Nursing Home eTool
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Common safety and health topics:
Acute and chronic back injury caused by:
- Lifting, reaching, or moving residents who cannot move on their own.
- Awkward postures: pulling lifting patients from tubs, whirlpools.
Good work practice recommends using the proper equipment to reduce risk of back injuries when
lifting, showering, or moving residents such as:
- Shower chairs - (residents are bathed in a shower chair with wheels, so lifting in and out of tub
- Gait belts - (Provides handles to enable health care workers (HCW) to help residents walk or move, with less strain on HCW's back).
- Wheelchair Scale - (Patients who cannot stand are weighed in their wheelchairs).
- Mechanical lifting equipment such as a Hoyer lift for residents who cannot support their own weight.
It is also recommended that employers provide training in:
Proper lifting techniques — avoiding awkward postures.
- The proper use of machinery and equipment.
Water spills that can lead to falls and injuries. Continually wet surfaces can also create a
health hazard by promoting the growth of molds and bacteria that can cause infections or allergic reactions in employees.
Other Recommended Good Practices:
- Floors shall be kept clean and dry [29
- Non-slip mats and other dry standing places should be provided where practicable
[29 CFR 1910.22(a)(2)].
In addition to being a slip hazard continually wet surfaces promote the growth of mold, fungi, and bacteria which
can cause infections.
- The OSHA Walking/ Working Surfaces Standard requires that all places of employment shall be kept
clean and orderly and in a sanitary condition [29 CFR 1910.22(a)(1)].
- The OSHA Sanitation Standard requires:
- Where wet processes are used, drainage shall be
maintained and false floors, platforms, mats, or other dry
standing places shall be provided, where practicable, or
appropriate waterproof footgear shall be provided [29 CFR 1910.141(a)(3)(ii)].
- Ensure spills are reported and cleaned up immediately.
- Use no skid waxes and surfaces coated with grit or waterproof footgear, may also help decrease slip/fall hazards.
Exposure to blood or other potentially infectious materials (OPIM)
- While physical therapists provide therapy to patients with bed sores or other open wounds.
- While nursing staff are showering residents and must stand in water that may have blood or fecal
matter in it.
Bloodborne Pathogens Standard
CFR 1910.1030 requires:
Other PPE includes:
- Exposure control plan in place to help reduce the risk of occupational exposure to bloodborne
- Communicate possible hazards to Physical Therapist.
- Educate and train all employees with occupational exposure to blood or OPIM to recognize hazards.
- Provide personal protective equipment (PPE), such as gloves and gowns.
- Use safe work practices and engineering controls.
- Provide Hepatitis B Vaccination.
- Provide "Shower Boots" for nursing staff to wear to protect their feet from exposure to water,
fecal matter and blood that may be present when they shower residents [29 CFR 1910.132(a)].
Exposure to Legionnaires' Disease through:
- Breathing aerosolized water that contains the legionella bacteria. This could occur in the shower
or whirlpool area, or areas that have a spray nozzle. Cooling towers, evaporative condensers, fluid coolers, and
domestic hot-water systems are water sources that frequently provide optimal conditions for growth of the
Good work practice includes appropriate maintenance of water systems, as recommended by the OSHA
Legionnaires' Disease Chapter 7 Section III Chapter 7 - Controls:
The OSHA Technical Manual also provides recommendations for
Source Identification of Legionnaires' disease and a employee
- Domestic hot-water systems:
- Store hot water at 140 degrees F. To avoid scalding problems install appropriate, fail-safe scald
protection equipment, such as preset thermostatic mixing valves.
- Where building cannot be retrofitted, periodically increasing the temperature to at least 158
degrees F or chlorination followed by flushing should be considered.
- Systems should be inspected annually to ensure equipment is functioning properly.
- Domestic cold-water systems:
- Maintain cold-water lines below 68 degrees F.
- Water tanks that allow water to remain uncirculated for long periods should be eliminated or
designed to reduce storage time to a day or less. They should also be covered and protected from temperature
- Cross-contamination of the domestic cold water system with other systems shall be prevented.
- If the cold-water lines have significant contamination, hyper chlorination can eradicate
- Cooling towers should be cleaned and disinfected at least twice a year:
- Periodic use of biocides is recommended to control bacteria growth.
- Provide visual inspection and periodic maintenance of the system, to prevent buildup of scale and
sediment and bio-fouling, which support legionella growth.
- Employee awareness program: The
purpose of an employee awareness program is to inform employees of any potential outbreak, to educate about the
disease, and provide early recognition of the disease. Sample forms and questions and answers about Legionnaires'
disease are provided in the technical chapter.
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