Slips, falls likely to rise, older HCWs at greater risk
'Don't be problem-focused, be solution-focused'
Older workers are generally safer workers, but there is one risk that rises steadily with age: slips, trips and falls. As the health care workforce ages, preventing those injuries becomes an increasingly urgent concern for hospitals.
Physiological changes, such as a diminished sense of balance and reaction time, may contribute to the greater risk of falls, says Kenneth Scott, MPH, outreach director at the Mountain and Plains Education and Research Center at the University of Colorado Aurora. Scott analyzed age-specific risks among health care workers and found that falls on the same level rose steadily with age.1
Workers who are 65 and older have a risk of falling that is five times greater than the risk among young workers who are 18 or 19, according to the analysis of 2010 data from the U.S. Bureau of Labor Statistics published in the Journal of the Association of Occupational Health Professionals in Healthcare.
"It is going to be increasingly important for slip, trip and fall programs to be strengthened in light of the aging workforce," he says.
Keeping those aging workers healthy — and in the workforce — will be important to meet the growing demand for health care services. The U.S. Bureau of Labor Statistics projects that health care will be the fastest-growing workforce through 2022.
"One of the ways to make sure you have an adequate supply of workers is recruiting and retaining older workers," says Scott. "Health status and injury status influences whether or not someone stays in the workforce."
Greatest culprit: Liquid on floors
Slips, trips and falls have been one of the leading sources of injury in hospitals, and there are clear hazards that can be addressed, says Jennifer L. Bell, PhD, research epidemiologist with the Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH) in Morgantown, WV.
"Typically no matter what worker population you look at, slipping on water or liquid contamination is the leading cause of falls," she says.
In hospitals, those liquid hazards are commonplace in kitchen areas, leading food service workers to have the highest rate of slip and fall claims, she says. In nursing homes, nurses' aides have the highest rate of falls and food service workers have the second-highest rate of claims.2
Slip-resistant footwear provides good protection for workers who are likely to be in a wet environment, says Bell, who is conducting research on the benefits of the footwear. "The slip-resistant footwear [appears] to be very effective in reducing slip injuries caused by grease and water contamination on the floor," she says.
Transitional areas also cause problems for workers. One study of slip and fall claims in seven hospitals found 58% occurred in transitional areas — dry to wet, from one floor type to another, or on uneven surfaces.3
Objects and cords create fall hazards in cluttered hallways or cramped patient rooms. (For a list of common fall hazards, see box on this page.) "It's challenging because there are so many different sources — indoors and outdoors. There's a potential tripping hazard in every room," says Bell.
Engage employees in solutions
One approach to preventing slips and falls focuses on the worker. At BJC Healthcare, a 13-hospital system based in St. Louis, MO, an awareness campaign enlisted employees to be part of the solution.
Employees could call a hotline to report slippery areas. In one contest to promote fall prevention, every employee who took action on a hazard and reported it to the hotline was entered into a monthly raffle for a small prize.
Pop-up signs were easily accessible, and employees were encouraged to put the sign over the spill before calling housekeeping. BJC provided buckets of ice-melting chemicals near employee shuttle stops so employees could place a scoop-full on icy spots.
BJC also provided a partial subsidy for slip-resistant shoes. "Our slip and fall program was successful in reducing the number of employees falling and the total workers' compensation cost the frequency and the severity," says Laurie D. Wolf, MS, CPE, Performance Improvement Engineer at Barnes-Jewish Hospital.
Awareness campaigns need to be revamped to keep them fresh, she advises. "You've got to be creative and keep coming up with new programs and incentives for employees," she says.
Wellness programs can play a role, as well. As employees age, they may benefit from exercises that improve strength and balance, such as Tai Chi. That Chinese mind-body practice has been shown to improve balance, says Scott. "It seems like that might be a good idea among older workers as well," he says.
Design out the problem
Yet falling is not the "fault" of the employee, and design changes can reduce the risk. "If you focus on the one person who fell you're never going to solve the problem. You have to focus on the environment," says Whitney Austin Gray, PhD, LEED AP, Health Research and Innovation Director at Cannon Design in Washington, DC.
"Design is not going to solve all the problems around slips, trips and falls, but it is a passive intervention," she says.
Imagine the slipperiness of wet tile versus water on rubber, she notes. In technical terms, rubber has a much higher coefficient of friction; in lay terms, it's much easier to keep your footing.
Other considerations include the design of patient rooms, hallways and storage areas to reduce clutter and cords, Gray says. (For information on the overlap between patient and employee falls, see related article below.)
NIOSH advises employee health and safety professionals to conduct rounds and look for slip, trip and fall hazards. "Each fix might seem small and inconsequential," says Bell. But together, they can result in a significant reduction in injuries, she says.
When the hospital is renovating or building an addition, employee health nurses and frontline workers should have input into the design, says Gray. "Every nurse is a health care designer. All it really takes is an awareness of your environment and [presenting the challenge] — 'Is the design the best it can be?'" she says.
"Don't be problem-focused, be solution-focused," she says.
- Scott K and Newman L. The Aging Healthcare Workforce: Employment and Occupational Injuries Among Workers in US Private Hospitals During 2010. Journal of AOHP 2013;
- Bell JL, Collins JW, Tiesman HM, et al. Slip, trip, and fall injuries to nursing care facility workers. Workplace Health & Safety 2013; 61:147-152.
- Courtney TK, Lombardi DA, Verma SK, et al. Slips, trips and falls in the hospital environment. Presentation to the American Public Health Association annual meeting, October 31, 2012, San Francisco.