NIOSH: Slips and falls are preventable injuries

BJC Healthcare uses comprehensive program

As health care workers age, their risk of serious injury from slips, trips, and falls rises. Yet while the cause of individual accidents may seem random — coffee spilled on the floor, an icy patch on the sidewalk — comprehensive efforts can reduce the incidence by as much as 59%, according to a 10-year study conducted by the National Institute for Occupational Safety and Health (NIOSH).1

"Most people have accepted falls on the same level as unpreventible acts of God," says Jim Collins, PhD, MSME, associate director for science in NIOSH's division of safety research, and co-principal investigator of the study. "This research has shown that it is in fact possible to reduce falls by applying a comprehensive slips, trips, and falls program. We really can do something about this."

It is an important problem to tackle. Patient handling, the No. 1 cause of injury in hospitals, gets the spotlight of injury prevention. But slips, trips and falls account for about 23% of lost workday injuries and illnesses among hospital workers — making it the second leading cause of serious injury, according to the U.S. Bureau of Labor Statistics.

About 8% of those injuries involve fractures, and 48% involve strains, sprains, dislocations, and tears, according to workers' compensation data analyzed by the NIOSH researchers. Older workers (over 45) have significantly more slip-and-fall-related workers' compensation claims, although experienced workers of any age have fewer claims than those who have worked on the job for less than a year. Collins presented the findings at the annual conference of the Association of Occupational Health Professionals in Healthcare (AOHP), held in Denver in September.

With patient handling, hospitals can hire consultants and purchase equipment. "With slips and falls, there are so many different ways they can happen, places they can happen, and things that can be done. It can be challenging," says Jennifer Bell, PhD, research epidemiologist in NIOSH's Division of Safety Research in Morgantown, WV, and principal investigator of the NIOSH study.

Hospitals need to think about it as one problem with multiple dimensions, she says. That is what BJC Healthcare in St. Louis has done, both as the site of the NIOSH interventions and even after the study ended. The study was conducted at three of BJC's 13 hospitals, but interventions have been used throughout the system.

"Injury prevention is just a process of continuous improvement. It's not a one-time campaign," says Laurie Wolf, MS, CPE, ASQ-CSSBB, management engineer in patient safety and quality at Barnes Jewish Hospital, who pioneered the slips and falls efforts. "You need to keep doing it and you need to keep it fresh."

Food service at highest risk

So if you want to keep people from falling, where do you start? Bell, Wolf, and other safety experts began by looking for trends in the injury data. A red flag: The largest number of injuries occurred in food service.

A closer look at the incidents revealed that greasy or wet floors caused a hazard in the food service area. One hospital in the Barnes Jewish system installed tiles that had grooves in them — but found the floors were then difficult to keep clean.

NIOSH studied different types of slip-resistant shoes and flooring. Using ergonomics funds, BJC also bought slip-resistant shoes for the at-risk employees and requires food and nutrition services workers to wear them on the job. Slip-resistant shoes are a promising intervention, but not all brands function equally well, says Bell. She advises hospitals to find what works best for them. "Try some out in a slippery situation and see how they work," she says.

Floor cleaning is another important area of focus. BJC discovered that a degreaser was bringing the grease to the surface of the flooring but then the grease wasn't being adequately removed, Wolf says. The health care system has experimented with other cleaners and techniques, she says.

Contaminants on the floor — such as spilled food or dripping water — cause almost one-quarter (23.6%) of slips and falls, according to the NIOSH study. So Barnes Jewish Hospital tries to provide a convenient way to keep them covered until housekeeping can clean them up.

Cones, tents, or nonslip mats or even the handy placement of paper towels can provide protection. "Use anything you can immediately have on hand to cover [the spill] — pop-up tents, spill pads. Quickly put something on a spill before someone has a chance to slip on it," says Bell.

For example, when housekeepers mop the bathroom at Barnes Jewish Hospital, they put up a barrier that looks like a makeshift shower curtain, along with a "wet floor" sign. Unfortunately, that can't completely prevent people from ignoring the barrier. In one case, a woman ducked under a barrier, fell, and suffered an injury.

It takes continuous education to keep people on guard for fall risks. BJC uses fliers, e-mail, closed-circuit television ads, and a presence at health and safety fairs. "It's just a [matter of] constant awareness," says Sandy Swan, RN, BSN, MS, COHN-S/CM, manager of occupational health and ergonomics.

In fact, employees must be partners in the effort to reduce slips and falls, says Swan. Every winter, BJC issues ice alerts when wintry weather is on the way and places salt bins by the walkways. "Any employee who sees an icy area can use the ice melt," she says.

The health system also bought Yaktrax for home health employees, ice traction devices that slip over shoes.

Meanwhile, BJC continues to explore new strategies for reducing slips and falls. "It's more than just a research project," says Wolf.


1. Bell JL, Collins JW, Wolf L, et al. Evaluation of a comprehensive slip, trip, and fall prevention programme for hospital employees. Ergonomics 2008; in press.