Injury prevention measures that reduce job risks to nurses and nurse assistants are urgently needed as part of a safety culture that emphasizes continuous improvement and resources such as patient lifting equipment and ongoing training, the Occupational Health Safety Network (OHSN) reports.

The OHSN is a Web-based portal that collects data about injuries among healthcare personnel at U.S. health care facilities to help target prevention efforts and measure their impact.

“OHSN does not collect culture of safety indicators, but in general we encourage a culture of safety and the attitude that every single injury is an opportunity to find the risk factor for the injury and put in place an unceasing effort to prevent similar future injuries,” says Ahmed Gomaa, MD, ScD, MSPH, a medical officer in the surveillance hazard evaluation branch of the National Institute for Occupational Safety and Health (NIOSH).

OHSN collected data on OSHA-reportable injuries at 112 hospitals in 19 states from January 1, 2012–September 30, 2014. The report included 10,680 total injuries, including 4,674 caused by patient handling; 3,972 that resulted from slips, trips, and falls; and 2,034 due to workplace violence — primarily physical assaults by patients.1

Incidence rates for patient handling; slips, trips, and falls; and workplace violence were 11.3, 9.6, and 4.9 incidents per 10,000 worker-months, respectively. (A worker-month was defined as the number of full-time equivalent workers at a facility multiplied by the number of months worked within the reporting period. For example, a facility with a stable workforce of 1,000 full-time workers has 12,000 worker-months in a 12-month reporting period. If this same facility reported data for only eight months, then they would have 8,000 worker-months.)

Patient handling and workplace violence injury rates were highest in inpatient adult wards, particularly in outpatient emergency departments, urgent care, and acute care centers and adult critical care departments. Rates of falls were highest in inpatient adult wards, non-patient care maintenance areas, and operating rooms. Of all patient handling injury reports, 62% included data on the use of lifting equipment. Of those, 82% of the injuries occurred when lifting equipment was not used.

“Similar to findings from other studies, OHSN data indicates that interventions [like] the use of lifting equipment could potentially reduce patient-handling injuries, particularly for activities involving positioning, transferring, or lifting a patient,” Gomaa says.

Slips, trips, falls

Those activities can result in musculoskeletal injuries and disorders, which are increasing among health care workers, the OHSN report noted. Nursing staff are routinely exposed to several musculoskeletal disorder risk factors, including:

• caring for overweight/obese and acutely ill patients;

• high patient-to-nurse ratios;

• long shifts;

• efforts to mobilize patients almost immediately after medical interventions.

Of all slips, trips, and falls injury reports, 65% had data on fall type. Of those 89% were falls on the same level, 9% were falls to a lower level (e.g., down stairs, ramps, etc.) and 2% were slips and trips without falling. On the basis of OHSN findings, the major causes of slip, trip, and fall injuries are floor contaminants and contact with objects. However, the variability in types of these injuries indicates that each facility should use facility-specific data to guide prevention measures. The OHSN Web page provides links to helpful resources on safe patient handling methods and prevention of falls among health care personnel, including a comprehensive falls hazards checklist. (

Nurse assistants were more likely to sustain injuries than workers in other job categories; this occupation had more than twice the injury rate of nurses for patient handling and workplace violence injuries. Injury rates for slips, trips, and falls were highest among nonpatient care staff (e.g., maintenance and security staff), nursing assistants, and nurses. Between 2012 and 2014, workplace violence injury rates increased for all job classifications and nearly doubled for nurse assistants and nurses.

Overall, the data indicate that interventions should first focus on prevention of injuries to nurse assistants and nurses from patient handling; slips, trips, and falls; and workplace violence. Patient handling and workplace violence injuries reported to OHSN were clustered in locations providing direct patient care, while slips, trips, and fall injuries occurred in both patient and non-patient areas. Analysis of detailed, facility-level data could identify the higher risk occupations and locations of each facility and assist in customizing prevention measures, the OHSN concluded.

“A culture of safety has been achieved if the healthcare facility — frontline workers up to top management — believe that their facility should offer the best hospital safety,” Gomaa says. [They] have a daily huddle and strive to target prevention opportunities based on data-driven information. Hospital safety means patient safety, worker safety, and environmental safety — which are highly interrelated.”


  1. Centers for Disease Control and Prevention. Occupational Traumatic Injuries Among Workers in Health Care Facilities — United States, 2012–2014. MMWR 2015:64(15);405-410