Manual Handling Theory Booklet for Non Clinical Staff

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1 Manual Handling Theory Booklet for Non Clinical Staff Learning & Development 2011

2 CONTENTS 2. Legal Requirements 3. Risk Assessments 4. Spinal Awareness 5. Everyday Back Care 6. Musculo-skeletal Injuries 7. Biomechanics 8. Guidelines for Lifting and Lowering 9. Good Handling technique for lifting Good Handling technique for pushing and pulling Special Lifts Awkward Objects Principles of Safe Manual Handling 2

3 LEGAL REQUIREMENTS SUMMARY OF KEY POINTS There are two main pieces of legislation relating to load management: 1. The Health and Safety at Work Act (HAWAWA) Manual Handling Operations Regulations 1992 (MHORegs) E m p lo ye rs Re sp o n sibilitie s Employers have general health and safety responsibilities concerning: 1. Employees 2. The workplace environment (rooms & equipment) 3. Provision, inspection & maintenance of equipment 4. Responsibilities to carry out lifting operations safely The Manual Handling Operations Regulations place responsibilities on the employer for: 1. Avoidance of manual handling 2. Assessment of risks 3. Reduction of risks 4. Provision of information on the load 5. Review of risk assessments E m p lo ye e s Resp on sibilities Every employee has health and safety responsibilities relating to: 1. People safeguarding yourself and others 2. Co-operating with the employer 3. Using equipment appropriately Under the Manual Handling Operations Regulations, the main responsibility of the employee is: 1. To make use of safe systems of work provided by the employer. The Reporting of Injuries The legal requirement for reporting injuries are mostly contained in the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (R.I.D.D.O.R.) Employers must: 1. Report all specified accidents and injuries to the appropriate outside agency 2. Provide accident books Employees must: 1. Report all accidents and injuries to the employer as soon as possible 2. Ensure all accidents and injuries are recorded in the accident book Other considerations It is essential that you are aware that you can be held personally and legally accountable for your actions or inactions as a carer who manually handles. 3

4 RISK ASSESSMENTS In an attempt to reduce the risk of injury during manual handling, consideration should be given to the following four factors: Factors Reducing the Risk of Injury TASK: Improving task layout Using the body more efficiently Improving work routine Provision of training in handling while seated Provision of training in team handling Provision of personal protective equipment Maintenance and accessibility of equipment LOAD: Make it lighter (not usually possible with clients*) Easier to manage Easier to grasp More stable Less damaging to hold WORKING ENVIRONMENT: Remove space constraints Consider condition and nature of floor Reduce work at different levels Control thermal environment Maximise lighting conditions INDIVIDUAL CAPABILITY: Awareness of personal capacity Provision of knowledge and training Staff selection appropriate for the task *But we can make a client effectively lighter by gaining their co-operation and maximum assistance, and also using handling aids and/or sharing the effort with a colleague 4

5 SPINAL AWARENESS SUMMARY OF KEY POINTS The Spine The spine is the central composition of the skeleton. It consists of thirty-three vertebrae, each pair with an intervertebral disc between them, and the muscles and ligaments. The most commonly injured areas of the spine are the cervical and lumbar regions, due to their mobility, position and lack of protection. The Spinal Unit & Intervertebral Disc The intervertebral disc has four main functions. It: Absorbs shock Acts as a spacer between vertebrae Reduces friction during movement Limits excessive movement The disc can be damaged by mechanical or chemical changes. It can rupture suddenly (a slipped disc ), which can be due to either direct trauma, or cumulative injury which occurs over time. The Spine has four regions: Cervical Region (7) Correct Posture The correct posture in any physical activity is one which: - Maintains the natural curvature of the spine - Maintains the balance of the body - Minimises the level of spinal stress Thoracic Region (12) Lumbar Region (5) Pelvis, including the Sacrum (5) And Coccyx (4) Three Key Principles of Safe Manual Handling 1. Maintain a natural, upright posture whenever possible during manual handling, keeping your Spine in Line 2. Always create a good, stable base with your legs and feet. If working on a bed, make stable base with your foot and knee, and hand and arm if appropriate. 3. Keep any load, or point of force, as close to your vertical centre of gravity as possible. Remember to use the large leg and buttock muscles to provide the power during a manoeuvre, rather than the relatively small, weak and vulnerable spinal muscle. 5

6 EVERY DAY BACK CARE POSTURE Bad posture is one of the leading causes of back pain particularly poor sitting posture. Lower backache is the body s warning sign that muscles are tired and overworked and injury could easily occur. The position of the pelvis and the strength and flexibility of supporting muscle groups affect the degree of extension to the lumbar vertebrae. We need to maintain good posture all the time i.e. with the pelvis in a central position. Whether the back is flattened or excessively curved, the result can be discomfort, pain and often injury. This means that whether we are standing in a bus queue, sitting at a desk, driving a car or relaxing on a settee, we should strive to maintain the 4 natural curves of the body and the correct position of the pelvis. Back pain can also be the symptom of overuse and is the body s response to tired, overworked, often unbalanced muscles which are then more likely to succumb to injury. Remember: The potentially damaging factors to the back are those activities that we do all or most of the time. To maintain full mobility and suppleness AVOID: Holding a stressed posture e.g. bending or twisting Holding a stressed posture whilst lifting a load Holding a double stressed posture e.g. bending and twisting together Repetition Sudden jerky back movements DO Exercise safely and regularly Include cardiovascular, strengthening and flexibility work Be aware of your posture all the time and strive to maintain good posture as much as possible. Muscle strength The stronger the muscles of the upper body, the more stable the spine becomes. It needs to be well supported and protected by strong muscles. But remember, we never use our back muscles to do a lift. The muscles we use and which must, therefore, be really strong are our quadriceps, gluteals and transverse abdominal muscles, and, to a lesser degree, the muscles of the shoulders, arms and upper body. Everyone needs to know the correct technique and the basic rules for lifting but that isn t enough! They also need to be strong enough to do the lift safely, whatever the lift may be. 6

7 MUSCULO-SKELETAL INJURY SUMMARY OF KEY POINTS Causes of Back Pain There are three main types of back pain that we have covered here: 1. PRIMARY 2. SECONDARY 3. REFERRED Primary back pain is widespread, and results from damage to soft tissue around the spine, due to trauma, pathological changes, fatigue or postural stresses. Secondary back pain often manifests itself as pain radiating into the leg, and muscle weakness or loss of sensation. It is caused by damage to the spinal nerves by a disc or by osteophytes. Referred back pain originates from the pelvis or abdomen, but is felt in the spinal area. The Injury Complex is a diagram which illustrates the factors which can contribute to Musculo-skeletal injuries: Ageing R.S.I & Cumulative Strain Congenital Defects The Injury Complex Direct Trauma Psychological Attitudes Chemical / Biological Factors Many injuries are of a cumulative nature, whereby continual trauma causes weakness, which in turn causes further injury. There are various activities that can increase the likelihood of back injury or pain due to their loading effects on the spine. These are worth remembering. If we add to those activities we ve already discussed, the list then includes: Physical manual work. Static postures. Repetitive manual work. Vibration. Poor posture, such as stooping, bending or twisting. Lifting and forceful movements. And unaccustomed work, when we re carrying out a handling task we re not used to. 7

8 BIOMECHANICS BIOMECHANICS is the application of mechanics to the living body. The vertebral column depends for its stability on the supporting musculature. The muscles of the spine and the abdominal wall control spinal movements and protect the spine from motion beyond the physiological range. HOW DIFFERENT POSITIONS AFFECT SPINAL PRESSURE When standing erect, the load on the spine arises mainly from the effect of gravity and little muscular activity is needed to main this position. When in forward flexion the muscles have to work to maintain the bent position against gravity and this produces a compressive force on the discs. This force is 6 times greater when the trunk is bent forward to the horizontal than when it is upright. (SEE POSTURE CHART) THE IMPORTANCE OF KEEPING THE LOAD CLOSE The load is mainly taken by the lumbro-sacral discs as this area acts as the fulcrum or pivot point. Hence, most frequently it is the lower lumbar area that is injured. It is also important to remember that holding loads away from the trunk has a similar effect upon the spine. To hold the load away from the trunk whilst being in forward flexion increases the force by lengthening the lever even further (SEE BIOMECHANICS CHART). 8

9 Guidelines for Lifting and Lowering CORRECT POSTURE in any physical activity Maintains the natural curvature of the spine Maintains the balance of the body Minimises levels of spinal stress THREE PRINCIPLES OF GOOD MANUAL HANDLING Keep your spine in line Create a stable base Keep any load as close as possible to your vertical centre of gravity 9

10 Getting to grips with manual handling Good handling technique for lifting Here are some practical tips, suitable for use in training people in safe manual handling. In the following section a basic lifting operation is taken as an example. Think before lifting/handling. Plan the lift. Can handling aids be used? Where is the load going to be placed? Will help be needed with the load? Remove obstructions such as discarded wrapping materials. For a long lift, consider resting the load midway on a table or bench to change grip. Keep the load close to the waist. Keep the load close to the body for as long as possible whilst lifting. Keep the heaviest side of the load next to the body. If a close approach to the load is not possible, try to slide it towards the body before attempting to lift it. Adopt a stable position. The feet should be apart with one leg slightly forward to maintain balance (alongside the load, if it is on the ground). The worker should be prepared to move their feet during the lift to maintain their stability. Avoid tight clothing or unsuitable footwear, which may make this difficult. Get a good hold. Where possible the load should be hugged as close as possible to the body. This may be better than gripping it tightly with hands only. Start in a good posture. At the start of the lift, slight bending of the back, hips and knees is preferable to fully flexing the back (stooping) or fully flexing the hips and knees (squatting). 10

11 Don t flex the back any further when lifting. This can happen if the legs begin to straighten before starting to raise the load. Avoid twisting the back or leaning sideways, especially when the back is bent. Shoulders should be kept level and facing in the same direction as the hips. Turning by moving the feet is better than twisting and lifting at the same time. Keep the head up when handling. Look ahead, not down at the load, once it has been held securely. Move smoothly. The load should not be jerked or snatched as this can make it harder to keep control and can increase the risk of injury. Don t lift or handle more than can be easily managed. There is a difference between what people can lift and what they can safely lift. If in doubt, seek advice or get help Put down, then adjust. If precise positioning of the load is necessary, put it down first, then slide it into the desired position.

12 Getting to grips with manual handling Good handling technique for pushing and pulling Here are some practical points to remember when loads are pushed or pulled. Handling devices. Aids such as barrows and trolleys should have handle heights that are between the shoulder and the waist. Devices should be well-maintained with wheels that run smoothly (the law requires that equipment is maintained). When purchasing new trolleys etc, ensure they are of good quality with large diameter wheels made of suitable material and with castors, bearings etc which will last with minimum maintenance. Consultation with your employees and safety representatives will help, as they know what works and what doesn t. Force. As a rough guide the amount of force that needs to be applied to move a load over a flat, level surface using a well-maintained handling aid is at least 2% of the load weight. For example, if the load weight is 400 kg, then the force needed to move the load is 8 kg. The force needed will be larger, perhaps a lot larger, if conditions are not perfect (eg wheels not in the right position or a device that is poorly maintained). The operator should try to push rather than pull when moving a load, provided they can see over it and control steering and stopping. Slopes. Employees should enlist help from another worker whenever necessary if they have to negotiate a slope or ramp, as pushing and pulling forces can be very high. For example, if a load of 400 kg is moved up a slope of 1 in 12 (about 5 o ), the required force is over 30 kg even in ideal conditions good wheels and a smooth slope. This is above the guideline weight for men and well above the guideline for women. Uneven surfaces. Moving an object over soft or uneven surfaces requires higher forces. On an uneven surface, the force needed to start the load moving could increase to 10% of the load weight, although this might be offset to some extent by using larger wheels. Soft ground may be even worse. Stand and place. To make it easier to push or pull, employees should keep their feet well away from the load and go no faster than walking speed. This will stop them becoming too tired too quickly.

13 Special lifts You may have to use different types of lift for some objects. Remember to always plan the task before you begin. One-handed lifting If you need to lift using only one hand, for example when lifting a bucket, take extra care. Divide the load if you can. Brace your body with the opposite arm, if possible. This will help steady and support your body. Reach for the load. Bend your knees, and keep your back straight. Grip the load firmly (use a handle if possible). Lift with your legs, using your free arm for balance. Keep your shoulders level. Switch hands regularly Team lifts If your load is heavy, large or awkward, you may need to work with one or more people. Work with others who are of similar build and height to you. Choose one person to give instructions Make sure everyone has a good grip on the load. Lift from the hips at the same time, then raise the load to the right level. Move smoothly and at the same time.

14 Awkward objects Some objects may be an unusual or difficult shape and size. Stand over one corner of the load, with your feet comfortably apart. Grasp the bottom inside and top outside corners. If the weight is unbalanced, lift and carry the object with its heaviest side close to your body. Bend your knees and lift, keeping the same grip. Lifting to a high place. Try not to lift anything above your shoulders as it may put strain on your body. Lighten the load if you can by dividing it into smaller loads. Stand on something sturdy (not a chair) with one foot in front of the other unless your are using a stepladder. Use a mechanical aid or get help if the load is awkward or heavy. Lowering from a high place Take extra care when you are lowering objects from above your head. Test the load s weight by pushing up on it. Check to see if the weight of the load will shift when you lift it. Check to make sure there isn t anything on top of the load that could fall off when you lift it. Stand as close to the load as possible. Grip the object firmly, sliding it down your body. Use a mechanical aid or get help if necessary. Get advice if you are not sure about anything.

15 PRINCIPLES OF SAFE MANUAL HANDLING 1. Never manually handle unless you have no other option. 2. Know your own handling capability and do not exceed it. Get help if needed. 3. Wear suitable clothing and footwear. 4. Assess the person or object to be handled before commencing a manoeuvre 5. Explain the manoeuvre to the person to be transferred and any assisting carer(s). 6. Prepare the handling area. 7. Where appropriate, apply the brakes on equipment. 8. Make a good stable base with your legs and feet. Work well within your circle of balance and maintain good posture. 9. Keep the person, or object, to be transferred as close to your body as possible. 10. Make sure of a good handhold. 11. Where appropriate, use rhythm and timing when transferring. 12. Raise your head on commencing the manoeuvre. 13. Bend the knees when transferring not your back. 14. Never twist during a manoeuvre. 15. Avoid static stooping (e.g. medical examination of patient in bed). Try to work as close to your natural, erect spinal posture as possible. IF IN DOUBT SEEK ADVICE

16 MANUAL HANDLING ADVICE If you have any manual handling issues/concerns in your department/ward, advice can be sought from:- Your department s/ward s manual handling key worker. Your line/department/ward manager. Occupational Health Veda Gilbert, Mandatory and Role Specific Lead ext 8127 For queries about manual handling training please contact either:- The Learning and Development Department ext The Trust Handling Trainers ext. 8127

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