NIOSH project seeks to prevent slips and falls
Are you ignoring the second costliest occupational injuries in hospitals? If so, you’re not alone. Hospitals are spending thousands of dollars to prevent ergonomic injuries, but devote little attention to the second most common and costly injuries: slips and falls.
Injuries from falls are about 40% more common in hospitals than in general industry, according to 2000 data from the Bureau of Labor Statistics. They cause more than 14,000 reported injuries per year, leading to back sprains, fractures, and lost workdays. And they are difficult to prevent.
Bringing the problem into focus
For all of those reasons, injuries from slips and falls in hospitals have become the focus of a comprehensive new study by the National Institute for Occupational Safety and Health (NIOSH) in the Morgantown, WV, research office.
"From the standpoint of nonfatal traumatic injuries, once you roll out your back injury program, this rises to the top [as a priority]," says James Collins, PhD, MSME, NIOSH epidemiologist/engineer and project officer for the Slips and Falls Prevention in Health Care Workers project. "That’s your No. 1 injury problem right behind the ergonomics issue."
"[But] it’s a little bit of a different situation because it’s not really clear how it’s to be controlled," he adds.
Collins is working with BJC Health Care in St. Louis, a 13-hospital system that hopes to save $1 million or more through prevention activities.
"Every year, we analyze our injuries and look at which entity has the worst injury rates and what type of injuries they are," says Laurie Wolf, MS, CPE, ergonomist and manager of WellAware program at BJC Health Care.
"The reason we’re so interested in slips and falls is that our workers’ comp claims are about equal to our back injuries," she says.
In 1999, an icy winter contributed to an awful year for slips and falls for BJC’s 22,000 employees. (The system includes five long-term care facilities and eight home health care units.)
That year, 55 outdoor injuries and 165 indoor injuries led to a peak of about $2 million in fall-related workers’ compensation claims, a substantial portion of the system’s $5 million total claims costs. Falls led to broken hips, shattered kneecaps, and broken legs, in addition to the usual bruises and sprains.
Wolf also realizes that her staff may become more vulnerable to serious injury as the work force ages. "If a fall happens when you’re 20, you might get up and walk away. If that same fall happens when you’re 45 or 50, you’re going to break something," she says.
Modest goal of 20% improvement
Often, falls seem like isolated incidents. One day, someone slips on a bit of soapy water that sloshed from a bucket. Another day, someone steps on an icy patch on the steps and falls. Could the events have been prevented?
By the time Collins finishes his three-year project, he hopes the answer will be yes — at least, sometimes, he says.
Collins is working with researchers from the Liberty Mutual Research Center for Safety and Health in Hopkinton, MA, and the Finnish Institute for Occupational Safety and Health in Helsinki, Finland.
They will review six years of injury data and compare interventions at five hospitals — including two Veterans Affairs facilities — with seven control hospitals. They will conduct laboratory tests of flooring, slip-resistant shoes, and floor waxes.
Yet Collins has modest goals. He doesn’t anticipate the dramatic gains that occur with patient-handling equipment or safer needle devices.
"When you put every conceivable effort going in, we’re looking at achieving a 20% reduction [in falls]," he says. "We’re trying to be realistic about it."
Still, a 20% reduction would amount to $400,000 in savings for BJC, based on the 1999 data. Wolf hopes the efforts might yield even more.
When Collins reviewed the results of 29 interviews on cases of falls, only one reported no injuries. There were four extremity sprains, three fractures, and 21 contusions and lacerations.
Let’s step outside
While falls may seem to involve unique circumstances, they can be grouped in some broad categories. For example, about a quarter of BJC’s falls occur outside.
Icy weather creates problems, but sometimes there’s an unnoticeable hole in the grass. Home health workers may trip as they approach someone’s house.
In one case, a shuttle bus let off employees at a spot where a downspout drained and left a puddle of ice. The hospital moved the shuttle stop. But most interventions are not so clear-cut.
"I can’t say [the falls are] all at the front entry way because it’s wet," Wolf says. "It’s not that simple. We’re trying to do a little bit of intervention everywhere."
In the winter, BJC now sends out e-mail alerts to staff when bad weather is expected, urging them to take precautions. Administrators ask employees to report slippery patches to safety contacts so the areas can be plowed or salted.
Researchers to test shoes, flooring
A shoe with no traction, a newly waxed floor, a little moisture: That’s a disaster scenario that Collins will try to unravel in the laboratory.
He’ll test unglazed ceramic tiles (with and without anti-skid particles), rubber, linoleum, vinyl tile, and sheet vinyl as well as new flooring materials for their friction measurements.
Collins says he will try to determine which types of shoes most commonly are worn, and will compare their slip resistance with that of special slip-resistant soles. NIOSH researchers will visit test hospitals and conduct friction measurements on site. Researchers also will compare the impact of various floor waxes.
Meanwhile, Collins is seeking interventions that reduce the hazards. For example, housekeeping managers will receive beepers so they can be notified immediately when there is a spill and act quickly to clean it up and mark the area as a fall hazard.
"I think our greatest hope is going to lie in aggressive housekeeping, keeping the floors clean and dry, and keeping wet floor signs down with chains on them so people can’t just run through the area," he says.
Then there are problems specific to different parts of the hospital. In the cafeteria, spilled oil or sloshing dishwater can leave dangerous slip zones.
In the operating room, infection control booties that become wet from water, blood, or other fluids can be as slick as an ice skate. The marble in the hospital lobby becomes a fall hazard when people track in rainwater.
For every problem that’s identified, Collins and his colleagues will look for a solution. In fact, he notes, there has never been such a comprehensive approach taken to occupational slips and falls in the hospital setting.
"Let’s hope we can cut down some injuries," he says.
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