Developing evidence-based interventions to address the leading causes of workers' compensation among healthcare workers.

Overexertion and slip, trip, and fall (STF) incidents are two of the leading sources of workers'compensation claims and costs in healthcare settings (Bell et al., 2008; Bureau of Labor Statistics [BLS], 2008). Working in conjunction with a team of international researchers, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research to demonstrate the effectiveness of comprehensive safe patient handling and STF-prevention programs. The purpose of this article is to summarize the research and outreach efforts of NIOSH and their partners to address the leading occupational injury hazards facing healthcare workers. This article also provides an overview of the changes that are occurring in the healthcare industry as a result of the evidence-based research on safe patient handling and STF prevention that has been conducted in recent years.

Linear regression models of floor surface parameters on friction between Neolite and quarry tiles.

For slips and falls, friction is widely used as an indicator of surface slipperiness. Surface parameters, including surface roughness and waviness, were shown to influence friction by correlating individual surface parameters with the measured friction. A collective input from multiple surface parameters as a predictor of friction, however, could provide a broader perspective on the contributions from all the surface parameters evaluated. The objective of this study was to develop regression models between the surface parameters and measured friction. The dynamic friction was measured using three different mixtures of glycerol and water as contaminants. Various surface roughness and waviness parameters were measured using three different cut-off lengths. The regression models indicate that the selected surface parameters can predict the measured friction coefficient reliably in most of the glycerol concentrations and cut-off lengths evaluated. The results of the regression models were, in general, consistent with those obtained from the correlation between individual surface parameters and the measured friction in eight out of nine conditions evaluated in this experiment. A hierarchical regression model was further developed to evaluate the cumulative contributions of the surface parameters in the final iteration by adding these parameters to the regression model one at a time from the easiest to measure to the most difficult to measure and evaluating their impacts on the adjusted R(2) values. For practical purposes, the surface parameter R(a) alone would account for the majority of the measured friction even if it did not reach a statistically significant level in some of the regression models.

Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees.

In 2007, the Bureau of Labor Statistics reported that the incidence rate of lost workday injuries from slips, trips and falls (STFs) on the same level in hospitals was 35.2 per 10,000 full-time equivalents (FTE), which was 75% greater than the average rate for all other private industries combined (20.2 per 10,000 FTEs). The objectives of this 10-year (1996-2005) longitudinal study were to: 1) describe occupational STF injury events in hospitals; 2) evaluate the effectiveness of a comprehensive programme for reducing STF incidents among hospital employees. The comprehensive prevention programme included analysis of injury records to identify common causes of STFs, on-site hazard assessments, changes to housekeeping procedures and products, introduction of STF preventive products and procedures, general awareness campaigns, programmes for external ice and snow removal, flooring changes and slip-resistant footwear for certain employee subgroups. The hospitals' total STF workers' compensation claims rate declined by 58% from the pre-intervention (1996-1999) rate of 1.66 claims per 100 FTE to the post-intervention (2003-2005) time period rate of 0.76 claims per 100 FTE (adjusted rate ratio = 0.42, 95% CI: 0.33-0.54). STFs due to liquid contamination (water, fluid, slippery, greasy and slick spots) were the most common cause (24%) of STF claims for the entire study period 1996-2005. Food services, transport/emergency medical service and housekeeping staff were at highest risk of a STF claim in the hospital environment. Nursing and office administrative staff generated the largest numbers of STF claims. STF injury events in hospitals have a myriad of causes and the work conditions in hospitals are diverse. This research provides evidence that implementation of a broad-scale prevention programme can significantly reduce STF injury claims.

The effect of surface waviness on friction between Neolite and quarry tiles.

Friction is widely used as an indicator of surface slipperiness in preventing accidents in slips and falls. Surface texture affects friction, but it is not clear which surface characteristics are better correlated with friction. Highly correlated surface characteristics could be used as potential interventions to prevent slip and fall accidents. The dynamic friction between quarry tiles and a commonly used sole testing material, Neolite, using three different mixtures of glycerol and water as contaminants at the interface was correlated with the surface parameters of the tile surfaces. The surface texture was quantified with various surface roughness and surface waviness parameters using three different cut-off lengths to filter the measured profiles for obtaining the profiles of either surface roughness or surface waviness. The correlation coefficients between the surface parameters and the measured friction were affected by the glycerol contents and cut-off lengths. Surface waviness parameters could potentially be better indicators of friction than commonly used surface roughness parameters, especially when they were measured with commonly used cut-off lengths or when the viscosity of the liquid contaminant was high.

Slip resistant properties of footwear on ice.

Current research on slipperiness of footwear has mainly focused on floors and lubricated floors. Slips and falls on icy and snowy surfaces involve not only outdoor workers, but also pedestrians and the general public; and occur in cold regions and in winter season in many parts of the world. However, in comparison with the size of the problem, research on slips and falls on icy and snowy surfaces has been scarce. The objective of this paper is to explore the slip resistant properties of footwear (soling materials, roughness and hardness) on ice. The coefficients of kinetic friction of four different soling materials (synthetic rubber, nitrile rubber, natural rubber and polyurethane) were measured on ice (-12 degrees C). The outsole roughness and hardness were also measured. Results showed that the polyurethane soling did not perform better than synthetic rubber, nitrile rubber and natural rubber on pure hard ice (-12 degrees C). Soling roughness was positively correlated with the coefficient of kinetic friction. The most slip resistant soling material (polyurethane) on floors and lubricated floors may not provide sufficient slip resistance on ice.

The validity and reliability of a portable slip meter for determining floor slipperiness during simulated heel strike.

A previously developed test rig was used as starting point for designing a portable slip meter with two new features. First, an inflatable pneumatic test wheel, consisting of six slider units, was introduced as the impacting contact element relative to floor surface. Second, an inductive trigger was built into the system to facilitate a precise timing of the slider-floor contact during the test. This new test rig was designed to measure transitional friction properties of contaminated floor surfaces during simulated heel strike, which is considered the most critical phase of gait from the slip and fall point of view. Another objective was to quantify the validity and reliability of this test method in the laboratory, but not yet in the field. The measurement process was evaluated on eight wet and oily floor surfaces (vinyl and ceramic tile floorings) using two slider materials (plain, profiled), two normal loads (100, 200 N), and two sliding velocities (0.15, 0.30 m/s) as independent variables. The outputs of the portable slip meter, in terms of transitional friction coefficients, were compared to force platform-based friction values and to slip resistance values obtained with a slip simulator apparatus for laboratory testing of shoes and floor surfaces. The outputs were also evaluated against slipperiness ratings made by three male subjects in paired comparison trials, in which the subjects walked over eight wet floor surfaces wearing shoes with the plain soling material. The results showed that test option 200 N and 0.15m/s led to optimum validity despite its tendency to promote frictional vibrations (stick-slip) in the contact surface. Compared to the lower sliding speed, the higher speed reduced both stick-slip and measurement bias. Test option 200 N and 0.30 m/s was the most reliable one in this experiment. It yielded lower friction coefficients than any other test option and reduced the likelihood of underestimating slip and fall hazards. The results implied that the minimum friction coefficient was 0.25 for preventing a fall on wet floor surfaces, whereas the limit for preventing a slip was in the range 0.30-0.35. Transitional friction measurement was found to be a valid and reliable indicator for slip resistance. A more accurate control of the normal force during testing is needed for actual field use of the test method.

Mechanisms of friction and assessment of slip resistance of new and used footwear soles on contaminated floors.

The great number of slipping accidents indicates that footwear providing good slip resistance must be rare. Slip resistance seems to be a purely physical phenomenon, however, more knowledge of the mechanisms of friction is needed to develop slip-resistant footwear and to ensure safer walking in slippery conditions. In the present study the influence of the normal wear of shoe heels and soles on their frictional properties was clarified. The slip resistance of three types of new and used safety shoes on four relatively slippery floor-contaminant combinations, was assessed with a prototype apparatus, which simulates the movements of a human foot and the forces applied to the underfoot surface during an actual slip. The used shoes were collected from 27 workers in a shipbuilding company and classified by sight into four wear classes: Good, satisfactory, poor, and worn-out. The assessed shoe heels and soles were in general more slippery when new compared to used heels and soles. However, footwear must be discarded before the tread pattern is worn-out. Used microcellular polyurethane (PU) heels and soles gave a considerably higher coefficient of kinetic friction (µk) on contaminated floors than used heels and soles made of compact nitrile (NR) and compact styrene rubber (SR). The heel-slide coefficient of kinetic friction (µkl) for used versus new shoes was on average 66% higher for PU (0·216 versus 0·130), 27% higher for SR (0·143 versus 0·113), and 7% lower for NR (0·098 versus 0·105). The fundamental mechanisms of friction between shoe soles and contaminated floors were also discussed, and experiments with seven slabs of sole materials were carried out to assess contact pressure effects from the viewpoint of slipping. Slip resistance particularly seemed to depend on the squeeze film and the contact pressure effects between the soling materials and the floor. An increasing contact pressure dramatically reduced the µk, thus indicating that the slip resistance varies considerably during the normal gait cycle. Hence, average friction readings are probably not at all decisive from the slip resistance point of view. An instantaneous coefficient of friction may be more relevant, because in walking the time available to achieve a sufficient coefficient of friction to avoid a slip is only a few tenths of a second.