Manual tasks involving patients and materials
Patient handling equipment (e.g. lifters), powered bed movers for travel between wards
Height adjustable equipment (e.g. beds/barouches
Use of trolleys
Purchasing strategies—safe and user-friendly design
Adequate lighting and space
Regular equipment maintenance
Wet, slippery floors
Traumatic injury, slip, fall
Appropriate flooring surfaces
Cancer, reproductive effects
Restricted area access
Systems to screen patients and visitors from staff
Adequate staffing levels
Needle stick injury (exposure to patient body fluid—e.g. blood
Transmission of blood-borne virus e.g. Hepatitis
Eliminate unnecessary use of sharps
Eliminate needle re-sheathing
Safe needle disposal systems
Staff training in technique and about post exposure management
Personal protective equipment
Provide latex free gloves
Alternative methods of cleaning, e.g. ultrasound
Substitute with less hazardous chemical alternative
Code of respectful conduct for all staff
Workload demands matched to staff capacity
Clarify work expectations to reduce role ambiguity
Stress management programs
When hazards have been identified an assessment of the possible outcomes following exposure, and the likelihood of it happening, needs to be undertaken. This is known as a risk assessment. The nature of the risk assessment will depend on the type of hazard, information relevant to the hazard and the available resources  This process should assist in determining the severity of the risk, the effectiveness of any existing control measures, the actions which should be taken, and the level of urgency.
Once hazards have been identified and risk assessed the next step is the development of control strategies . A hierarchical approach provides a range of options for controlling risk. These range from the most to the least preferred  As a general principle, the higher the level of assessed risk (death or serious injury) the higher up the hierarchy the control strategy should be (elimination or substitution). In descending order the preferences are:
Elimination—Removal of the hazard and its associated risk
Substitution—Where elimination is not possible the hazard is substituted for a less-hazardous option
Engineering—Where elimination or substitution are not possible engineering controls designed to reduce the level of risk are provided (such as the provision of mechanical devices
Administrative Controls—These include the development of policies and safe operating procedures, staff education and training
Personal Protective Equipment—This is the least preferred option and requires worker compliance
Note: where elimination is not possible controls are often used in combination—for example a noisy workplace may introduce engineering (noise dampening), administrative (job rotation) and PPE controls (hearing protection.
Manual handling tasks associated with patient care are an integral part, and a high risk aspect, of healthcare; they often result in musculoskeletal disorders . An example of a hazardous task is transferring a patient (who is unable to assist) from a bed to a barouche. Table 9.2 illustrates the use of the control hierarchy in the development of strategies to manage this task safely.
Control strategies for the manual handling task of moving patients from bed to barouchea
Can we eliminate (manually) moving patients from bed to barouche?
This task cannot be eliminated but the method can be improved (i.e. redesign task
What equipment could assist?
Assistive devices such as lifting devices, Hovermatts, slide boards and slide sheets may assist. These devices will reduce the load on staff
The beds are height adjustable so can be set to an appropriate height to facilitate the transfer
Are there policies to guide staff?
No lift/no injury policy
What training might be needed?
Train staff in use of new equipment, safe systems of work and problem solving
Personal protective equipment
Is there any appropriate PPE available?
PPE considerations are not appropriate
Evaluating and Reviewing Outcomes
An evaluation of control measures determines whether they are effective in controlling the risk. It also ensures that their introduction has not created an unforeseen outcome—e.g. the introduction of a new risk in another work unit. Reviewing risk controls is an ongoing process. Any change to the work environment, such as the purchase of new equipment or the identification of new hazards, generally requires a review of existing control measures.
The safety culture of an organisation is an important concept. It has been defined as “the product of individual and group values, attitudes , perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation’s health and safety management system” . It is more than the existence of a health and safety system and reflects the everyday context within which hospital staff work.
Senior staff and managers set the tone of the safety culture at the workplace and have a key role in safety promotion. Their activities reveal their beliefs about safety more strongly than their words, thus employees can determine managers’ attitudes to safety and follow their lead. While there may be an overall organisational safety culture, workgroups within an organisation may have their own discrete culture . Some teams foster a collaborative and reporting culture. Others foster a blame culture. There is a correlation between poor (negative) safety culture and work injury . Organisations with a positive safety culture are characterised by communications founded on mutual trust, by shared perceptions of the importance of safety and by confidence in the efficacy of preventive measures .
A positive safety leader will work proactively to promote safety, consult with staff, encourage the reporting of hazards and facilitate the implementation of controls. However, this frequently relies on the provision of adequate resources and staffing levels .
The most prevalent of occupational risks in healthcare is the moving and handling of patients and equipment and the adoption of sustained or static postures. Injuries related to these activities result in musculoskeletal disorders—predominantly in the lower back. These are among the most frequent and costly of work-related injuries  and have been the focus of numerous interventions and reviews. Despite consistent evidence that technique training in isolation has little to no effect on injury rates this remains the most commonly used intervention [13–15]. Where evidence for its effectiveness does exist it is as part of a multi-component intervention including exercise  and risk assessment programs .
Reasons for the ineffectiveness of training may be related to the inadequacy of the techniques taught or to the inability of the training to change ingrained behaviours . Other reasons may also be due to the failure of such training programs to address the non-physical factors such as work organization and job satisfaction  which have been linked with both the severity and prevalence of back pain [18–21].