Slips, trips, and falls of healthcare workers

Slips, trips, and falls (STFs) are a significant problem for healthcare workers and can result in serious injury and occupational injuries that cause time off from work. STFs are the second leading cause of serious injury among hospital workers, with overexertion being the first leading cause of nonfatal occupational injuries and illnesses according to the United States Bureau of Labor (BOL).
In 2007, BOL statistics showed incidence rates of 35 injuries per 10,000 full-time RNs that involved days away from work as well as selected events or exposures for RNs that led to injury or illness due to STFs. Data show that hospitals have a 67% higher rate of STF incidence than all other employers in U.S. private industry. The average cost to an employer when a worker experiences a fall is $12,470. Therefore, employers who implement a prevention program can experience substantial savings.
What is causing these injuries? STFs may be due to multiple factors, including wet floors, low-profile equipment and cords, poor lighting, improper footwear, improper drainage, and adverse weather conditions.
Wet floors can occur as a result of spills or routine housekeeping or can be related to weather or even assisting patients to the shower. Wet floors can best be signaled by placing highly visible “Caution: Wet floor” signs, preferably 4 feet tall and with flashing lights, in areas that have been mopped recently, or wall-mounted pop-up tents can be placed over the wet area so employees are aware of the hazard until housekeeping can address the spill. Barriers should be removed promptly once the floor is dry so they do not become trip hazards.
Anticipatory planning to avoid wet spots reduces falls. Providing lids on all cups being transported helps to avoid spills, which are particularly prone to occur at exits from the cafeteria or in an elevator. Paper-towel holders strategically placed in these high-spill areas help employees clean up the spills promptly. In clinical areas, pads can be used to temporarily cover a spill that occurs in an operating room, since fluids spilled during surgery create hazards. Nurses who assist patients in the shower can be provided positive-grip shoe covers so they do not slip or fall.
Pathways must be kept clear, particularly of low-profile equipment and cords that can be overlooked in patients’ rooms, hallways, operating rooms, or other care areas. Lighting must be adequate to visualize pathways, particularly stairways, when supplies or other items are being carried. Outside parking areas and entrances/exits must have proper lighting to aid personnel traversing the area.
Proper footwear is important in preventing STFs. Lessons can be learned from industries, such as food service and commercial fishing, in which anti-slip footwear is standard. Some manufacturers make specialized slip-resistant footwear. In addition to being slip resistant, shoes should fully surround the foot and provide support.
Certain weather conditions can lead to water being tracked indoors or can cause drainage problems across parking areas and outdoor walkways, which can create icy conditions in cold weather. Walk-off mats help when the water source is weather-related. Umbrella bags available to those entering the facility from outside in inclement weather help contain liquid that would otherwise drip onto the floor.
It is important to correct external drainage problems when possible. In some STF prevention programs, employees were provided with conveniently located ice melt that could be applied as soon as icy weather conditions occurred. Employees received weather alerts to help them plan the proper outdoor foot­wear and to exercise caution. Ice cleats can be offered to nurses who must traverse icy or snowy areas when providing home health care.
Because of the diversity of healthcare workers in terms of age, job duties, and experience in their current roles, an STF program is critical to create a safe work environment. During program development, each healthcare facility conducts a hazard vulnerability analysis to look at the facility’s unique set of hazards so they can be appropriately addressed in a workplace safety program that targets STFs.
Although STF injuries are a significant problem for healthcare workers, many STF injuries are preventable through a comprehensive preventive program.

Nancy L. Hughes is the director of ANA’s Center for Occupational and Environmental Health.

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