On March 13, 2003, the Occupational Safety and Health Administration (OSHA) released the final version of its Voluntary Guidelines for Preventing Workplace Ergonomic Injuries in the Nursing Home Industry. The March 13th release follows a public comment period, a one-day meeting held by OSHA in September 2002 to discuss the draft ergonomics standards, as well as a meeting of the National Advisory Committee on Ergonomics (NACE), which contributed guidance to OSHA. The guidelines are the first set of industry-specific guidelines developed by OSHA under its initiative to reduce ergonomic-related injuries, which was initiated by Secretary of Labor Elaine L. Chow on April 5, 2002.

The final guidelines stress five areas of attention for employers: (1) developing a process for protecting workers; (2) identifying problems and implementing solutions for the lifting and repositioning of residents; (3) identifying problems and implementing solutions for activities other than resident lifting and positioning; (4) training; and (5) additional sources of ergonomic information. While the guidelines are specifically designed for the nursing home industry, OSHA states that other employers with similar working environments will find the information useful.

Among other processes for protecting workers, the guidelines suggest elimination of manual lifting of residents when feasible. The guidelines also recommend that employers develop a process for addressing ergonomics issues in their facilities and integrating such approaches into their overall safety and health program. The guidelines suggest that, to identify problems that may result from lifting and repositioning a particular resident, nursing facilities should evaluate the needs and abilities of the residents involved, including an assessment of the level of assistance each resident requires, the size and weight of the resident, the ability and willingness of the resident to understand and cooperate, and medical conditions that may influence the choice of methods for lifting or repositioning. To assist nursing home facilities with implementing solutions for resident lifting and repositioning problems, the guidelines provide 22 descriptive examples, with illustrations, of options that a facility can use. Additionally, the guidelines offer several examples of possible solutions for activities other than resident lifting and repositioning, including storage and transfer of food and supplies; handling of mobile medical equipment; working with liquids in housekeeping and in kitchens; working with hand tools, linen carts, and bags; as well as working in deep sinks.

The guidelines also suggest preemptive training of nursing home employees, their supervisors, and program managers responsible for implementing a nursing home's ergonomics efforts. The guidelines suggest employees be trained prior to lifting or repositioning residents and receive education sufficient to ensure workers understand policies and procedures, how to recognize musculo-skeletal disorders, and the procedures for reporting such injuries. The guidelines also suggest that charge nurses and supervisors be trained in how to effectively reinforce the safety program of a nursing home facility, with a focus on the issues specific to the particular facility. Finally, the guidelines suggest that program managers be trained on effective methods for identifying potential problems through observation of various employees, the use of checklists, use of injury data analyses, and other analytical tools.

The Nursing Home Ergonomics Guidelines are available through OSHA's website at:

www.osha.gov/ergonomics/guidelines/
nursinghome/final_nh_guidelines.pdf.