Injuries: Repositioning is a major culprit

Ergonomics must address this high-risk area

If your ergonomics program focuses only on patient lifts, you’re missing the greatest cause of patient-handling injuries, according to a recent study.

About 18% of health care workers are injured while repositioning patients in bed, a study at seven hospitals found.1 "I think we need to bring more attention to this problem. I don’t know if a lot of hospitals understand how big this problem really is," says Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester and lead author of the study.

Injuries occur when health care workers reach out or bend over to move a patient in bed. At the seven hospitals studied, 153 injuries resulting in strain or sprain — or 17.9% of all such injuries — occurred while repositioning a patient in bed. Patient lifts accounted for 102 (11.9%) injuries; transfers between beds and chairs resulted in 97 (11.3%) injuries; transport of patients led to 94 (11%) injuries; and lateral transfers were cited in 49 (5.7%) of injuries.

Those results highlight the difference between long-term care ergonomics and injuries at acute care hospitals. Hospital workers engage in more frequent repositioning of patients, while long-term care facilities focus more on transfer of residents from beds to chairs or wheelchairs, Fragala says.

Health care workers may not be aware of the risk associated with repositioning, he notes.

"Larger patients will increase the risk, but any adult patient is going to be of a significant weight and is going to present a risk," Fragala explains.

Ideally, hospitals should try to eliminate the need for repositioning altogether. New beds with "sheerless pivot" have been designed to prevent patients from sliding down, he says.

"To this point, there really hasn’t been an effective mechanized way to do this repositioning," he says. "We’ve been trying to do it with friction-reducing devices, but you’ve got to get them under the patient. Then once you slide the person up . . . [he or she often will] slide back down."

Mechanical repositioning devices are under development, Fragala says. Some beds have features that assist in turning. The simplest aid is a slip sheet.

"One of the immediate things [health care workers] can do is to get the bed at the appropriate height," he says. "Get help if necessary. Try to avoid awkward postures and reaching. Try some repositioning aids and friction-reducing devices." (See repositioning flowchart.)

Meanwhile, research continues into repositioning. "We need more technology to assist us to make improvements in this realm of repositioning," Fragala says.


1. Fragala G; Bailey LP. Addressing occupational strains and sprains: Musculoskeletal injuries in hospitals. AAOHN Journal 2003; 51:1-8.