COMMENTARY

Slipping, Tripping, and Falling at Work

James W. Collins, PhD, MSME; Jennifer L. Bell, PhD

Disclosures

June 11, 2012

Editorial Collaboration

Medscape &

In This Article

Prevention Guidance

Written housekeeping program. This document helps to ensure the quality and consistency of housekeeping procedures. The program should outline procedures and products needed for routine floor care, proper use of "wet floor" caution signs and physical barriers, timely removal of signage after floors are dry, and procedures for promptly cleaning spills or other unexpected contaminants on floor surfaces.

Employee communication and training. Annual safety training for employees should include STF injury awareness, tips on recognition and prevention of common STF hazards, and procedures for reporting and clean-up of contaminants. It should be communicated that STF incidents are largely preventable and that all hospital staff share the responsibility for maintaining safe floor conditions and should promptly report spills, icy patches, and other contaminants on walking surfaces.

Contaminants on the floor. Most walking surfaces in hospitals are slip-resistant when they are clean and dry. Contaminants on the floor, such as water, body fluids, spilled drinks, and grease, are the leading cause of STF incidents in hospitals.[5,8] These hazards can be found at building entrances where rain and snow are tracked in, food service areas, operating rooms, patient rooms, and areas where surgical instruments are decontaminated. The following strategies can help keep floors clean and dry:

  • Encourage workers to clean or cover and report spills promptly;

  • Add spill stations throughout the hospital so that employees have convenient access to clean-up materials;

  • Advertise telephone/pager numbers through emails, posters, paycheck stubs, or awareness campaigns so that hospital employees know how to contact housekeeping to clean up spills promptly;

  • Ensure that cleaning products are mixed according to the manufacturer's recommendations;

  • Implement effective procedures to degrease floors in food preparation and serving areas; and

  • Use water-absorbent mats with beveled edges at hospital entrances. Shoes should not leave tracks on the floor beyond the last mat. During inclement weather, add mats or replace saturated mats.

Prevention of pedestrian access to wet floors. Mopping, disinfecting, stripping, and waxing floor surfaces create slipping hazards for hospital staff. To reduce this risk, include the following simple steps:

  • Use tall, high-visibility "wet floor" caution signs to warn of slippery conditions;

  • Cordon off slippery areas and direct pedestrian traffic to clear, dry lanes; and

  • Promptly remove "wet floor" signs after the floor is dry to prevent staff from becoming complacent about the sign's intended warning.

Slip-resistant shoes. Nurses and aides; housekeepers; custodians; instrument decontamination; food service; and other staff who work regularly on surfaces that are wet, greasy, or slippery may benefit from slip-resistant shoes. Employee compliance with a slip-resistant shoe program is enhanced when the employer provides shoes, shares the cost of shoes, or facilitates a payroll deduction for shoe purchases. Slip-resistant overshoes can be a low-cost alternative if slip-resistant shoes are ill-fitting or uncomfortable.

Minimization of tripping hazards. Exposed cords and clutter in walkways and under workstations can lead to trips and falls. To minimize tripping hazards:

  • Keep hallways, work areas, and walkways clear of objects, clutter, and cords;

  • Use cord organizers to bundle and secure loose cords under nursing stations, computer workstations, and patient rooms;

  • Use retractable phone cords in patient rooms and nursing stations;

  • Replace or restretch loose or buckled carpet;

  • Replace curled or ripped mats;

  • Replace damaged floor tiles;

  • Patch or fill indoor walkway cracks wider than one-quarter inch;

  • Patch and repair holes, deep grooves, and cracks larger than one-half inch in cement or asphalt in parking areas and sidewalks; and

  • Create visual cues for pedestrians by highlighting changes in outdoor walkway elevation with yellow warning paint or tape.

Operating rooms. In addition to injuring staff, a fall in the operating room can cause patient injury or surgical error, or delay future surgeries.[9] Brogmus and colleagues[9] recommend the following to reduce the risk for STFs in operating rooms:

  • Install slip-resistant flooring;

  • Implement proper floor cleaning methods;

  • Minimize tripping hazards by securing or routing cords, cables, and equipment out of walking paths through the use of cord clamps and mobile utility booms;

  • Use slip-resistant absorptive mats to control contaminants;

  • Use enhanced room lighting;

  • Efficiently set up equipment and supplies to minimize walking to obtain these items;

  • Place ample waste receptacles and contaminant clean-up materials in strategic locations;

  • Ensure surgical team efficiency by conducting planning briefings before surgeries to discuss equipment arrangement and tube routing and clean-up duty assignments; and

  • Have architects, engineers, builders, and hospital administrators collaborate with the end users of operating rooms, including surgeons, nurses, and technicians, on decisions about the design of these areas.

Ice and snow removal. The most important aspect in controlling risks during winter weather is the prompt removal of snow and ice. Display phone/pager numbers to encourage employees to report icy conditions to the groundskeeping department.

  • Provide ice cleats or slip-resistant shoe covers for home health workers, maintenance workers, and other outdoor workers.

  • Distribute winter weather warnings by email.

  • Provide bins containing ice-melting chemicals near outdoor stairways, parking areas, and heavily traveled walkways that are prone to refreezing, so that the chemicals can be used by any employee who notices icy patches.

Lighting. Inadequate lighting impairs vision and the ability to see hazards. Particular attention should be paid to lighting levels in parking structures, storage rooms, hallways, and stairwells. Adequate lighting makes walking safer and allows employees to see their surroundings. Prevention strategies include:

  • Installing more light fixtures in poorly lit areas;

  • Verifying that light bulbs have an appropriate level of brightness; and

  • Installing light fixtures that emit light from all sides.

Stairs and handrails. Proper construction and maintenance of stairs and handrails[10,11] can reduce hazards. Uneven and poorly marked stairs can lead to missteps that can result in employee falls.

  • Ensure that handrails are 34-38 inches above the walking surface;

  • Paint the edge of each step to provide a visual cue of the change in elevation; and

  • Ensure that stairwells have adequate lighting.

Empower the Prevention of STFs

Injuries that result from STF events can be serious and are one of the leading causes of workers' compensation claims in hospital settings. Little emphasis has been placed on fall prevention among healthcare staff because of the widespread perception that these incidents are not preventable. However, research shows that implementation of a comprehensive STF prevention program can significantly reduce STF injury claims involving hospital staff. Because STFs result from a wide variety of circumstances, a coordinated effort is required by the safety department, housekeeping, food services, and even healthcare staff to prevent STF incidents. Key components of a successful STF prevention program are to raise awareness about the importance of STF prevention and to empower every employee to share in the responsibility of eliminating STF hazards.

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