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Top slip and fall hazard: Water on the floor
Measures can reduce major cause of injury
The water that splashes onto the floor in the kitchen, gets tracked into the lobby on a rainy day, and spills near the nurses' station is more than just a nuisance. It's a hazard that could lead to costly injuries.
Contaminants on the floor, including water, are the leading cause of slips and falls, according to research by the National Institute for Occupational Safety and Health (NIOSH). Almost half (48%) result in sprains and strains and 8% result in fractures. Overall, slips and falls are second only to overexertion as the most common source of reportable injury in hospitals, according to U.S. Bureau of Labor Statistics data.
The good news: Slips and falls are preventable with a comprehensive program that includes walk-arounds to look for potential hazards.
"The problem can be larger than it appears at first glance," says Jennifer Bell, PhD, research epidemiologist with the Division of Safety Research at NIOSH in Morgantown, WV. "If you treat it [in as comprehensive way], as you would a safe patient handling and movement program, you can really have an impact."
Bell advises employee health professionals to look for patterns in their slip and fall incidents. But be aware that injury reports may not contain sufficient information. "Slipped on water" doesn't tell you whether the floor was wet from a recent mopping or whether a leaky pipe is creating a hazard. And too often, the report simply says an employee fell, without a full explanation, she says.
Look for the most detailed report often, that's the first report of employee injury, advises Jim Collins, PhD, MSME, associate director for science in NIOSH's Division of Safety Research.
NIOSH developed a workbook and checklist to help hospitals reduce their slips and falls (www.cdc.gov/niosh/docs/2011-123/pdfs/2011-123.pdf). An evaluation of a slips and falls prevention program at BJC Healthcare in St. Louis found that slips and falls workers compensation claims declined by 59% over a 10-year period.
A comprehensive slips and falls program involves a shift in safety culture. Hazards exist throughout the facility, so the approach must be interdisciplinary, including housekeeping, maintenance, dietary, nursing, and others.
Too many employees just walk past a spill hazard with a feeling of disregard, Collins says. "Very few people in a hospital feel that it's their responsibility to clean up spills," he says. But a comprehensive program arms them with a way to respond, from paging housekeeping to placing an absorbent spill mat on the spills.
BJC Healthcare built awareness and a spirit of fun by rewarding employees who were spotted cleaning a spill with a $25 restaurant gift certificate.
The NIOSH workbook provides suggestions on addressing hazards, from uneven pavements to tangled cords. "They are simple recommendations, but we have evidence that they are effective in preventing worker injuries," says Bell.
Top 10 causes of slips and falls
1. Contaminants on the floor, including water, grease, and other fluids. The kitchen is one of the most fall-prone areas of the hospital because of water and grease that often spills onto the floor. Water-absorbent mats and slip-resistant shoes can help prevent falls.
Highly visible barrier signs can keep employees (and visitors) from walking on floors that are still wet from cleaning. Just be sure environmental services workers don't keep the barriers up after the floor is dry, says Bell. Employees will begin to ignore the signs if they remain up when the floor is dry, she says.
If disposable spill pads are available at convenient locations, employees can place them on the spills until housekeeping arrives to clean the area. Plastic umbrella bags at doorways also minimize the dripping of water in entry areas.
2. Poor draining of pipes and drains. Sometimes the hazardous puddles of water in the kitchen or in walkways outdoors are caused by clogged drains. A walk-around inspection also may reveal drainage pipes that direct water onto sidewalks or walkways rather than draining away from them.
3. Indoor walking surface irregularities. Damaged or uneven floor tiles and buckled carpet creating unnecessary and unexpected tripping hazards.
4. Outdoor walking surface irregularities. The path from the parking lot to the hospital entrance can contain a variety of hazards, including stones and debris, holes in grassy areas, and cracks in walkways. Make sure that curbs or changes in pavement elevation are marked with yellow caution paint.
5. Weather conditions. It may seem inevitable that ice and snow will create a greater falling hazard, but there are steps you can take to reduce it. Some hospitals use temperature-sensitive ice alert signs at entrances to serve as a caution. Special bins with ice-melting chemicals and scoops allow employees to respond to icy patches. Slip-resistant mats and footwear may be especially beneficial in winter weather.
6. Inadequate lighting. Although poor lighting in itself won't cause slips and falls, it may make it more difficult for employees to see fall hazards such as uneven pavement. Make sure that walking areas both inside and outside the hospital have good lighting.
7. Stairs and handrails. Sometimes handrails are missing or are too low to be useful. Steps should be clearly marked and should be slip-resistant.
8. Step stools and ladders. Reaching for supplies from atop a step stool or ladder creates a fall hazard in many parts of the hospital from the kitchen to medical records. Train employees in the safe way to use ladders. They should wear shoes with a closed back that have sufficient tread, and they should maintain three-point contact at all times (two hands and one foot).
9. Clutter, exposed cords, and other trip hazards. As equipment is placed in patient rooms, nursing stations, and other work stations, sometimes loose cords or cables stretch into walking areas. Bundle cords, tape them to the floor, or rearrange the space to clear walkways.
10. Mats can be helpful to avoid slips and falls, but they need to be in good condition. If they are damaged or may slide on the floor, they can cause a problem instead of preventing one. Replace damaged or inadequate mats and use larger or additional mats, if necessary.