Walking and Working Surfaces including Fall Protection www

Walking and Working Surfaces including Fall Protection www. Career. Safe. Online. com

Slips, Trips, and Falls � � � Slips, trips, and falls cause the majority of general industry accidents. Falls are one of the most common causes of serious work related injuries and deaths, accounting for about 15% of all fatalities across all occupations. Healthcare workers may also fall while assisting patients. Fall prevention strategies covered in this module also help prevent falls by patients. The greatest source of injury to healthcare workers is not from falls, but from musculoskeletal injuries. These injuries can be caused when trying to assist patients, especially when they are unstable or falling themselves. The Ergonomics module in this series has additional information to help you learn more about how to protect yourself from musculoskeletal. www. Career. Safe. Online. com

Slips, Trips, and Falls (cont. ) � Research indicates that awareness and knowledge of falling hazards, along with conscious awareness about preventing injury from slips, trips, and falls is the best way to reduce the number of injuries from these hazards. www. Career. Safe. Online. com

Typical Injury Types and Injury Sites Caused by Falls � Here Falls are a leading cause of non-life-threatening injuries to healthcare workers in the workplace. ◦ ◦ ◦ � From 2008 through 2010, injuries were reported for the following body areas: 37% to lower extremities 22% to the trunk area 27% to multiple body parts 13. 5% to upper extremities, including head, neck, and throat 0. 5% unknown Slips, trips, and falls cause a variety of injuries to the body. A few examples are: ◦ ◦ Sprains, strains, dislocations, and tears Bruises, contusions, and concussions Fractures Abrasions and lacerations www. Career. Safe. Online. com

OSHA’s standards for Walking and Working Surfaces � � OSHA standard 29 CFR 1910 requires that employers reduce employee exposure to potential injury due to hazards. Specific requirements are that the workplace surfaces be: ◦ Kept clean and orderly. ◦ Maintained in a sanitary manner. ◦ Free from obstructions at all times. In addition to a clean, clutter-free environment, appropriate warning signs are required for temporary hazards. For example, warning signs and warning cones should be used when floors are being cleaned and may be wet. www. Career. Safe. Online. com

OSHA’s standards for Walking and Working Surfaces (cont. ) � � � In healthcare work environments, such as hospital emergency rooms, there are times when these requirements are difficult to implement as they occur. For example, it might not be possible to clean floors during an emergency situation and healthcare workers should be aware of the danger. You should also always keep an eye out for common objects that could become trip hazards, such as cords for beds and medical machines, or medical waste such as syringes. OSHA standards are required in both indoor and outdoor areas, such as: ◦ Aisles and passageways, including exits and stairs ◦ Break rooms, cafeterias, restrooms, labs, offices, patient treatment or care areas, and common areas for both visitors and the general public ◦ Parking lots, sidewalks, ramps and lawns ◦ Any other spaces designated for healthcare. www. Career. Safe. Online. com

OSHA’s standards for Walking and Working Surfaces (cont. ) � � Workers must be guarded from holes and gaps found in walking and working surfaces, including: ◦ Indoor floor openings, floor holes, and wall openings. ◦ Outdoor cracks, grooves, or holes in walkways. Elevation changes in multi-level surfaces including curbs, steps, and any type of parking stops. www. Career. Safe. Online. com

Slips, Trips, and Falls Continued � Below describes what happens during slips, trips, and falls: ◦ Slips: Slips are the loss of balance that is caused by too little friction or traction between feet and a walking and working surface. An example of a slip is when someone slides on a freshly mopped floor. ◦ Trips: Trips happen when the foot or lower leg hits an object and the upper body continues to move, or when stepping between two levels and a loss of balance results. ◦ Falls: Falls happen when the center of balance has been lost. Falls also happen when there are surfaces at two different levels, such as from the curb to the parking lot. Falls also happen on walking and working surfaces that are level, for example while walking on pavement or walkways with irregular surfaces, like bricks or cobblestones. www. Career. Safe. Online. com

Maintenance of Walking and Working Surfaces � � Slipping on a surface can lead to injury whether or not one actually falls. In order to avoid injury to yourself and others, be mindful about potential hazards on walking and working surfaces. A few ways to prevent injuries are: ◦ Know the written housekeeping policies and times that housekeeping personnel are available in your workplace ◦ Prevent entry into areas that are wet ◦ Wear slip-resistant footwear ◦ Use additional caution when weather conditions reduce friction on outdoor surfaces ◦ Know where to find the written housekeeping policies in your workplace. A written housekeeping policy can help ensure the quality and consistency of housekeeping procedures. www. Career. Safe. Online. com

Maintenance of Walking and Working Surfaces (cont. ) � � The policy should include: ◦ Contact information for the housekeeping department ◦ The location and use of cleaning products ◦ Storage and use of wet floor signs and barriers ◦ When specific areas of the healthcare facility should be cleaned and the proper method of cleaning—for example, is the area cleaned after specific events or after each patient ◦ Cleaning methods for different areas and surfaces Workplaces include a variety of floor types that must be kept clean. Carpet may be present in a doctor’s office, or a waiting room in a dental clinic. Other locations may have hard surfaces, like vinyl or ceramic tile, wood, or concrete. www. Career. Safe. Online. com

Maintenance of Walking and Working Surfaces (cont. ) � � � Each floor type requires a different cleaning method. Keep floors clean and dry. Floors kept clean and dry are much less likely to create a risk for slips, trips or falls. A few ways to keep floors clean and dry include: ◦ Cover, clean, or report spills promptly ◦ Keep spill pads located in convenient areas �Post contact numbers for housekeeping �Place water absorbent mats where water, ice, or soap may drip onto the floor �Use only secure, non-slip mats �Maintain drip pans for ice machines and food carts www. Career. Safe. Online. com

Maintenance of Walking and Working Surfaces (cont. ) � � � Patient health is the number one goal for healthcare, so you have to be extra aware of your environment to avoid slips, trips, and falls. For example, you may be exposed to body fluids, such as urine overflow due to catheter bags not being changed quickly enough, or if a patient is a victim of trauma and there is an accumulation of blood or body fluids on the floor. As a healthcare worker, it is important for you to learn about the housekeeping policy for how to deal with emergency situations that result in unsafe floor conditions in your work environment. Preparing for these kinds of occurrences is your best bet for avoiding injury. www. Career. Safe. Online. com

Fall Prevention Strategies � Patient Some fall prevention strategies include: ◦ Prevent entry into areas that are wet: Use highly-visible caution signs to inform employees and visitors to be careful and avoid contaminated areas. ◦ Block off areas during floor cleaning, stripping, and waxing: Use OSHAapproved barriers or caution tape to prevent employees from entering an area while it is being cleaned or to prevent stepping on a spill. During an emergency healthcare situation, it may not be possible to keep employees from entering the room when body fluids are on the floor. It is critical to everyone’s safety that you become aware of potential hazards as you are working under such conditions. ◦ Use a long barrier device if a dry lane must be kept clear for passage: Use barrier devices to prevent water and other fluids from entering hallways when cleaning rooms. Use along with a tension bar or other blocking device so the floor barrier does not become a tripping hazard. � Remove all signs once the floor is clean and dry so they do not become commonplace and ignored by staff. www. Career. Safe. Online. com

Slip Resistant Footwear � � � You should always wear slip-resistant footwear for adequate traction between feet and walking or working surfaces. Slip-resistance refers to the amount of friction between the shoe and a walking surface. The greater the amount of friction, the less likely it is that the shoe will slip while someone is walking. Materials like rubber provide a large amount of friction between the shoe and walking surface. In a healthcare workplace, shoes should also help prevent a loss of balance while walking, and help provide protection from things like biological fluids. Therefore, work shoes should also have low heels to prevent a loss of balance while walking, and should also be close-toed to prevent exposure to body fluids or medical equipment, like syringes, used during an emergency. Often, workers in food services, housekeeping, and maintenance have a higher risk of slipping due to water, grease, or other contaminants on the floor. However, all healthcare facility employees are at risk from slips, trips, and falls. www. Career. Safe. Online. com

Slip Resistant Footwear (cont. ) � You are more likely to wear slip-resistant shoes when the shoes fit well, are very comfortable, and have an appealing style. However, never forget that safety from slips, trips, and falls as well as safety from exposure to things like body fluids and medical equipment are just as important to consider when selecting shoes. www. Career. Safe. Online. com

Working Outdoors � � � The primary work area for healthcare workers is indoors. However, workers must go outdoors to get to parking lots or to assist with transporting patients into or out of the healthcare facility. Additional caution should be used while on outdoor walking and working surfaces, especially when weather conditions reduce the friction on outdoor surfaces, and when it is dark. When weather conditions result in ice and snow, be especially cautious around building entrances, in parking garages and lots, on walkways, and outside stairs as they may be extra slippery. � Prevention strategies that employers can use when they employees must be outdoors include the following: ◦ Place freezing weather warning monitors at entrances to employee parking areas. ◦ Place labeled bins filled with ice melting chemicals and scoops that anyone can use immediately on icy patches. www. Career. Safe. Online. com

Working Outdoors (cont. ) � Consider placing bins in areas of heavy pedestrian traffic, such as the top and bottom of outdoor stairways, parking garage exits, and entrances, and health care facility entrances. � The bins should be labeled with the appropriate Safety Data Sheets and include instructions for handling ice melting chemicals. Bins should be secured so they cannot be removed. � Additional prevention strategies to avoid slipping and falling when weather conditions warrant include: ◦ Promptly remove ice and snow from parking lots, garages, and sidewalks ◦ Send an email to staff when ice and snow are predicted and provide notices on bulletin boards ◦ Encourage employees to report icy conditions ◦ Provide additional slip resistant mats in entrances during winter months and when it rains ◦ Encourage employees to wear slip-resistant footwear ◦ Warn patients and others entering the healthcare facility to use caution ◦ Provide umbrella bags during rainy, wet weather www. Career. Safe. Online. com

Tripping � � Tripping on a surface can lead to injury whether or not you actually fall. Be proactive and continuously monitor your workplace environment for potential tripping hazards. Ways to reduce the likelihood of tripping include: ◦ As your employer to highlight or repair surface irregularities ◦ Use adequate lighting to increase visibility of surface irregularities ◦ Eliminate loose materials and clutter on all walking and working surfaces ◦ Use non-slip mats and runners that are secured from moving ◦ Use OSHA-approved handrails when walking on stairs www. Career. Safe. Online. com

Surface Hazards � Employers must protect employees from slips, trips and falls caused by irregularities in walking and working surfaces—both indoors and outdoors. Here are some tips to prevent slips, trips, and falls by drawing attention to walking and working surface irregularities: ◦ Sloped Pavement and Curbs: Changes in curb or walkway elevation should be highlighted with safety yellow or red warning paint or tape. Pavement that is sloped for any reason is a walking surface irregularity and can cause employees to stumble, trip, slip, or fall. ◦ Prevention strategies your employer should implement include: �Draw attention to sloped pavement �Mark elevation changes on curbs �Use paint to designate parking spots instead of concrete wheel stops as they can be a tripping hazard www. Career. Safe. Online. com

Surface Hazards (cont. ) � � Surface Irregularities: Poorly maintained walking and working surface structures should be repaired or replaced to prevent injuries from trips, slips, and falls. ◦ Prevention strategies your employer should implement include: �Patch or fill cracks in walkways greater than ½" wide �Draw attention to gaps between surfaces Patch, fill, or repave outdoor areas that have deep grooves, cracks, or holes Clutter on Outdoor Surfaces: Poorly maintained, uneven ground, protruding structures, holes, rocks, leaves, and other debris can cause employees to trip, slip, or fall. Prevention strategies your employer should implement include: ◦ Cover or highlight underground watering system structures.

Surface Hazards (cont. ) � � � ◦ Remove stones and debris from walking surfaces. ◦ Healthcare workers may also need to inspect grounds to prevent injury to patients or athletes. For example, an athletic trainer needs to observe the ground for uneven or unsafe playing surfaces to prevent injuries to athletes. Grassy Area: Poorly maintained, uneven ground in grassy areas can cause employees to stumble, trip, slip, or fall. Any potential hazards that you observe on grassy areas around the facility should be reported to your supervisor. Athletic trainers, for example, usually observe areas of the playing field for potential injuries from uneven ground. Fall prevention strategies your employer should implement include: ◦ Periodically checking for any surface irregularities in grassy areas ◦ Patching or filling outdoor areas with deep grooves, cracks, or holes

Visibility and Clutter � � Your employer should use adequate lighting to increase visibility of surface irregularities. Poor lighting impairs vision and your ability to see hazards. With adequate lighting, you will be better able to see the walking and working surfaces and notice unsafe conditions in time to prevent injuries. Inadequate lighting is a hazard in parking structures, storage rooms, hallways, stairwells, and walkways—both inside and outside the facility. Ways your employer can reduce the likelihood of tripping in low-light areas include: ◦ Installing adequate light fixtures in poorly lit areas. ◦ Ensuring all light bulbs are working and bright enough for the setting. ◦ Verifying light bulbs have an appropriate brightness. ◦ Installing light fixtures that emit light from all sides

Visibility and Clutter (cont. ) � � Adequate lighting may not always be available so healthcare workers must be constantly aware of the environment and slip hazards. For example, when a patient is sleeping at night, or when first responders are at a scene in the dark. Eliminate loose materials and clutter on all walking and working surfaces and in storage areas. Clutter can build up in storage areas, work areas, hallways, and walkways and may pose a fall hazard for employees. Exposed cords on the floor, stretched across walkways, and tangled near work spaces can catch an employee’s foot and lead to a trip and fall incident. Ways to prevent injury from clutter include: ◦ Organizing storage areas. ◦ Securing any cords in use. ◦ Clearing walkways and work areas.

Visibility and Clutter (cont. ) � � � To prevent the risk of injury from slips, trips, or falls due to clutter, you should organize storage areas and secure cords and cables. Storage Areas: Ways to organize storage areas include: ◦ Installing wall-mounted storage hooks, shelves, etc. ◦ Clearing walkways to allow safe movement in the room. Cords and Cables: Ways to secure cords and cables include: Bundling cords in cord organizers. ◦ Covering cords on the floor with a beveled protective cover. ◦ Taping cords to flooring. ◦ Using retractable cord holders. Mounting cords or cables underneath furniture or equipment, or making sure that they are covered.

Mats � � Along with clutter, sources of tripping, slipping, or falling that can result in injury include: ◦ Improper use of floor mats. ◦ Missing handrails on stairs or handrails that not OSHA-approved. Improper use of floor mats may cause tripping, slipping, or falling that can cause injury. Mats provide slip-resistant walking surfaces by absorbing liquid or by removing dirt, debris, and liquid from shoes. Mats are only effective if properly used and maintained. Locations where mats can be found include; building entrances, food preparation and serving areas, under sinks, around water fountains, and in labs. Proper use and maintenance of mats to help prevent slips, trips, and falls include: ◦ Placing large mats and runners at health care facility entrances to accommodate several footsteps of walking to remove contaminants from shoes.

Mats (cont. ) � � � Placing additional mats at entrances, as needed, when ice, snow, or rainy conditions are present. There should be no wet areas around mats at entrances. Using non-slip mats where flooring is routinely wet. For example, around sink areas or water fountains. Using small markers painted on the floor to indicate where to lay mats in the correct position for best results. Using beveled edge, flat, and continuous or interlocking mats. Securing edges of mats with carpet tape, if needed. Replacing mats that are curled, ripped, or worn.

OSHA Guidelines for Stairs � � � Elevation differences in surface levels, due to either building structures or equipment pose a fall hazard. Structures associated with two-level falls include: stairs, steps, elevated or sloping walkways or ramps, and parking structures. Equipment associated with two-level falls includes steps stools, and ladders. Knowing and using the OSHA guidelines for stairs is a key factor in preventing slips, trips, and falls on stairs. Guidelines for Stairways ◦ Stairways with four or more stairs or a total height of 30 inches (equivalent to 76 cm) in height, whichever is less, must have at least one handrail. ◦ Do not use stairways when the tread width is less than 6 inches (equivalent to 15 cm), or you can lose your balance.

OSHA Guidelines for Stairs (cont. ) � Guidelines for Handrails ◦ Handrails must provide an adequate handhold for employees to grasp to prevent falls. ◦ Handrails must be placed at a height of 30 inches (equivalent to 76 cm) to 37 inches (equivalent to 94 cm) from the upper surface of the handrail to the surface of the tread. ◦ Handrails must be able to withstand, without failure, at least 200 pounds of weight applied within 2 inches (equivalent to 5 cm) of the top edge in any downward or outward direction, at any point along the top edge. ◦ Handrails must be built to prevent dangerous projections, such as nails, or the rails themselves, protruding beyond the end posts of the system. ◦ Temporary handrails must have a minimum clearance of 3 inches (equivalent to 8 cm) between the handrail and walls, stair rail systems, and other objects.

OSHA Guidelines for Stairs (cont. ) � � Guidelines for Steps ◦ Elevation changes and the edges of steps, which is termed the nosing, should be marked by painting or taping the edges safety yellow. ◦ Only slip-resistant stair treads should be used. This is especially important for outside stairs exposed to the elements or stairways exposed to wet conditions. ◦ Keep stairs free of ice, snow, water, and other slippery contaminants. Other Considerations for Stairways ◦ All stairways need adequate lighting. ◦ All parts of stairways shall be free of hazardous projections or clutter

Step Stools and Ladders � � � � Step stools and ladders used to work from heights can result in injuries caused by an elevated fall. Always use the right step stool or ladder for the job. Follow these guidelines for safe ladder and step stool usage: Make sure that the step stool or ladder is high enough for you to reach your work area without having to stand on the top rung. Wear shoes with a closed back and sufficient tread on the sole to prevent slipping on ladder rungs or steps. Place ladders on level surfaces before climbing. Before climbing, make sure that ladders are fully opened. Maintain three points of contact with the ladder at all time while moving up or moving down. This means that you should keep two hands and one foot or one hand two feet in contact with the ladder.

Step Stools and Ladders (cont. ) � � Do not use a ladder if it is bent or if it is missing a step. Try not use ladders near doorways. If you have to use one near a doorway, make sure that the door is locker. Do not lean away from the ladder to carry out your task. Always keep your weight centered between the side rails. You may need to go up and down the ladder several times or may need to move the ladder to cover all areas. Moving the ladder is safer than reaching. Do not use chairs, furniture, or other objects in place of OSHAapproved step stools or ladders.

Distractions � Slipping and tripping hazards become more of a risk when someone is not paying attention or is otherwise distracted while moving along walking and working surfaces. ◦ Here a few strategies to help you remove the added risk for falls caused by faulty judgment and behaviors: ◦ Watch where you’re going at all times and avoid distractions like texting or using your cell phone while walking ◦ Pay attention to potential hazards around you – do not rush. One of the first things EMTs learn is to never run. Both feet should always remain in full contact with the ground to prevent becoming injured on the way to care for a patient. ◦ Use walkways and pathways designated for walking – do not take shortcuts or move over materials not intended as walking surfaces ◦ Make sure that you can see your pathway when you are caring objects

Guarding � � � Guarding is the term that OSHA uses to describe specific things employers need to do to protect employees from specific kinds of falling hazards. Employers must guard employees from three types of hazards. These include: ◦ A floor opening that is large enough for a person to fall into ◦ A floor hole that is large enough and deep enough for small items to fall into ◦ A wall opening that is large enough for a person to fall through and is at least 4 feet above the ground These hazard types often apply to construction sites. Since healthcare workplaces may be undergoing construction for remodeling or adding to a building, healthcare workers need to know what to be aware of in construction zones.

Floor Opening, Floor Hole, and Wall Opening � � What is a floor opening? ◦ An opening is a hole or a gap measuring 12 inches deep or more in any floor, platform, pavement, or yard through which persons may fall; such as a stair opening indoors and a large manhole outdoors. ◦ Floor openings occupied by elevators, dumb waiters, conveyors, machinery, or containers are excluded from this subpart. How is a floor opening guarded? ◦ A floor opening in stairs is guarded by railing provided on all sides except the entrance to the stairway. ◦ A floor opening created by a manhole is guarded by a cover when not in use and is guarded by a person when the cover is not in place.

Floor Opening, Floor Hole, and Wall Opening (cont. ) � � � What is a floor hole? ◦ An opening measuring less than 12 inches deep but more than one inch across in any floor, platform, pavement, or yard, through which materials but not persons may fall; such as a pipe opening or slot opening. How is a floor hole guarded? ◦ A floor hole created by a pipe or a drainage slot should be guarded with a grating over the top. ◦ The grading reduces the size of the hole so as to prevent items from falling into that floor hole. What is a wall opening? ◦ An opening at least 30 inches high and 18 inches wide, in any wall or partition, through which persons may fall; such as a doorway or chute opening. Employees must be guarded from any wall opening that is 4 feet or higher from the ground.

Floor Opening, Floor Hole, and Wall Opening (cont. ) � How is a wall opening guarded? ◦ A wall opening, such as a doorway, must be guarded using a rail, picket fence, half door, or some equivalent barrier to prevent an employee from falling through the doorway and four feet or more to the ground.

Primary Fall Protection Methods � � Employers are required to take specific steps to prevent falls on walking and working surfaces in the work place. Here is an overview of the topics presented in this module. Single Level Surfaces: To protect employees from falls on a level surface, employers should: ◦ Keep floors clean and dry. ◦ Provide warning signs for wet floors. ◦ Keep aisles and passageways, including exits, clear of clutter and obstruction. ◦ Organize storage areas to eliminate clutter in aisles.

Primary Fall Protection Methods (cont. ) � Elevated Surfaces: To protect employees from injuries due to slips, trips, and falls wherever elevation changes are present, employers should: ◦ Guard employees for falls in wall openings, floor openings, and floor holes in both indoor and outdoor environments of the workplace. ◦ Install OSHA-approved handrails, slip-resistant treads on steps, and highlighted nosing. ◦ Provide OSHA-approved ladders and stepstools and instruct employees how to safely use that equipment.

Primary Fall Protection Methods (cont. ) � Human Factors ◦ Although OSHA does not regulate the control of human factors, such as paying attention while on walking are working surfaces, it is an essential practice to make yourself aware of your surroundings and potential hazards at all times. ◦ Do not engage in distractive behavior, like texting or talking to friends, while working. Save those activities for break periods.