Strategies for reducing slips, trips and falls

The National Institute for Occupational Safety and Health (NIOSH) identified these strategies for reducing slips and falls in hospitals:

Keep floors clean and dry

  • Encourage workers to clean up, cover and/or report floor contaminants promptly.
  • Install wall-mounted spill pads or paper towel holders conveniently throughout the hospital to provide easy access to cleaning materials.
  • Advertise the phone/pager numbers to call for housekeeping through e-mails, posters, and general awareness campaigns.
  • Install wall-mounted wet floor signs throughout the hospital to provide easy access to products to cover/identify a spill.
  • Provide walk-off mats, paper towel holders, trash cans and umbrella bags near entrances to minimize wet floors.
  • Provide cups, paper towel holders and trash cans (waste bins) near water fountains.
  • Place water-absorbent walk-off mats with beveled edges at hospital entrances. The mats should be large enough for multiple steps to fall on the mat and wide enough to cover the entire doorway. Ideally, the soles of shoes should not be depositing ice or water on the floor when they step off the mat. Consider use of those mats in areas where employees may be continually exposed to wet conditions.
  • Use appropriate methods for cleaning and degreasing kitchen floors; choose appropriate cleaning product for the conditions; mix cleaning products according to manufacturer's directions.
  • Redirect drains away from walkways with high pedestrian traffic.
  • Check that pipes are correctly aligned with the drain they are emptying into.
  • Unclog drains, particularly in kitchens, regularly.

Prevent entry into areas that are contaminated

  • Use barrier signs that block off areas (tension rod with hanging sign across doorways, tall cones with chains, hallway barriers).
  • Install pop-up tent-style warning signs in wall-mounted tubes in easy accessible locations.
  • Use taller, more noticeable STF signage (48-inch tall wet-floor signs, flashing lights on top of signs, pop-up tent style signs).
  • Promptly remove wet floor signs after the floor is dry to avoid habituation.
  • Completely block off area during floor waxing or stripping; place door-stopper barrier to prevent wax from overflowing into adjacent areas during waxing.

Use slip-resistant shoes

  • A voluntary slip-resistant shoe program was implemented, primarily for food service workers and housekeeping staff, and included ice cleats for home health nurses.

Keep walkways clear of objects and reduce clutter

Provide adequate lighting in all work areas including outdoor stairwells and parking garages

Secure loose cords, wires and tubing

  • Use cord bundlers and cord containers to secure cords under desks and computers and around medical and kitchen equipment.
  • Cover cords on floor with a beveled protective cover.
  • Organize operating rooms so that equipment cords are not stretched across walkways.
  • Consider retractable cord holders on phones in patient rooms and nursing stations.

Eliminate outdoor surface irregularities

  • Consider eliminating wheel-stops in parking areas.
  • Patch, fill or slope cracks, holes or changes in level in walkways and parking areas that are greater than 0.5 inch.
  • Create visual cues; highlight changes in curb or walkway elevation with yellow warning paint.

Eliminate indoor surface irregularities

  • Replace or restretch loose or buckled carpeting.
  • Replace mats that are curled or ripped; secure edges with carpet tape.
  • Remove, patch underneath, and replace indented or blistered tile.
  • Consider replacing smooth flooring materials with rougher surfaces with a higher coefficient of friction.
  • Patch or fill cracks in walkways that are greater than 0.25 inch.
  • Highlight changes in curb or walkway elevation with yellow warning paint.

Check stairs

  • Ensure stairs and handrails are in compliance with safety codes and recommendations.
  • Highlight the nosing of each step with contrasting paint or strips.

Prepare for ice and snow

  • Provide ice cleats (or similar product) for home health and maintenance workers to put over regular shoes.
  • Distribute winter weather e-mail warnings to all workers with e-mail access.
  • Provide bins that anyone can use to spread ice melting chemicals on icy patches outside.

General awareness campaign

  • Phone and pager numbers for maintenance and housekeeping departments prominently displayed and e-mailed intermittently to staff, to be used for reporting spills, slippery conditions, ice and other STF hazards.
  • Slips, trips, and falls hazard awareness campaigns that are promoted through health fairs, posters, paycheck inserts, and e-mails.

Joint Comm awards flu vaccination push

Hospitals rewarded for rate of 43% or more

The Joint Commission requires hospitals to work toward better rates of health care worker influenza immunization. It's an infection control standard. But now, the accrediting body also is offering an incentive for success.

In this carrot-and-stick approach, hospitals with a vaccination rate above the national average will receive recognition from the Joint Commission Resources, an education and publishing affiliate. Vaccinating just 43% of your employees will earn the recognition.

Attention! Attention! All Health Care Workers!

This is Not a Test
This is an Important Notice about Common Misperceptions of the Flu


You are not at risk for getting the flu because you're healthy, and as someone who works in a health care environment, you've been exposed to so many germs that you're immune to everything.


Health care workers can have an increased risk of exposure to the flu due to the nature of the job.


You don't have any flu symptoms so you can't transmit the flu virus to your patients.


The flu is a contagious and potentially deadly infection. Even if you don't show symptoms of having the flu yet, the virus can still be transmitted to patients. Health care workers infected with the flu can transmit the virus to patients in their care, which is particularly troubling for the many patients at high-risk for flu-related complications that can lead to serious illness, and even death (mostly in adults 65 and older). Importantly, people who live with or care for persons at high-risk of complications should get vaccinated; vaccination can help caregivers stay healthy and avoid passing the infection to others. This group includes all health care workers.


You work in a large facility and there are many staff members who don't get vaccinated against the flu. So, one flu vaccination won't make a difference.


You can demonstrate your leadership by getting vaccinated against the flu and show that quality of patient care is important to you. The CDC's Advisory Committee on Immunization Practices (ACIP) recommends an annual flu vaccination for a number of groups, including adults at high risk of complications from the flu and those persons who are in contact with them, including health care workers. In past years, flu infections have been documented in health care settings and health care workers have been implicated as the potential source of these infections.

According to the CDC, annual flu vaccination is the most effective method for preventing the flu virus infection and its complications.


The flu shot isn't safe.


The flu shot does not cause the flu. The flu shot contains inactivated viruses, which cannot cause infection. Many people will feel soreness in their arm after getting a flu shot, but, in general, flu shots are well tolerated. Other symptoms can include: mild fever, muscle pain, and feelings of discomfort or weakness, but these are generally less common. However, serious adverse events, including allergic reactions, may occur.


The flu vaccine doesn't work.


The ability of the flu vaccine to protect a person depends on the age and health status of the person getting the vaccine, and the similarity or "match" between the virus strains in the vaccine and those in circulation.


Antibiotics can work just as well as the flu vaccine.


The flu is a viral infection and cannot be treated by antibiotics. Antibiotics are not a substitute for the flu vaccine. However, antibiotics may be useful in treating infectious complications of the flu.


By January, it's too late to get the flu vaccine.


The beginning, severity and length of the flu season can vary widely from year to year. According to CDC data, the peak in flu activity between the years 1976 and 2008 frequently occurs after December, most commonly in February. In general, health care providers should begin offering vaccination soon after the vaccine becomes available and if possible by October.

The Flu Vaccination Challenge is a complement to the existing standard. The low rate required to receive recognition doesn't reflect low expectations, says Louise Kuhny, RN, MPH, MBA, CIC, senior associate director of the standards interpretation group at the Joint Commission, which is based in Oak Brook Terrace, IL.

"We are expecting organizations to continuously improve year to year in their vaccination rates," she says.

This is just another way for the Joint Commission to emphasize the importance of influenza immunization, says William Schaffner, MD, chair of the Department of Preventive Medicine at Vanderbilt University School of Medicine in Nashville and vice president of the board of directors of the National Foundation for Infectious Diseases. "It telegraphs that the Joint Commission is indeed very interested in health care worker immunization and is willing to promote these activities," he says.

Hospitals register for the program online, at They report their previous vaccination rate and set a goal to achieve by May 2009. So far, hospitals have signed up with vaccination rates ranging from 8% to 98%, says Gina T. LaMantia, MS, Med, manager of audio/web conferences for Joint Commission Resources.

"The campaign is meant to be a self-motivating program for hospitals," she says. "It's a way for them to reach an achievement, to be recognized, and to tell their customers this is something [they] value in terms of patient safety."

To help hospitals in their efforts, the Joint Commission Resources is sharing information on best practices and myths and facts about the flu vaccine. Hospitals also can improve their rates by continuing to vaccinate after the traditional fall campaign, says Schaffner. Every time an employee comes to employee health, nurses should make sure she has received the vaccine, he says.

"I'll bet you can add another 10% to your total if you keep vaccinating beyond the campaign and use every patient encounter as an opportunity to deliver influenza vaccine," he says.