Draw sheets shown to be lateral transfer hazard

Friction-reducing devices work best

When a patient needs to be moved from a bed to a stretcher, do your nurses reach across for the draw sheet and pull? If so, they’re at risk for debilitating back injury.

The awkward posture and forces placed on the lumbar spine and key joints create a hazard and make the draw sheet the worst choice for performing a lateral patient transfer,1 according to a study conducted at the Patient Safety Center of the James A. Haley VA Medical Center in Tampa, FL. A disposable plastic bag performed little better than the draw sheet.

"Many hospitals are still using draw sheets. It’s the traditional way to perform a lateral transfer from the bed to a stretcher because the sheet’s already there," says Andrea Baptiste, MA, CIE, biomechanist/ergonomist and a co-author of the study. "It’s easy, it’s time-efficient, but you’re subjecting your staff to a high risk of injuries."

The best devices have extended pull straps, minimizing the stretch and awkward posture required to conduct the transfer, she says. They also have friction-reducing properties.

Baptiste and her colleagues analyzed the forces involved in using 11 different nonmechanical lateral transfer devices, the spinal compression they cause, and the percentage of the population capable of performing the transfer safely. Friction-reducing sheets with well-positioned pull straps, such as the Phil-E-Slide and Aqua Elite flat sheet set, produced the lowest spinal compression, the study found.

How much do lateral transfers contribute to injuries? They are part of a cumulative effect, says Baptiste, who presented her findings at Safe Patient Handling and Movement Conference held recently in St. Petersburg, FL.

"Lateral transfers are just one of the many tasks [nurses] have to do. We know that it is a high-risk task," she notes.

The frequency of lateral transfers also adds to the risk, notes Guy Fragala, PhD, PE, CSP, director of compliance programs at Environmental Health and Engineering, a consulting group based in Newton, MA. He has conducted much research on patient handling and ergonomics.

You may need a variety of lateral transfer devices to meet your needs. They vary greatly by price and they have very different properties.

"Your choice of which device to use should not be a cookie-cutter approach," Baptiste notes. "It should really depend on the needs of your patient population."

For bariatric or obese patients, you may want to have mechanical lifts or air-assisted devices. For example, the On3 by Hill-Rom is designed for lateral moves using the draw sheet or pad that is already on the bed. It has a weight limit of 400 pounds, as does the Arjo TotaLift II, which can be used for lateral transfers and transport.

Air-assisted devices, such as the Air Matt, HoverMatt, or Air Pal, have no weight limit and are available in different widths to accommodate larger patients. The patient is logrolled onto the mat, which is then inflated.

Friction-reducing lateral transfer aids are the least expensive option. They include the Arjo Maxislide, a simple flat sheet that can be used to assist in repositioning as well as lateral transfer of the patient.

Hospitals should use a mix of the lateral transfer devices based on their patient population, Baptiste advises. The inexpensive slide aides may be adequate for most patients, but the air-assisted devices may be essential for bariatric patients, she points out. "All of this is based on clinical judgment. It should really depend on the needs of your patient population."

Your purchasing decision also needs to take into account other factors, Baptiste says. "Infection control is another really important issue that a lot of people forget to factor into these devices. They have to be cleaned in between patients. Are you going to have devices that stay with the patient or are you going to share them among patients?"

Using lateral transfer devices actually can save time and money by lowering the number of employees needed to perform a lift. "With the standard draw sheet, you need a lot of people to make that transfer safe," Fragala notes.

By contrast, lateral transfers with friction-reducing mats can be performed by two employees, and one employee may be able to safely use the air-supplied devices, he says.


1. Lloyd JD, Baptiste A. Biomechanical Evaluation of Friction-Reducing Devices for Lateral Patient Transfers. March 12, 2003. Web site: www.drergonomics.com/articles/Biomechanical Evaluation of Friction Reducing Devices.pdf.