suffer higher rates of musculoskeletal injuries than any other occupation; these injuries are often caused by manually lifting and moving patients in hospitals or residents in elder care facilities. Direct and indirect costs associated with back injuries in the healthcare industry are estimated by the National Institute for Occupational Safety and Health (NIOSH) to be a staggering $20 billion annually!

To help reduce these healthcare worker injuries through improved safe patient handling, MEMIC is now providing newly designed safe assist belts (commonly referred to as gait belts) to several hundred of our healthcare policyholders across the Eastern Seaboard. Safety management consultants hand deliver the belts and provide training on the proper use of these ergonomically improved gait belts.

I’ve already delivered a safe assist belt to Eric Pooler, the administrator at Southridge Rehabilitation and Living Center in Biddeford, Maine. He told me what I’ve heard echoed at many healthcare facilities; the older style gait belts are not easy to use and are not well-liked by the staff nor the residents. He believed they would find success with the new belts because they are much easier to use. The residents may actually start asking for them because they are much more comfortable.

I showed Eric how using the legs (instead of arms and back) with a push-pull method, enhanced by the ergonomic design and vertical handles of the safe assist belt, is far easier and less stressful on the caregiver’s body than the riskier lifting methods that are too often practiced with conventional gait belts. The safe assist belts are also wider than conventional gait belts with extra padding and a slip resistant lining for enhanced patient comfort.

Beth Stowell Gait Belts
[MEMIC safety management consultant Beth Stowell providing a safe assist belt to Eric Pooler, administrator at Southridge Rehabilitation and Living Center in Biddeford, Maine.]

Over the years patient handling has changed tremendously. When I started in nursing school the ‘hook and toss’ method of raising people up by their armpits was the norm, but that method can actually do damage to the patient’s or resident’s shoulders. As a result, the traditional gait belt, which wraps around a patient’s waist and was originally intended for caregivers to assist the patient with walking and ambulation, became a common method for patient lifting. The misuse of the device as “patient handles” to lift patients increases the chance of injury to the caregiver and can be uncomfortable for the patient.

MEMIC has had great success in supporting cultural changes in healthcare facilities. MEMIC is now investing more than ten thousand dollars in the safe assist belt program so that caregivers and employers will see the benefits these advanced safe assist belts have in providing superior care and reducing injuries. MEMIC has also negotiated a discount rate from the manufacturer to make it that much easier for facilities to replace their older belts and lifting methods. Advances in safe patient handling through improved tools, like the safe assist belt, and reinforced by improved training is truly a win-win-win for patients, healthcare workers and their employers.

Click here for more information on the safe assist belt.

  MEMIC Team Gait Belts
[MEMIC safety management consultants for the territories of Florida, Virginia, Maryland, Pennsylvania, New Jersey, New York, Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire and Maine pick up safe assist belts at MEMIC’s Albany, New York office.]

  GaitBeltDesign


 

 


How Much Is Too Much To Lift?

Scott Valorose 2014 Posted by Scott Valorose, CPE, CSP

What a great question. It is often answered by professional ergonomists, safety consultants, physical and occupational therapists, and the like with – it depends. Helpful right? The fact is, it depends on several factors such as the size of the load, the load’s center, its stability, or whether it has handles or not. How close one gets to the load and the beginning and final heights of a lift are important factors. What if a load is rarely lifted versus frequently lifted? Who’s performing the lift: a male or female; someone who’s 25 or 55 years old; an experienced trained employee or a new hire with little experience and a basic orientation; a larger and therefore [typically] stronger person or someone just hired to do the job?

In terms of a specific number, many workplaces have established a 50-pound manual lifting limit. Heavier loads are either, substituted, eliminated, or lifted by mechanical means. More and more healthcare facilities acknowledge 35 pounds as their maximum load to manually lift or transfer a patient or resident. These limits should be considered the maximum loads if manual lifting is performed under optimal conditions. If a load is too far away, near the floor, or can suddenly shift, then lower limits need to be considered. These adopted limits have been established from decades of research and can be enforceable by OSHA:

NIOSH - Revised Lifting Equation
OSHA - Heavy Lifting
OSHA - General Duty Clause & Lifting Limit
Thomas R. Waters, PhD – When Is It Safe to Manually Lift a Patient?
OSHA - Safe Patient Handling
Fragala Commentary - 35 Pounds & Better Understanding of Limits

To some, these numbers may seem low but it’s important to recognize that the question is not simply about strength. As one leading researcher in the industry stated back in the late 1960’s, the question is about “capacity” or what we’re physically capable of over time without undue fatigue or injury.

If you’re struggling to answer this question, reach out to your loss control consultant or contact Christine Collomy, Loss Control Service Coordinator, at ccollomy@memic.com.

BoxLiftAniBlog


What Is This Herd Immunity?

Tony Jones 2014 Posted by: Anthony Jones, RN, COHN

Three times in the last year I have heard the term “Herd Immunity.” The first was during my physical, in the history taking portion. The second time was during treatment of a minor eye infection. The third was in an article I was studying for continuing education in occupational health. The rather odd sounding phrase prompted a little intellectual curiosity. “What is this herd immunity?”

“Herd Immunity; A Rough Guide” lists three uses for the term “herd immunity.” Used to:

  1. Describe the portion of “immune” individuals within a population.
  2. Threshold portion of immune individuals that should lead to a decline in incidence of infection.
  3. Risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals.

As I understand it, the basic theory of “herd immunity” is this: the incidence of a disease decreases over time because more people are immune to the disease. If a large percentage of the population is immune to a disease, the risk of transmitting the disease declines because less people are becoming sick. The cycle of disease transmission is theoretically broken.

Vaccination programs obviously provide an important element in the battle against the spread of communicable disease. The subject gets complex as more people elect to forgo immunizations, or have never had the opportunity for vaccinations.

I found this reference to a CDC (Centers for Disease Control and Prevention) report in a “Health Day” article listing the percentage of adults in the general population that have received vaccinations for specific diseases. The adult/vaccination rates included:

  1. Pneumonia: Overall, 20 percent of high-risk adults received this vaccination in 2012, about the same number as in 2011. Among adults 65 and older, 60 percent were vaccinated overall.
  2. Tetanus: About 64 percent of adults aged 19 to 64 received some tetanus-containing vaccine in the previous 10 years -- about the same as the previous year.
  3. Tdap: Coverage against diphtheria, pertussis and tetanus increased modestly to nearly 16 percent, but in homes with infants under 1 year, coverage was almost 26 percent, similar to the prior year.
  4. Hepatitis A: Only 12 percent of adults aged 19 to 49 had full hepatitis A vaccination coverage (at least two doses) in 2012.
  5. Hepatitis B: About 35 percent of U.S. adults aged 19 to 49 had the recommended three or more doses of hepatitis B vaccine, much the same as in 2011.
  6. Herpes Zoster: Twenty percent of adults age 60 and older received this vaccine to protect against shingles, up from fewer than 16 percent in 2011.
  7. HPV: Almost 35 percent of women aged 19 to 26 received one or more doses of this vaccine, which protects against cervical cancer, up from about 30 percent the year before. About 2 percent of males in this age group got the vaccine, similar to the 2011 number.

What’s the implication for businesses? Sick workers can’t work. An outbreak of some of the diseases listed above can spread rapidly through a largely unprotected work force. Healthcare workers and other employees with direct contact with the very young, elderly and critically sick persons can have a dramatic impact on outcomes.

Are your workers aware of the health effects of some of these diseases? Are workers making use of medical resources available to them? Have vaccines been included in the medical benefits package? What’s your immunological status?

This CDC Quiz can be a tool to help an adult determine what vaccines are recommended based upon one’s answers.

image from www.sott.net